Questions Flashcards
Based on labs, the FNP diagnoses her 45 year old patient with DMII, pt has a sulfa allergy, which would be avoided. Glipizide metformin miglitol rosigl
Glipizide- considered a sulonulyrea
Which of the following classes of drugs is implicated with masking the s/s of hypoglycemia in DM? CCB Diuretics Beta-blockers ARBs
Beta-Blockers - block the sympathetic surge and masks the symptoms of hypoglycemia
What is the 1st line treatment (drug) for GERD? A. Lifestyle B. Antacids C. H2 Blockers D. PPIs
H2 Blockers
PPIs are not meant to be long term therapy
Which of the following is not an acceptable screening test for Type II DM?
A. 2 hour plasma glucose during an OGTT
B. fasting blood glucose level
C. HgA1C
D. Urine glucose
Urine Glucose
Which of the following would be the best choice of insulin for a long-acting effect that can be given at night? A. insulin glargine B. insulin lispro C. NPH D. 70/30
insulin glargine (lantus)
All of the following patients should be screened for DM except
a. an obese man of hispanic descent
b. an overweight middle aged black women whose mother has type 2 DM
c. a women who delivered an infant weighing 9.5 lbs
d. a 30 year old white man with HTN
30 year old white man with HTN
your patient has chronic kidney disease and needs to be treated for HTN. which class would be first line option? ARB ACE BB CCB thiazide diuretic
ACE or ARB
A patient with Type 2 DM is taking Metformin (Glucophage) and Glipizide (Glucotrol). He presents complaining of hypoglycemia episodes. He also takes Losartan (Cozaar) and Atorvastatin (Lipitor ). His glucoses have been dropping as low as 50mg/dL. Which medication is likely causing the hypoglycemia?
a. atorvastatin
b. glipizide
c. losartan
d. metformin
glipizide
Lauren is 41 years old and is now unexpectedly pregnant. Her family has very strong history of heart attack, diabetes type 2 and hyperlipidemia.Her lipid profile reveals that she is now hyperlipidemic as well. Which of the following would be the safest choice?
a. atorvastatin
b. vitamin B3
c. fenofibrate
d. cholestyramine
D. cholestyramine ( the only one safe in pregnancy)
Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
- Patients with kidney stones
- Pregnant patients
- Patients with heartburn
- Postmenopausal women
- Patients with kidney stones
Patients taking antacids should be educated regarding these drugs, including letting them know that:
- They may cause constipation or diarrhea
- Many are high in sodium
- They should separate antacids from other medications by 1 hour
- All of the above
- All of the above
Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide:
- Can be given to patients of all ages, including infants and children, for viral gastroenteritis
- Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
- Is the treatment of choice for the diarrhea associated with E. coli 0157
- May be used in pregnancy and by lactating women
- Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate:
- May lead to toxicity if taken with aspirin
- Is contraindicated in children with flu-like illness
- Has antimicrobial effects against bacterial and viral enteropathogens
- All of the above
- All of the above
Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking:
- Loperamide four times a day throughout the trip
- Bismuth subsalicylate with each meal and at bedtime
- A prescription for diphenoxylate with atropine to use if she gets diarrhea
- None of the above
- Bismuth subsalicylate with each meal and at bedtime
Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?
- Prochlorperazine (Compazine)
- Meclizine (Antivert)
- Promethazine (Phenergan)
- Ondansetron (Zofran)
per the book Phenergan
Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:
- Omeprazole (Prilosec) twice a day
- Ranitidine (Zantac) twice a day
- Famotidine (Pepcid) once a day
- Metoclopramide (Reglan) four times a day
- Ranitidine (Zantac) twice a day
_Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
- Iron deficiency anemia, vitamin B12 and calcium deficiency
- Folate and magnesium deficiency
- Elevated uric acid levels leading to gout
- Hypokalemia and hypocalcemia
- Iron deficiency anemia, vitamin B12 and calcium deficiency
Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for:
- Megaloblastic anemia
- Osteoporosis
- Hypertension
- Both A and B
- Both A and B Megaloblastic anemia (blood dyscrasias)
Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:
- PEG 3350 (Miralax)
- Bisacodyl (Dulcolax) suppository
- Docusate (Colace) suppository
- Polyethylene glycol electrolyte solution
- Bisacodyl (Dulcolax) suppository
Methylnaltrexone is used to treat constipation in:
- Patients with functional constipation
- Patients with irritable bowel syndrome-associated constipation
- Children with encopresis
- Opioid-associated constipation
- Opioid-associated constipation
An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include:
- Electrolytes, including potassium and chloride
- Bone mineral density for osteoporosis
- Magnesium level
- Liver function
- Electrolytes, including potassium and chloride
Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of:
- Lipase
- Protease
- Amylase
- Pancreatin
- Lipase
Brands of pancreatic enzyme replacement drugs are:
- Bioequivalent
- About the same in cost per unit of lipase across brands
- Able to be interchanged between generic and brand-name products to reduce cost
- None of the above
- About the same in cost per unit of lipase across brands
When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?
- 15 to 30 minutes
- 60 to 90 minutes
- 3 to 4 hours
- 6 to 8 hours
- 60 to 90 minutes
Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:
- “Fruity” breath odor and rapid respiration
- Diarrhea, abdominal pain, weight loss, and hypertension
- Dizziness, confusion, diaphoresis, and tachycardia
- Easy bruising, palpitations, cardiac dysrhythmias, and coma
- Dizziness, confusion, diaphoresis, and tachycardia
Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:
- Increase blood glucose levels
- Produce unexplained diaphoresis
- Interfere with the ability of the body to metabolize glucose
- Mask the signs and symptoms of altered glucose levels
- Mask the signs and symptoms of altered glucose levels
Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?
- Optimal time of preprandial injection is 15 minutes.
- Duration of action is increased when the dose is increased.
- It is compatible with neutral protamine Hagedorn insulin.
- It has no pronounced peak.
- Duration of action is increased when the dose is increased.
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
- The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
- The initial dose of glargine is 2 to 10 units per day.
- Patients who have been on high doses of NPH will need tests for insulin antibodies.
- Obese patients may require more than 100 units per day.
- The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?
- Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
- Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
- Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
- Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.
- Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:
- Substitutes for insulin usually secreted by the pancreas
- Decreases glycogenolysis by the liver
- Increases the release of insulin from beta cells
- Decreases peripheral glucose utilization
- Decreases glycogenolysis by the liver