NSG 533 ADVANCED PHARMACOLOGY EXAM 1
COMPLETE STUDY GUIDE WITH Q&A
COMPREHENSIVE NURSING
PHARMACOLOGY
PREPARATION MATERIAL 2026/2027
What are the various types of oral and non-insulin medications and what
represents a rational combination of medications? -
✔ ✔✔ANSWER-Combinations should have different mechanism of
action
Combinations should avoid overlapping ADRs
Combinations should ideally be selected based on need for better basal
vs post-prandial control
Selection should account for patient specific concerns (eg. weight,
CVD risk, etc)
What antidiabetic medications have compelling indications: -
Page | 1
,✔✔✔ANSWER-for those with underlying ASCVD or at high risk for
CVD
for those with CKD
for those with a compelling need to avoid hypoglycemia for those
where weight is an important consideration (ie which are associated
with weight loss, gain or are weight neutral)
What are the various insulins and describe the pharmacokinetics
(onset, peak, duration)and how are they used (eg basal, basal- bolus,
split-mixed, sliding scale (..Ask if you don't understand)). -
✔✔✔ANSWER-Basal-bolus (long acting basal + rapid/fast acting bolus)
provides the greatest flexibility and control of all regimens
Sliding Scale Should NOT be used
Difficult to do in home setting, requires education and understanding of
patient and caregiver
Allows patient to become hyperglycemic, better to schedule dosing and
prevent rises in BG
Requires frequent blood glucose monitoring, $$$ and compliance issues
Page | 2
,What are the goals set by ACE /ACCE and are they written in stone for
all patients? - ✔✔✔ANSWER-Primary target for glycemic control is
HbA1C
Individualize HbA1C goal - based on...Duration of DMAge/life
expectancyComorbid conditions
Known CVD or advanced comorbid conditionsHypoglycemic
unawareness
Individual patient considerations
Please note when transitioning from oral therapy for type II DM to
insulin, metformin is retained! Secretagogues are discontinued possibly
when basal insulin is initiated, but definitely when prandial (fast/rapid)
insulin is to be added - ✔✔✔ANSWER-Options to add to basal insulin
for prandial coverage...
Fast-acting insulin
DPP-4 inhibitors
Incretin mimetics
Glinides
Alpha-glucosidase inhibitors
Colesevelam
Page | 3
, EP is a 38-year-old female patient that comes in for diabetes education
and management. She was diagnosed 12 years ago and states lately she
is not able to control her diet although she continues a 1600 calorie diet
with appropriate daily carbohydrate intake (per dietitian prescription)
and walks 40 minutes every day of the week. She states compliance
with all medications. She denies any history of hypoglycemia despite
being able to identify signsand symptoms and describe appropriate
treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20
mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L,
BUN - ✔✔✔ANSWER-Exenatide - Exenatide (Bydureon) once weekly
has been able to demonstrate weight loss and decrease A1C% by 0.7 %
to 1.2% in clinical trials; however it is contraindicated for EP due to the
self-reported history of thyroid cancer.
Page | 4
COMPLETE STUDY GUIDE WITH Q&A
COMPREHENSIVE NURSING
PHARMACOLOGY
PREPARATION MATERIAL 2026/2027
What are the various types of oral and non-insulin medications and what
represents a rational combination of medications? -
✔ ✔✔ANSWER-Combinations should have different mechanism of
action
Combinations should avoid overlapping ADRs
Combinations should ideally be selected based on need for better basal
vs post-prandial control
Selection should account for patient specific concerns (eg. weight,
CVD risk, etc)
What antidiabetic medications have compelling indications: -
Page | 1
,✔✔✔ANSWER-for those with underlying ASCVD or at high risk for
CVD
for those with CKD
for those with a compelling need to avoid hypoglycemia for those
where weight is an important consideration (ie which are associated
with weight loss, gain or are weight neutral)
What are the various insulins and describe the pharmacokinetics
(onset, peak, duration)and how are they used (eg basal, basal- bolus,
split-mixed, sliding scale (..Ask if you don't understand)). -
✔✔✔ANSWER-Basal-bolus (long acting basal + rapid/fast acting bolus)
provides the greatest flexibility and control of all regimens
Sliding Scale Should NOT be used
Difficult to do in home setting, requires education and understanding of
patient and caregiver
Allows patient to become hyperglycemic, better to schedule dosing and
prevent rises in BG
Requires frequent blood glucose monitoring, $$$ and compliance issues
Page | 2
,What are the goals set by ACE /ACCE and are they written in stone for
all patients? - ✔✔✔ANSWER-Primary target for glycemic control is
HbA1C
Individualize HbA1C goal - based on...Duration of DMAge/life
expectancyComorbid conditions
Known CVD or advanced comorbid conditionsHypoglycemic
unawareness
Individual patient considerations
Please note when transitioning from oral therapy for type II DM to
insulin, metformin is retained! Secretagogues are discontinued possibly
when basal insulin is initiated, but definitely when prandial (fast/rapid)
insulin is to be added - ✔✔✔ANSWER-Options to add to basal insulin
for prandial coverage...
Fast-acting insulin
DPP-4 inhibitors
Incretin mimetics
Glinides
Alpha-glucosidase inhibitors
Colesevelam
Page | 3
, EP is a 38-year-old female patient that comes in for diabetes education
and management. She was diagnosed 12 years ago and states lately she
is not able to control her diet although she continues a 1600 calorie diet
with appropriate daily carbohydrate intake (per dietitian prescription)
and walks 40 minutes every day of the week. She states compliance
with all medications. She denies any history of hypoglycemia despite
being able to identify signsand symptoms and describe appropriate
treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to
thyroid cancer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20
mg daily, sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L,
BUN - ✔✔✔ANSWER-Exenatide - Exenatide (Bydureon) once weekly
has been able to demonstrate weight loss and decrease A1C% by 0.7 %
to 1.2% in clinical trials; however it is contraindicated for EP due to the
self-reported history of thyroid cancer.
Page | 4
