NR565 WEEK 5 QUESTIONS WITH ACCURATE ANSWERS
- Be able to calculate the total daily dose of insulin based on weight. Calculate
with the lowest possible dose unless otherwise specified. correct answer For
example, the total daily dose (TDD) of insulin can be calculated by taking the total
weight of the patient's weight in kilograms (kg), which is 80 kg (184 pounds)
multiplied by 0.6 units equals 48 units. This means 24 units of the TDD is the basal
insulin dose of glargine (Lantus) (50%) and the other 24 units of rapid-acting
bolus/mealtime insulin (50%).
80x0.6= 48 (tdd)
- Be familiar with benefits of various nicotine replacement options correct answer
Nicotine Chewing Gum (Nicotine Polacrilex):
Nonprescription; user controls dose
Nicotine Lozenges (Nicotine Polacrilex):
Nonprescription; user controls dose; easier to use than nicotine gum
Nicotine Transdermal Systems (Patches):
Nonprescription; provides a steady level of nicotine; easy to use; unobtrusive
Nicotine inhaler:
User controls dose; mimics hand-to-mouth motion of smoking
Nicotine nasal spray:
,User controls dose; fastest nicotine delivery and highest nicotine levels of all
nicotine-based products
- Be familiar with frequency of Hgb A1C monitoring timeline. correct answer
Perform the A1C test at least two times a year in patients who are meeting
treatment goals (and who have stable glycemic control). E
Perform the A1C test quarterly in patients whose therapy has changed or who are
not meeting glycemic goals. E
Point-of-care testing for A1C provides the opportunity for more timely treatment
changes. E
pg. 398
- Be familiar with metoclopramide's use, MOA, side effects, monitoring and
patient teaching. correct answer Metoclopramide (Reglan) has two beneficial
actions: (1) it suppresses emesis (by blocking receptors for dopamine and
serotonin in the CTZ), and (2) it increases upper GI motility (by enhancing the
actions of acetylcholine).
Indications depend on the route (oral or intravenous). Oral metoclopramide has
two approved uses: diabetic gastroparesis and suppression of gastroesophageal
reflux. Intravenous metoclopramide has four approved uses: suppression of
postoperative nausea and vomiting, suppression of CINV, facilitation of small
bowel intubation, and facilitation of radiologic examination of the GI tract. Off-
label uses include the treatment of hiccups and nausea and vomiting of early
pregnancy.
, Adverse Effects
With high-dose therapy, sedation and diarrhea are common. Long-term high-dose
therapy can cause irreversible tardive dyskinesia, characterized by repetitive,
involuntary movements of the arms, legs, and facial muscles. Older adults are
especially vulnerable and can develop involuntary movement disorders after a
single dose. To reduce the risk for tardive dyskinesia, treatment should be as brief
as possible using the lowest effective dose. Owing to its ability to increase gastric
and intestinal motility, metoclopramide is contraindicated in patients with GI
obstruction, perforation, or hemorrhage. Of note, exposure to metoclopramide
during the first trimester of pregnancy is not associated with an excess risk for
congenital malformations.
- Be familiar with roflumilast - Know when to use LABA, SABA, Combo drugs in
COPD correct answer One phosphodiesterase 4 (PDE4) inhibitor, Roflumilast
(Daliresp. Daxas) is approved for management of COPD. In patients with severe,
chronic COPD with a primary chronic bronchitis component, the risk for
exacerbations may be reduced with this drug.
Mechanism of action.
Roflumilast is a selective inhibitor of PDE, an enzyme that inactivates cyclic
adenosine monophosphate (cAMP). By raising levels of cAMP in lung cells, the
drug reduces inflammation by suppressing cytokine release and by decreasing
pulmonary infiltration by neutrophils and other white blood cells. As a result,
cough and excessive mucus production are reduced and mucociliary clearance is
improved.
Therapeutic use.
Romflumilast is approved only for management of COPD. It is not a first-line drug;
rather, it is used for exacerbation prophylaxis in patients with severe COPD with a
primary chronic bronchitis component and a history of frequent exacerbations.
- Be able to calculate the total daily dose of insulin based on weight. Calculate
with the lowest possible dose unless otherwise specified. correct answer For
example, the total daily dose (TDD) of insulin can be calculated by taking the total
weight of the patient's weight in kilograms (kg), which is 80 kg (184 pounds)
multiplied by 0.6 units equals 48 units. This means 24 units of the TDD is the basal
insulin dose of glargine (Lantus) (50%) and the other 24 units of rapid-acting
bolus/mealtime insulin (50%).
80x0.6= 48 (tdd)
- Be familiar with benefits of various nicotine replacement options correct answer
Nicotine Chewing Gum (Nicotine Polacrilex):
Nonprescription; user controls dose
Nicotine Lozenges (Nicotine Polacrilex):
Nonprescription; user controls dose; easier to use than nicotine gum
Nicotine Transdermal Systems (Patches):
Nonprescription; provides a steady level of nicotine; easy to use; unobtrusive
Nicotine inhaler:
User controls dose; mimics hand-to-mouth motion of smoking
Nicotine nasal spray:
,User controls dose; fastest nicotine delivery and highest nicotine levels of all
nicotine-based products
- Be familiar with frequency of Hgb A1C monitoring timeline. correct answer
Perform the A1C test at least two times a year in patients who are meeting
treatment goals (and who have stable glycemic control). E
Perform the A1C test quarterly in patients whose therapy has changed or who are
not meeting glycemic goals. E
Point-of-care testing for A1C provides the opportunity for more timely treatment
changes. E
pg. 398
- Be familiar with metoclopramide's use, MOA, side effects, monitoring and
patient teaching. correct answer Metoclopramide (Reglan) has two beneficial
actions: (1) it suppresses emesis (by blocking receptors for dopamine and
serotonin in the CTZ), and (2) it increases upper GI motility (by enhancing the
actions of acetylcholine).
Indications depend on the route (oral or intravenous). Oral metoclopramide has
two approved uses: diabetic gastroparesis and suppression of gastroesophageal
reflux. Intravenous metoclopramide has four approved uses: suppression of
postoperative nausea and vomiting, suppression of CINV, facilitation of small
bowel intubation, and facilitation of radiologic examination of the GI tract. Off-
label uses include the treatment of hiccups and nausea and vomiting of early
pregnancy.
, Adverse Effects
With high-dose therapy, sedation and diarrhea are common. Long-term high-dose
therapy can cause irreversible tardive dyskinesia, characterized by repetitive,
involuntary movements of the arms, legs, and facial muscles. Older adults are
especially vulnerable and can develop involuntary movement disorders after a
single dose. To reduce the risk for tardive dyskinesia, treatment should be as brief
as possible using the lowest effective dose. Owing to its ability to increase gastric
and intestinal motility, metoclopramide is contraindicated in patients with GI
obstruction, perforation, or hemorrhage. Of note, exposure to metoclopramide
during the first trimester of pregnancy is not associated with an excess risk for
congenital malformations.
- Be familiar with roflumilast - Know when to use LABA, SABA, Combo drugs in
COPD correct answer One phosphodiesterase 4 (PDE4) inhibitor, Roflumilast
(Daliresp. Daxas) is approved for management of COPD. In patients with severe,
chronic COPD with a primary chronic bronchitis component, the risk for
exacerbations may be reduced with this drug.
Mechanism of action.
Roflumilast is a selective inhibitor of PDE, an enzyme that inactivates cyclic
adenosine monophosphate (cAMP). By raising levels of cAMP in lung cells, the
drug reduces inflammation by suppressing cytokine release and by decreasing
pulmonary infiltration by neutrophils and other white blood cells. As a result,
cough and excessive mucus production are reduced and mucociliary clearance is
improved.
Therapeutic use.
Romflumilast is approved only for management of COPD. It is not a first-line drug;
rather, it is used for exacerbation prophylaxis in patients with severe COPD with a
primary chronic bronchitis component and a history of frequent exacerbations.
