NSG 6320 AGNP Board Exam – Endocrinology Prescription
Exam
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. Question:
Patients taking dipeptidyl-peptidase-4 (DDP-IV) inhibitors for the treatment of
Type 2 diabetes do NOT routinely need to be monitored for:
Exam
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. Question:
Patients taking dipeptidyl-peptidase-4 (DDP-IV) inhibitors for the treatment of
Type 2 diabetes do NOT routinely need to be monitored for:
