Quiz #3 Concepts

Question 1

Metformin

• Why is it the primary drug of choice?
• What labs would you order prior to starting?

Answer 1

• Decreases glucose production by the liver and increases glucose uptake by muscle and adipose tissue. In patients who need to lose weight can also help by reducing appetite.
• Does not cause hypoglycemia
• Labs- creatinine, need to know baseline renal function.

Question 2

Byetta

-When to administer?

Answer 2

•2 times a day, at any time within 60 minutes before your morning and evening meals (or before the 2 main meals of the day) approximately 6 hours or more part. Do not take after meal.

Question 3

Levothyroxine
–Adverse drug reactions (ADR) elderly
-When to order labs after starting

Answer 3

• Taken on an empty stomach in the AM, at least 30 minutes before breakfast.
• Thyroid function test after 4 weeks.
• Increased risk of osteoporosis, tachycardia and angina in the elderly.
• Can intensify the anticoagulant effects of warfarin.

Question 4

Pancreatic enzymes

-What medical states indication

Answer 4

• Cystic fibrosis
• Pancreatitis
• Bariatric procedures

Question 5

Diabetes

-Diagnostic criteria

Answer 5

• Hemoglobin A1C of 6.5% or higher
• Fasting plasma glucose 126mg/dL or higher
• Casual blood glucose 200mg/dL or higher
• Classic s/s: polyuria, polydipsia and sudden weight loss that cannot be attributed to other common causes.

Question 6

Insulin

Answer 6

Mechanism of action- Anabolic hormone; it promotes conservation of energy and the buildup of energy stores.

Two basic effects
 Stimulates uptake of glucose, amino acids, and potassium
 Promotes synthesis of complex organic molecules (glycogen, proteins, triglycerides).

Insulin deficiency puts the body into a catabolic mode; glycogen is converted to glucose, proteins are degraded to amino acids, and fats are converted to glycerol (glycerin) and free fatty acids.

Insulin deficiency promotes hyperglycemia by increasing glycogenesis and gluconeogenesis and reducing glucose utilization. This increases peripheral glucose uptake by skeletal muscle and fat.

Question 7

Type I Diabetes

Answer 7

Education re: exercise and carbs

Very important to check your blood sugar, plan ahead, and be prepared to treat hypoglycemia.

Blood sugar response to exercise will vary depending on:
• Prior blood sugar level.
• Intensity of activity.
• Length of time you are active.
• Changes you’ve made to insulin doses.

Question 8

Diabetic Drugs Recommended for Children

Answer 8

Metformin and Insulin

Question 9

ADA Guidelines for Diabetes Management

Answer 9

Hemaglobin A1C should be measured every 3-6 months to assess long-term glycemic control.
The target value is 7% of total hemoglobin or lower.

Normal-5
Pre- 5.7-6.4
6.5 or greater = Diabetic

Question 10

What DM meds increase genital yeast infections?

Answer 10

SGLT-2 Inhibitors (Sodium gluocse co-transporter 2)

Question 11

Hyperthyroidism

After starting when do you see total reversal of signs/symptoms?

Answer 11

Methimazole- full benefits may take 6-12 months to develop.

Question 12

Goals for Thyroid Replacement

Answer 12

Testing serum for elevated levels of TSH is the most sensitive way to diagnose hypothyroidism.

Goal: Normalize thyroid levels

Question 13

Congential Hypothyroid

Answer 13

Lifelong treatment

Question 14

Natural Thyroid Products

Answer 14

No readily prescribed

Not regulated by the FDA, not reliable how much hormone it contains

Question 15

After years of treatment and TSH at low end of normal…

Answer 15

Pt is at high risk for osteoporosis

Question 16

Oral Combined Contraceptives

Answer 16

Mechanism of action- inhibit ovulation. Progestin thickens cervical mucous and slows the tubal motility.

Education to improve actual effectiveness

Smoking can increase chance of thrombotic event

Efficacy can be reduced by agents that induce hepatic drug-metabolizing enzymes (rifamipin, phenobarb, St. John’s wart) Use a back up method.

Contraindications
o Thrombophila’s
o Pregnancy

Question 17

Progesterone Pills used only:

Answer 17

Breastfeeding
Migraines
Can’t take estrogen

Question 18

Depo Provera

Answer 18

Can decrease bone density

Question 19

Hormone Replacement Therapy

Answer 19

Maximum time: 5 years.

Indications for not starting HRT
o Should not be used for preventing osteoporosis
o Previous breast, ovarian, endometrial CA
o Blood clot in the legs or lungs
o Stroke
o Liver disease
o Unexplained vaginal bleeding

Question 20

Vaginal Estrogen

Answer 20

Advantage is it does not increase CV risk

Question 21

Goals of STD Treatment

Answer 21

Treat infection
Prevent spread
Prevent long term complications

Question 22

Best Treatment for Third Trimester Pregnant Women with Syphilis

Answer 22

IM PCN G

Question 23

Best Treatment for Gonorrhea/Chlamydia Non-Pregnant Women

Answer 23

Azithromycin 1g PO x1

Question 24

Best Treatment for Vaginal Candidiasis Treatment

Answer 24

OTC Clotrimazole or Intravaginal Miconazole or oral Fluconazole x1 dose

Question 25

Best Treatment for Bacterial Vaginosis Treatment

Answer 25

If not pregnant, use Metronidazole 500mg PO for 7 days

Question 26

UTI

• Goals of Treatment
• Children Treatment
• Treatment for Adults

Answer 26

Goals of treatment- Eradicate bacteria, relieve symptoms and prevent reoccurrence.

Treatment for child- Bactrim

Treatment for adults- Bactrium treatment of choice for oral therapy. Penicillins, cephalosporins and fluoroquinolones may be used for parenteral therapy of UTIs. If patient has a sulfa allergy, ciprofloxacin can be used instead. If patient has pyelonephritis, may need IV antibiotics.