2025 NSG 533 Advanced Pharmacology – Exam
1 Complete Study Guide with Questions and
100% Correct Verified Answers, Fully Updated,
Graded A+, and Comprehensive Nursing
Pharmacology Preparation Material
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
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: -
✔✔✔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
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 signs
and 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.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in
this patient due to hyperkalemia which could be made worse
by this drug. The package insert does not indicate a specific
potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of
less than 7% based on clinical trials and currently the patient
does not have any cautionary objective measures to not use this
medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however,
it may be recommended to reduce or stop the sulfonylurea dose.
1 Complete Study Guide with Questions and
100% Correct Verified Answers, Fully Updated,
Graded A+, and Comprehensive Nursing
Pharmacology Preparation Material
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
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: -
✔✔✔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
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 signs
and 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.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in
this patient due to hyperkalemia which could be made worse
by this drug. The package insert does not indicate a specific
potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of
less than 7% based on clinical trials and currently the patient
does not have any cautionary objective measures to not use this
medication. DPP-IV inhibitors are weight neutral. DPP-IV
inhibitors can be used in patients taking sulfonylureas; however,
it may be recommended to reduce or stop the sulfonylurea dose.
