NSG6005 FINAL EXAM 2 LEARNING
WORKBOOK 2026 PATIENT ASSESSMENT AND
DIAGNOSTIC REASONING
◉ Preventing Diabetic Nephropathy.
Answer: ACE inhibitors, such as lisinopril. Or ARBs such as losartan
if patient cannot tolerate ACEs
◉ ADAs Stepped Care Approach to DM Treatment.
Answer: 1. Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
◉ Biguanides.
Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle
receptors to insulin (increased uptake of insulin). Safe in pregnancy.
GI side effects so take with meals. Excreted by kidneys so increased
toxicity (lactic acidosis) if renal impairment. Low risk of
hypoglycemia.
,◉ 1st vs. 2nd Generation Sulfonylurea.
Answer: All 1st generation have been discontinued. 2nd generation
(Glipizide) have shorter duration of action and increased potency.
◉ Sulfonylureas.
Answer: glipizide, glyburide, glimepiride. Promote insulin release by
beta cells. Block potassium channels of pancreatic islets to let
calcium in, which stimulates insulin release. Do not take with ETOH
(disulfiram reaction includes flushing, palpitations, nausea).
Hypoglycemia and weight gain are also common side effects. Do not
take if pregnant or breastfeeding. Increased risk of toxicity if liver or
kidneys are impaired.
◉ Meglitinides MOA.
Answer: Stimulate a rapid/ short-lived release of insulin from the
pancreas.
◉ Meglitinides (Glinides).
Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
◉ Meglitinides patient teaching.
Answer: Tell patient to eat within 30 minutes.
,◉ Meglitinides (Glinides) precautions.
Answer: Hypoglycemia increased in patients with liver dysfunction
2/2 slower metabolism of the drug.
◉ Meglitinides vs. Sulfonylureas.
Answer: -meglitinides are rapid acting and will have its effect on a
single meal-decreasing post prandial hyperglycemia. Taken with
each meal.
-sulfonylureas continuously stimulate insulin release- having most
of its effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
◉ Thiazolidinediones (TZDs).
Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
◉ Thiazolidinediones (TZDs) MOA.
Answer: Peroxisome proliferator-activated receptor gamma agonists
(PPAR𝜸 agonists) that increase peripheral insulin sensitivity.
Promotes increased glucose uptake by skeletal and adipose cells.
, ◉ Thiazolidinediones (TZDs) adverse effects.
Answer: Renal retention of fluid- so not for patients with stage 3 or 4
heart failure. May also cause upper respiratory infections, headache,
and myalgia. Hepatotoxic. Monitor liver function.
◉ Dipeptidyl Peptidase-4 Inhibitors.
Answer: Sitagliptin (Januvia), gliptins
◉ Dipeptidyl Peptidase-4 Inhibitors MOA.
Answer: DDP-4 is an enzyme that inactivate incretin hormones. So,
by inhibiting this enzyme, sitagliptin enhances the activity of
incretins, stimulate release of insulin from pancreatic B cells,
decrease hepatic glucose production
◉ Dipeptidyl Peptidase-4 Inhibitors Adverse effects.
Answer: -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
◉ Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors.
Answer: Canagliflozin
WORKBOOK 2026 PATIENT ASSESSMENT AND
DIAGNOSTIC REASONING
◉ Preventing Diabetic Nephropathy.
Answer: ACE inhibitors, such as lisinopril. Or ARBs such as losartan
if patient cannot tolerate ACEs
◉ ADAs Stepped Care Approach to DM Treatment.
Answer: 1. Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
◉ Biguanides.
Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle
receptors to insulin (increased uptake of insulin). Safe in pregnancy.
GI side effects so take with meals. Excreted by kidneys so increased
toxicity (lactic acidosis) if renal impairment. Low risk of
hypoglycemia.
,◉ 1st vs. 2nd Generation Sulfonylurea.
Answer: All 1st generation have been discontinued. 2nd generation
(Glipizide) have shorter duration of action and increased potency.
◉ Sulfonylureas.
Answer: glipizide, glyburide, glimepiride. Promote insulin release by
beta cells. Block potassium channels of pancreatic islets to let
calcium in, which stimulates insulin release. Do not take with ETOH
(disulfiram reaction includes flushing, palpitations, nausea).
Hypoglycemia and weight gain are also common side effects. Do not
take if pregnant or breastfeeding. Increased risk of toxicity if liver or
kidneys are impaired.
◉ Meglitinides MOA.
Answer: Stimulate a rapid/ short-lived release of insulin from the
pancreas.
◉ Meglitinides (Glinides).
Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
◉ Meglitinides patient teaching.
Answer: Tell patient to eat within 30 minutes.
,◉ Meglitinides (Glinides) precautions.
Answer: Hypoglycemia increased in patients with liver dysfunction
2/2 slower metabolism of the drug.
◉ Meglitinides vs. Sulfonylureas.
Answer: -meglitinides are rapid acting and will have its effect on a
single meal-decreasing post prandial hyperglycemia. Taken with
each meal.
-sulfonylureas continuously stimulate insulin release- having most
of its effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
◉ Thiazolidinediones (TZDs).
Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
◉ Thiazolidinediones (TZDs) MOA.
Answer: Peroxisome proliferator-activated receptor gamma agonists
(PPAR𝜸 agonists) that increase peripheral insulin sensitivity.
Promotes increased glucose uptake by skeletal and adipose cells.
, ◉ Thiazolidinediones (TZDs) adverse effects.
Answer: Renal retention of fluid- so not for patients with stage 3 or 4
heart failure. May also cause upper respiratory infections, headache,
and myalgia. Hepatotoxic. Monitor liver function.
◉ Dipeptidyl Peptidase-4 Inhibitors.
Answer: Sitagliptin (Januvia), gliptins
◉ Dipeptidyl Peptidase-4 Inhibitors MOA.
Answer: DDP-4 is an enzyme that inactivate incretin hormones. So,
by inhibiting this enzyme, sitagliptin enhances the activity of
incretins, stimulate release of insulin from pancreatic B cells,
decrease hepatic glucose production
◉ Dipeptidyl Peptidase-4 Inhibitors Adverse effects.
Answer: -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
◉ Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors.
Answer: Canagliflozin
