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Nurs5334 Pharmacology Practice Exam With Answers (153 Solved Questions)

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    Nurs 5334 Exam 3 1. Drugs for Gestational Diabetes Metformin and Insulin 2. A1C Value for Diabetes Mellitus 6.5% or greater is diabetes, 5.7-6.4% pre-diabetes 3. Fasting and Random Values for DM Fasting plasma glucose—126 or greater is dia- betes. Random plasma glucose—anything greater than 200 is diabetes 4. Complications of In- sulin Therapy Hypoglycemia, Lipohypertrophy, Allergic reac- tions, Desensitization procedure, Hypokalemia 5. Insulin Drug Interac- tions Hypoglycemic agents intensify hypoglycemia, Use with caution with hyperglycemic agents 6. Beta Blockers' Effect on Insulin Delay awareness of hypoglycemia, Impair glycogenolysis, Prevent counter-regulatory re- sponse 7. Other Therapeutic Uses Hyperkalemia, Diagnosis of GH deficiency, Diabet- ic ketoacidosis 8. Coordinating Insulin Dosage Carbohydrate intake 9. Blood Pressure Goal in Diabetes Controlled within normal 120/80 10. Medication for Diabetic Nephropathy Risk ACE inhibitor or ARB 11. Role of Exercise in DM Treatment Exercise increases cellular responsiveness to in- sulin and glucose tolerance. 150 minutes per week of moderate intensity exercise is recommended. 12. 4-Step Approach Steps Step 1: Diagnosis and lifestyle changes plus met- formin. Step 2: Lifestyle changes, metformin, and a second drug. Step 3: Three drug combination. Step 4: Complex insulin regimen if needed. 1 / 20

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    13. Insulin Therapy Blood Glucose Goals Before meals: 70-130. Bedtime: 100-140. 14. A1C Goal and Excep- tions A1C goal is 7% or below. Exceptions: Severe hy- poglycemia risk, limited life expectancy, advanced complications. 15. Types of Insulins Short acting: Rapid acting insulins. Intermediate: NPH insulin, insulin detemir. Long acting: Insulin glargine. 16. Use of Short Duration Insulins Administered with meals to control post-prandial blood glucose rise. 17. Need for Intermediate Insulins Administered 2-3 times daily for glycemic control between meals and at night. 18. Duration of Insulins Glargine: Up to 24 hours. Levemir: 12-24 hours. Degludec: Up to 42 hours. 19. Routes of Insulin Ad- ministration Subcutaneous injection and IV infusion. Inhalation: Afrezza for mealtime insulin. 20. Insulin Dosing for Type 1 and Type 2 Type 1: Initial doses 0.5-0.6 units/kg/day. Type 2: Initial doses 0.2-0.6 units/kg/day, adjusted based on carb intake and activity. 21. 3 Dosing Schedules o Twice daily dosing o Intensive basal/bolus strategy o Continued subcutaneous insulin 22. Metformin Mechanism of Action o Inhibits glucose production in the liver o Reduces glucose absorption in the gut o Sensitizes insulin receptors in target tissues (fat and skeletal muscle) to increase glucose uptake and response to insulin 23. Metformin Side Effects and BB Warning o GI effects—diarrhea o Lactic acidosis 2 / 20

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    24. Alcohol Effect Inhibits the breakdown of lactic acid 25. Therapeutic Uses Other Than DM o Gestational diabetes o PCOS 26. Sulfonylureas o 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 and Main Side Effect MOA: Promote insulin release Main side effect: Hypoglycemia, Weight gain 28. Cimetidine Effect and Beta Blockers Cimetidine—intensifies the response Beta blockers—diminish the benefits by suppress- ing insulin release 29. Meglitinides (Repaglin- ide and Nateglinide) o MOA—stimulate pancreatic insulin release o Drug/Drug interaction—gemfibrozil 30. Thiazolidinediones (Glitazones) Reduce glucose levels primarily by decreasing in- sulin resistance Only indication is type 2 diabetes, mainly as an add-on to metformin Rosiglitazone [Avandia]: Restricted use Pioglitazone [Actos] Can they be used in patients with CHF? No 31. Alpha-Glucosidase In- hibitors Effective in Latinos and African Americans 32. DPP-4 Inhibitors (Gliptins) MOA: Enhance incretin hormones, stimulate in- sulin release, suppress glucagon 33. 0.5% 3 / 20

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    A1C Reduction Per- centage 34. Colesevelam and Bromocriptine in DM Treatment Colesevelam: Lowers cholesterol, helps lower blood glucose. Bromocriptine: Adjunct to diet and exercise (0.5% reduction) 35. Injectables: Amylin Memetics Pramlintide. Side effects: Hypoglycemia when used with insulin 36. Injectables: GLP-1 Re- ceptor Agonists Can cause medullary thyroid cancer 37. Treatment of Diabet- ic Ketoacidosis (DKA) and Hypoglycemia Insulin replacement, reverse acidosis with bicar- bonate, replace fluids/electrolytes. Hypoglycemia: IV glucose, glucagon if glucose not available 38. Hyperosmolar Hyper- glycemia State (HHS) Occurs with type 2 diabetics during acute infec- tion/illness. Treatment: Correct hyperglycemia/de- hydration with IV insulin, fluids, electrolytes 39. Iodine and Thyroid Low iodine decreases thyroid hormone production 40. Importance of Normal Thyroid Function in First Trimester of Preg- nancy Fetus unable to produce hormones, can lead to neuropsychologic deficits. Requirement may in- crease up to 50% in pregnant women taking thy- roid supplements 41. Fetal Thyroid Gland Full Functionality At 16 weeks 42. If not treated, what does Hypothyroidism cause in an infant? Large protruding tongue, potbelly, and dwarfish stature Development of nervous system, bones, and teeth impaired 43. When should treatment be stopped? How long? At 3 years of age for 4 weeks, then TSH is checked Rise indicates permanent deficiency, normalize in- dicates transient deficiency 4 / 20

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    44. How is Graves' Disease treated? Surgical removal, destruction of thyroid tissue, suppression of thyroid hormone synthesis and/or beta blockers Non-radioactive iodine can be used to distract thy- roid tissue 45. Thyroid Storm? Hyperthermia, severe tachycardia, restlessness, agitation, tremor Unconscious, hypotensive, heart failure Treatment: methimazole, beta blocker, sedation, cooling, glucocorticoids, IV fluids 46. Levothyroxine T4 Long half life Morning, 30-60 minutes before breakfast Side effects: tachycardia, angina tremors Drug interactions: Warfarin, H2 blockers, PPIs, etc. 47. How is Levothyroxine dosed? 1.6-1.8 mcg/kg/day Obese: ideal body weight Underweight: actual weight Elderly with CAD: 12.5-25 mcg Elderly: start low, go slow Children dosages based on age 48. Liotrix Mixture of synthetic T4 plus synthetic T3 in 4:1 ratio No advantage over Levothyroxine for most indica- tions 49. Armour Consists of desiccated animal thyroid glands Standardized based on iodine, levothyroxine, lio- thyronine content Ratio of T4 to T3 not less than 5:1 50. Methimazole Used in hyperthyroidism Cell form of therapy for Graves' disease Adjunct to radiation therapy, thyroid gland surgery Suppresses thyroid hormone synthesis 51. Propylthiouracil 5 / 20

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    Inhibits thyroid hormone synthesis Second line for Graves' Short half-life Uses: graves', radiation therapy, thyroid surgery, thyrotoxic crisis Adverse effects: agranulocytosis, liver damage 52. 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 death risk, and only thyroid tissue is injured. Disad- vantages include delayed treatment, potential hy- pothyroidism, and need for levothyroxine. Diag- nostic uses: hyperthyroidism, hypothyroidism, and goiter. Contraindicated in pregnancy. 53. Indications for Lugol Solution Adults with hyperthyroidism, patients not respond- ing to other treatments, thyroid cancer. Side ef- fects: brassy taste, burning sensation, soreness of teeth and gums, headache, coryza, salvation, and skin eruptions. 54. Stages of Menstrual Cy- cle Follicular phase, luteal phase, full cycle about 28 days. 55. Estrogen Effects on Sex Characteristics Influence reproduction processes, affect breast ductal growth, vaginal epithelium changes, uterine epithelium proliferation, and endocervical gland secretion. 56. Metabolic Effects of Es- trogen Positive effect on bone mass, favorable cholesterol effects, impact on blood coagulation, influence on glucose homeostasis. 57. Adverse Effects of Es- trogen Endometrial hyperplasia and carcinoma, in- creased cardiovascular events, N/V, gallbladder disease, jaundice, headache, and chloasma. 58. Therapeutic Uses of Es- trogen Menopausal hormone therapy, female hypogo- nadism, acne. 6 / 20

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