Nurs5334 Pharmacology Practice Exam With Answers (153 Solved Questions)

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Nurs 5334 Exam 31.Drugs for GestationalDiabetesMetformin and Insulin2.A1C Value for DiabetesMellitus6.5% or greater is diabetes, 5.7-6.4% pre-diabetes3.Fasting and RandomValues for DMFasting plasma glucose—126 or greater is dia-betes. Random plasma glucose—anything greaterthan 200 is diabetes4.Complications of In-sulin TherapyHypoglycemia, Lipohypertrophy, Allergic reac-tions, Desensitization procedure, Hypokalemia5.Insulin Drug Interac-tionsHypoglycemic agents intensify hypoglycemia, Usewith caution with hyperglycemic agents6.Beta Blockers' Effecton InsulinDelay awareness of hypoglycemia, Impairglycogenolysis, Prevent counter-regulatory re-sponse7.Other Therapeutic UsesHyperkalemia, Diagnosis of GH deficiency, Diabet-ic ketoacidosis8.Coordinating InsulinDosageCarbohydrate intake9.Blood Pressure Goal inDiabetesControlled within normal 120/8010.Medication for DiabeticNephropathy RiskACE inhibitor or ARB11.Role of Exercise in DMTreatmentExercise increases cellular responsiveness to in-sulin and glucose tolerance. 150 minutes per weekof moderate intensity exercise is recommended.12.4-Step Approach StepsStep 1: Diagnosis and lifestyle changes plus met-formin. Step 2: Lifestyle changes, metformin, anda second drug. Step 3: Three drug combination.Step 4: Complex insulin regimen if needed.1 / 20

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13.Insulin Therapy BloodGlucose GoalsBefore meals: 70-130. Bedtime: 100-140.14.A1C Goal and Excep-tionsA1C goal is 7% or below. Exceptions: Severe hy-poglycemia risk, limited life expectancy, advancedcomplications.15.Types of InsulinsShort acting: Rapid acting insulins. Intermediate:NPH insulin, insulin detemir. Long acting: Insulinglargine.16.Use of Short DurationInsulinsAdministered with meals to control post-prandialblood glucose rise.17.Need for IntermediateInsulinsAdministered 2-3 times daily for glycemic controlbetween meals and at night.18.Duration of InsulinsGlargine: Up to 24 hours. Levemir: 12-24 hours.Degludec: Up to 42 hours.19.Routes of Insulin Ad-ministrationSubcutaneous injection and IV infusion. Inhalation:Afrezza for mealtime insulin.20.Insulin Dosing for Type1 and Type 2Type 1: Initial doses 0.5-0.6 units/kg/day. Type 2:Initial doses 0.2-0.6 units/kg/day, adjusted basedon carb intake and activity.21.3 Dosing Scheduleso Twice daily dosingo Intensive basal/bolus strategyo Continued subcutaneous insulin22.Metformin Mechanismof Actiono Inhibits glucose production in the livero Reduces glucose absorption in the guto Sensitizes insulin receptors in target tissues (fatand skeletal muscle) to increase glucose uptakeand response to insulin23.Metformin Side Effectsand BB Warningo GI effects—diarrheao Lactic acidosis2 / 20

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24.Alcohol EffectInhibits the breakdown of lactic acid25.Therapeutic Uses OtherThan DMo Gestational diabeteso PCOS26.Sulfonylureaso First generation: Chlorpropamide [Diabinese],Tolazamide [Tolinase], Tolbutamine [Orinase]o Second generation: Glyburide [Diabeta, Gly-nase, Micronase] with metformin [Glucovance],Glypizide (Glucotrol, Glucotrol XL) with metformin[metaglip], Glimepiride (Amaryl) with metformin[Amaryl M] with pioglitazone [Duetact] with rosigli-tazone [Avandaryl]27.Sulfonylureas Mecha-nism of Action andMain Side EffectMOA: Promote insulin releaseMain side effect: Hypoglycemia, Weight gain28.Cimetidine Effect andBeta BlockersCimetidine—intensifies the responseBeta blockers—diminish the benefits by suppress-ing insulin release29.Meglitinides (Repaglin-ide and Nateglinide)o MOA—stimulate pancreatic insulin releaseo Drug/Drug interaction—gemfibrozil30.Thiazolidinediones(Glitazones)Reduce glucose levels primarily by decreasing in-sulin resistanceOnly indication is type 2 diabetes, mainly as anadd-on to metforminRosiglitazone [Avandia]: Restricted usePioglitazone [Actos]Can they be used in patients with CHF? No31.Alpha-Glucosidase In-hibitorsEffective in Latinos and African Americans32.DPP-4 Inhibitors(Gliptins)MOA: Enhance incretin hormones, stimulate in-sulin release, suppress glucagon33.0.5%3 / 20

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A1C Reduction Per-centage34.Colesevelam andBromocriptine in DMTreatmentColesevelam: Lowers cholesterol, helps lowerblood glucose. Bromocriptine: Adjunct to diet andexercise (0.5% reduction)35.Injectables: AmylinMemeticsPramlintide. Side effects: Hypoglycemia whenused with insulin36.Injectables: GLP-1 Re-ceptor AgonistsCan cause medullary thyroid cancer37.Treatment of Diabet-ic Ketoacidosis (DKA)and HypoglycemiaInsulin replacement, reverse acidosis with bicar-bonate, replace fluids/electrolytes. Hypoglycemia:IV glucose, glucagon if glucose not available38.Hyperosmolar Hyper-glycemia State (HHS)Occurs with type 2 diabetics during acute infec-tion/illness. Treatment: Correct hyperglycemia/de-hydration with IV insulin, fluids, electrolytes39.Iodine and ThyroidLow iodine decreases thyroid hormone production40.Importance of NormalThyroid Function inFirst Trimester of Preg-nancyFetus unable to produce hormones, can lead toneuropsychologic deficits. Requirement may in-crease up to 50% in pregnant women taking thy-roid supplements41.Fetal Thyroid Gland FullFunctionalityAt 16 weeks42.If not treated, what doesHypothyroidism causein an infant?Large protruding tongue, potbelly, and dwarfishstatureDevelopment of nervous system, bones, and teethimpaired43.When should treatmentbe stopped? How long?At 3 years of age for 4 weeks, then TSH is checkedRise indicates permanent deficiency, normalize in-dicates transient deficiency4 / 20

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44.How is Graves' Diseasetreated?Surgical removal, destruction of thyroid tissue,suppression of thyroid hormone synthesis and/orbeta blockersNon-radioactive iodine can be used to distract thy-roid tissue45.Thyroid Storm?Hyperthermia, severe tachycardia, restlessness,agitation, tremorUnconscious, hypotensive, heart failureTreatment: methimazole, beta blocker, sedation,cooling, glucocorticoids, IV fluids46.LevothyroxineT4Long half lifeMorning, 30-60 minutes before breakfastSide effects: tachycardia, angina tremorsDrug interactions: Warfarin, H2 blockers, PPIs, etc.47.How is Levothyroxinedosed?1.6-1.8 mcg/kg/dayObese: ideal body weightUnderweight: actual weightElderly with CAD: 12.5-25 mcgElderly: start low, go slowChildren dosages based on age48.LiotrixMixture of synthetic T4 plus synthetic T3 in 4:1 ratioNo advantage over Levothyroxine for most indica-tions49.ArmourConsists of desiccated animal thyroid glandsStandardized based on iodine, levothyroxine, lio-thyronine contentRatio of T4 to T3 not less than 5:150.MethimazoleUsed in hyperthyroidismCell form of therapy for Graves' diseaseAdjunct to radiation therapy, thyroid gland surgerySuppresses thyroid hormone synthesis51.Propylthiouracil5 / 20

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Inhibits thyroid hormone synthesisSecond line for Graves'Short half-lifeUses: graves', radiation therapy, thyroid surgery,thyrotoxic crisisAdverse effects: agranulocytosis, liver damage52.Radioactive Iodine 131(Lugol Solution)Effect on the thyroid is destruction of thyroid tis-sue by emission of beta particles. Advantages in-clude low cost, spared risk of surgery, rare deathrisk, and only thyroid tissue is injured. Disad-vantages include delayed treatment, potential hy-pothyroidism, and need for levothyroxine. Diag-nostic uses: hyperthyroidism, hypothyroidism, andgoiter. Contraindicated in pregnancy.53.Indications for LugolSolutionAdults with hyperthyroidism, patients not respond-ing to other treatments, thyroid cancer. Side ef-fects: brassy taste, burning sensation, soreness ofteeth and gums, headache, coryza, salvation, andskin eruptions.54.Stages of Menstrual Cy-cleFollicular phase, luteal phase, full cycle about 28days.55.Estrogen Effects onSex CharacteristicsInfluence reproduction processes, affect breastductal growth, vaginal epithelium changes, uterineepithelium proliferation, and endocervical glandsecretion.56.Metabolic Effects of Es-trogenPositive effect on bone mass, favorable cholesteroleffects, impact on blood coagulation, influence onglucose homeostasis.57.Adverse Effects of Es-trogenEndometrial hyperplasia and carcinoma, in-creased cardiovascular events, N/V, gallbladderdisease, jaundice, headache, and chloasma.58.Therapeutic Uses of Es-trogenMenopausal hormone therapy, female hypogo-nadism, acne.6 / 20

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