AGNP BOARD EXAM PRESCRIPTION OF ENDOCRINOLOGY

AGNP BOARD EXAM PRESCRIPTION OF ENDOCRINOLOGY (89 QUESTIONS) Question: When patients administer regular insulin (Humulin R U-500), they should be taught: 5 units of Humulin R U-500 is equal to 10 units on a U-100 insulin syringe. 10 units of Humulin R U-500 is equal to 5 units on a U-100 insulin syringe. 10 units of Humulin R U-500 is equal to 10 units on a U-500 insulin syringe. Correct it should only be used in an insulin pump. Explanation: U-500 insulin is a concentrated form of insulin containing 500 units of insulin per mL. U-500 regular insulin vials are to be used only in conjunction with a dedicated U-500 insulin syringe; dosage conversion is not required with the U-500 syringe. When using a U-100 syringe or a tuberculin syringe to deliver Humulin R U-500 (from vial), a conversion step is required to ensure the correct amount of Humulin R U-500 is drawn up in the syringe. To avoid dosing errors when using a U-100 insulin syringe, the prescribed dose should be written in actual insulin units and as unit markings on the U-100 insulin syringe (e.g., Humulin R U-500 50 units = 10 units on a U-100 insulin syringe). For safety, ONLY the U-500 syringe should be used. It is not recommended for use in insulin pumps due to possibility of precipitation. Question: Patients taking thiazolidinedione (TZD) medications should be monitored for: diarrhea and flatulence. fluid retention and weight gain. Correct hypotension and dizziness. weight loss and fatigue. Explanation: Thiazolidinediones including pioglitazone hydrochloride (Actos), may precipitate or exacerbate heart failure in some patients by causing dose-related fluid retention. After initiation of pioglitazone tablets, and after dose increases, monitor patients carefully for signs and symptoms of heart failure (e.g., excessive, rapid weight gain, dyspnea, and/or edema). If heart failure develops, pioglitazone should be discontinued or dosage reduced. Pioglitazone tablets are not recommended in patients with symptomatic heart failure. Initiation of pioglitazone hydrochloride in patients with established New York Heart Association (NYHA) Class III or IV heart failure is contraindicated. Question: A patient diagnosed with Type 2 diabetes mellitus has an initial hemoglobin A1C of 7.2%. Assuming no contraindications, the American Diabetes Association's (ADA) initial recommendation for this patient includes: acarbose (Precose). metformin (Glucophage). Correct glipizide (Glucotrol). liraglutide (Victoza). Explanation: Metformin (Glucophage) is the initial recommended pharmacological treatment for type 2 diabetes mellitus, providing there are no contraindications. The other medications have FDA indications as monotherapy for treatment in this patient, but are not as evidence-based as metformin, and thus not initially recommended by ADA. Question: Gynecomastia is NOT likely to be caused by: clonazepam. Correct ketoconazole. lavender oil. marijuana. Explanation: Gynecomastia is not likely to be caused by clonazepam (Klonopin). Ketoconazole, finasteride, spironolactone, lavender oil and tea tree oil are identified as androgens or inhibitors of androgen synthesis and thus are associated with gynecomastia. Alcohol, amphetamines, heroin, marijuana and methadone are also potential medication-related causes of gynecomastia. Question: Which of the following medications may cause gynecomastia? amlodipine (Norvasc). enalapril (Vasotec). Correct losartan (Cozaar). verapamil (Calan). Explanation: Enalapril (Vasotec) and captopril (Capoten) are angiotensin-converting enzyme inhibitors used in the treatment of hypertension. They may cause gynecomastia. Question: Sodium-glucose co-transporter 2 (SGLT2) inhibitors reduce blood glucose by: increasing insulin sensitivity at the cellular level. increasing urinary glucose excretion. Correct potentiating insulin secretion from the pancreas. suppressing glucagon secretion from the liver. Explanation: Sodium-glucose co-transporter 2 (SGLT2) are transporters of glucose in the kidney's proximal tubules and mediate reabsorption of approximately 90% of the filtered renal glucose load. Sodium-glucose co-transporter 2 (SGLT2) INHIBITORS inhibit this action. Examples include dapagliflozin (Farxiga), canagliflozin (Invokana), and empagliflozin (Jardiance). These SGLT2 inhibitors decrease renal uptake of glucose and promote renal excretion of glucose by lowering the renal threshold for glucose. Thus, more glucose is excreted. This modestly lowers elevated blood glucose levels in patients with type 2 diabetes. Question: A patient who is started on a glucagon-like peptide (GLP-1), such as Victoza, should be informed that this class of medications may: increase satiety. Correct cause hypoglycemia. cause weight gain. are inexpensive. Explanation: Advantages of glucagon-like peptide (GLP-1) incretin mimetics such as Byetta, Victoza, Trulicity, and others include that they delay gastric emptying, increase satiety and promote weight loss. The disadvantages are that they must be injected, are expensive, and the long-term effects are not known. Question: The most frequent side effect of metformin (Glucophage) is: diarrhea. Correct hypoglycemia. heartburn. constipation. Explanation: The most frequent side effect of metformin (Glucophage) is gastrointestinal upset; including diarrhea, nausea and flatulence. These symptoms are usually dose dependent and may be alleviated by decreasing the dose, prescribing a once-daily formulation, or administering the medication at nighttime. Question: Patients taking dipeptidyl-peptidase-4 (DDP-IV) inhibitors for the treatment of Type 2 diabetes do NOT routinely need to be monitored for: pancreatitis. severe joint pain. skin exfoliation. weight loss. Correct Explanation: Dipeptidyl-peptidase-4 (DDP-IV) inhibitors including sitagliptin (Januvia); saxagliptin (Onglyza) and linagliptin (Tradjenta) are used in the treatment of Type 2 diabetes. They are NOT likely to cause weight loss or weight gain or risk of hypoglycemia (in the absence of concomitant treatment with insulin or sulfonylureas). Anaphylaxis, angioedema, and exfoliative skin conditions including Stevens-Johnson syndrome, severe and disabling arthralgia and acute pancreatitis (sometimes fatal) syndrome have been reported. Question: A patient who has Addison's disease has received a prescription for fludrocortisone. Fludrocortisone acts by: suppressing immunity. increasing inflammation.