NURS5366Module3week3quiz32024A+
NURS5366 Module3week3quiz3
2024 A+Grade
Exam3StudyQuestions
• Whatdrugsareusedtotreatgestationaldiabetes?
o Metformin and Insulin
• WhatA1Cvalueindicatesdiabetesmellitus?Pre-DM?
o 6.5%orgreaterisconsidereddiabetes
o 5.7-6.4%pre-diabetes
• WhatfastingandrandomvaluesindicateDM?
o Fastingplasmaglucose—126orgreaterisdiabetes
o Random(casual)plasmaglucose—anythinggreaterthan200isdiabetes
• Whatarecomplicationsofinsulintherapy?
o Hypoglycemia
o Candeveloplipohypertrophy
▪ Accumulationofsubcutaneousfatthatoccurswhenitisinjectedtoofrequently at
the same site
o Allergicreactions
▪ Characterizedbyredandintenselyitchywelts,breathingbecomesdifficult
▪ Ifsevereallergydevelops:
• Desensitizationprocedure(smalldosestolargerdoses)
o Hypokalemia
▪ Promotestheuptakeofpotassiumcellsandinsulinactivatesamembrane-bound
enzymewithsodiumpotassiumandATPasethatpumpspotassiumintothecells and
sodium out
• Druginteractions?
o Hypoglycemicagents
▪ Canintensifythehypoglycemiaincludedbyinsulin
▪ Examples:sulfonylureas,glinides,alcohol
o Usewithcautionwithhyperglycemicagents
▪ Examples:thiazideandglucocorticoidsandsympathomimetics
• Whateffectdobetablockershaveoninsulin?
o delayawarenessofandresponsetohypoglycemiabymaskingthesignsthatare
associatedwith stimulationofsympatheticnervous system
o Impairglycogenolysis
o Prevent thebodies counter-regulatoryresponse
• WhatareothertherapeuticusesbesidesDM?
o Hyperkalemia
o AidsindiagnosisofGHdeficiency
o Diabeticketoacidosis
• Insulindosagemustbecoordinatedwithwhat?
o Carbohydrateintake
• WhatisB/Pgoalindiabetic?
A+ Page 1
, NURS5366Module3week3quiz32024A+
o Tobecontrolled,withinnormal120/80
• Whatmedicationcanbegiventodecreaseriskofdiabeticnephropathy?
o ACEinhibitororARB
A+ Page 2
, NURS5366Module3week3quiz32023A+
• Whatroledoesexerciseplayintreatmentofbothtype1andtype2DM?
o Exerciseincreasescellularresponsivenesstoinsulinandincreasesglucosetolerance
o 150minuteperweekofmoderateintensityexerciseisrecommended
• Whatarethe4stepsinthe4-stepapproach?
o Step1—diagnosis
▪ Lifestylechangesplusmetformin
o Step2
▪ Lifestylechangesplusmetforminandaseconddrug(sulfonylurea,TZDoraDPP4
inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like
peptide 1, or a GLP-1 receptor agonist or basal insulin
▪ Second drug choice made considering efficacy, the hypoglycemia risk of the
patient, the patient tolerability, and weight-related considerations (some help
weight loss, some cause weight gain), cost
o Step3
▪ Threedrugcombination
• Metformin
• Plus2otherdrugsfromstep2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
▪ If3drugcombinationthatincludesbasalinsulinfailsafter3-6months,more
complex insulin regimen
▪ Usuallyincombinationwithoneormorenon-insulinmedications
• Whenapatientisoninsulintherapywhatarethebloodglucosegoalsbeforemeals?At
bedtime?
o Beforemeals—70-130
o Bedtime—100-140
• WhatistheA1Cgoal?Whenisgoalbelow7notappropriate?
o 7%or below
o Thosewithseverehypoglycemiarisk,limitedlifeexpectancy,advancedmicrovascularor
macrovascular complications—not below 7
• Whataretheshortactinginsulins?Intermediate?Longacting?
o Shortduration:Rapidacting
▪ Insulinlispro[Humalog]
▪ Insulinaspart[NovoLog]
▪ Insulinglulisine[Apidra]
o Shortduration:Sloweracting
▪ Regularinsulin[HumulinR,NovolinR]
o Intermediateduration
▪ NeutralprotamineHagedorn(NPH)insulin
▪ Insulindetemir[Levemir]
o Longduration
▪ Insulinglargine
• Whenareshortdurationinsulinsused?
2
, NURS5366Module3week3quiz32023A+
o Administeredinassociationwithmealstocontrolthepost-prandialriseinbloodglucose
between meals and at night
• Whenareintermediateinsulinsneeded?
o Administer2-3timesdailytoprovideglycemiccontrolbetweenmealsandduringthe
night
• Howlongisdurationofglargine?Levemir?Degludec?
o Glargine—upto24hours
o Levemir
▪ Lowdose(0.2units/kg)—12hours
▪ Highdoses(0.4units/kg)—20-24hours
o Degludec—upto42hours
• Whatareroutesofadministration?Whichcanbeinhaled?
o SQinjection
o IVinfusion
o Inhalation—Afrezza,mealtimeinsulin
• Whatistypicaldosingfortype1?Type2?
o Totaldosesmayrangefrom0.1unit/kgbodyweighttomorethan2.5units/kg
o Type 1
▪ Initialdosestypicallyrangefrom0.5-0.6units/kgperday
o Type 2
▪ Initialdosesrangefrom0.2-0.6units/kgperday
▪ Dosageincreasedordecreasedaccordingtocarbintake,activity
• Whatarethe3dosingschedules?
o Twicedailydosing
o Intensivebasal/bolusstrategy
o Continuedsubcutaneousinsulin
• Howdoesmetforminwork?
o Inhibitsglucoseproductionintheliver
o Reducesglucoseabsorptioninthegut
o Sensitizesinsulinreceptorsintargettissues(fatandskeletalmuscle)thusincrease
glucose uptake and response to whatever insulin is available
• Whataresideeffects?BBwarning?
o GIeffects—diarrhea
o Lacticacidosis
• Howdoesalcoholeffect?
o Inhibitsthebreakdownoflacticacid
• WhatarethetherapeuticusesotherthanDM?
o Gestationaldiabetes
o PCOS
• Sulfonylureas
o Firstgeneration
▪ Chlorpropamide[Diabinese]
▪ Tolazamide[Tolinase]
3
NURS5366 Module3week3quiz3
2024 A+Grade
Exam3StudyQuestions
• Whatdrugsareusedtotreatgestationaldiabetes?
o Metformin and Insulin
• WhatA1Cvalueindicatesdiabetesmellitus?Pre-DM?
o 6.5%orgreaterisconsidereddiabetes
o 5.7-6.4%pre-diabetes
• WhatfastingandrandomvaluesindicateDM?
o Fastingplasmaglucose—126orgreaterisdiabetes
o Random(casual)plasmaglucose—anythinggreaterthan200isdiabetes
• Whatarecomplicationsofinsulintherapy?
o Hypoglycemia
o Candeveloplipohypertrophy
▪ Accumulationofsubcutaneousfatthatoccurswhenitisinjectedtoofrequently at
the same site
o Allergicreactions
▪ Characterizedbyredandintenselyitchywelts,breathingbecomesdifficult
▪ Ifsevereallergydevelops:
• Desensitizationprocedure(smalldosestolargerdoses)
o Hypokalemia
▪ Promotestheuptakeofpotassiumcellsandinsulinactivatesamembrane-bound
enzymewithsodiumpotassiumandATPasethatpumpspotassiumintothecells and
sodium out
• Druginteractions?
o Hypoglycemicagents
▪ Canintensifythehypoglycemiaincludedbyinsulin
▪ Examples:sulfonylureas,glinides,alcohol
o Usewithcautionwithhyperglycemicagents
▪ Examples:thiazideandglucocorticoidsandsympathomimetics
• Whateffectdobetablockershaveoninsulin?
o delayawarenessofandresponsetohypoglycemiabymaskingthesignsthatare
associatedwith stimulationofsympatheticnervous system
o Impairglycogenolysis
o Prevent thebodies counter-regulatoryresponse
• WhatareothertherapeuticusesbesidesDM?
o Hyperkalemia
o AidsindiagnosisofGHdeficiency
o Diabeticketoacidosis
• Insulindosagemustbecoordinatedwithwhat?
o Carbohydrateintake
• WhatisB/Pgoalindiabetic?
A+ Page 1
, NURS5366Module3week3quiz32024A+
o Tobecontrolled,withinnormal120/80
• Whatmedicationcanbegiventodecreaseriskofdiabeticnephropathy?
o ACEinhibitororARB
A+ Page 2
, NURS5366Module3week3quiz32023A+
• Whatroledoesexerciseplayintreatmentofbothtype1andtype2DM?
o Exerciseincreasescellularresponsivenesstoinsulinandincreasesglucosetolerance
o 150minuteperweekofmoderateintensityexerciseisrecommended
• Whatarethe4stepsinthe4-stepapproach?
o Step1—diagnosis
▪ Lifestylechangesplusmetformin
o Step2
▪ Lifestylechangesplusmetforminandaseconddrug(sulfonylurea,TZDoraDPP4
inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagon-like
peptide 1, or a GLP-1 receptor agonist or basal insulin
▪ Second drug choice made considering efficacy, the hypoglycemia risk of the
patient, the patient tolerability, and weight-related considerations (some help
weight loss, some cause weight gain), cost
o Step3
▪ Threedrugcombination
• Metformin
• Plus2otherdrugsfromstep2
o Decidedbasedonadrugandpatientspecificconsiderations
o Step4
▪ If3drugcombinationthatincludesbasalinsulinfailsafter3-6months,more
complex insulin regimen
▪ Usuallyincombinationwithoneormorenon-insulinmedications
• Whenapatientisoninsulintherapywhatarethebloodglucosegoalsbeforemeals?At
bedtime?
o Beforemeals—70-130
o Bedtime—100-140
• WhatistheA1Cgoal?Whenisgoalbelow7notappropriate?
o 7%or below
o Thosewithseverehypoglycemiarisk,limitedlifeexpectancy,advancedmicrovascularor
macrovascular complications—not below 7
• Whataretheshortactinginsulins?Intermediate?Longacting?
o Shortduration:Rapidacting
▪ Insulinlispro[Humalog]
▪ Insulinaspart[NovoLog]
▪ Insulinglulisine[Apidra]
o Shortduration:Sloweracting
▪ Regularinsulin[HumulinR,NovolinR]
o Intermediateduration
▪ NeutralprotamineHagedorn(NPH)insulin
▪ Insulindetemir[Levemir]
o Longduration
▪ Insulinglargine
• Whenareshortdurationinsulinsused?
2
, NURS5366Module3week3quiz32023A+
o Administeredinassociationwithmealstocontrolthepost-prandialriseinbloodglucose
between meals and at night
• Whenareintermediateinsulinsneeded?
o Administer2-3timesdailytoprovideglycemiccontrolbetweenmealsandduringthe
night
• Howlongisdurationofglargine?Levemir?Degludec?
o Glargine—upto24hours
o Levemir
▪ Lowdose(0.2units/kg)—12hours
▪ Highdoses(0.4units/kg)—20-24hours
o Degludec—upto42hours
• Whatareroutesofadministration?Whichcanbeinhaled?
o SQinjection
o IVinfusion
o Inhalation—Afrezza,mealtimeinsulin
• Whatistypicaldosingfortype1?Type2?
o Totaldosesmayrangefrom0.1unit/kgbodyweighttomorethan2.5units/kg
o Type 1
▪ Initialdosestypicallyrangefrom0.5-0.6units/kgperday
o Type 2
▪ Initialdosesrangefrom0.2-0.6units/kgperday
▪ Dosageincreasedordecreasedaccordingtocarbintake,activity
• Whatarethe3dosingschedules?
o Twicedailydosing
o Intensivebasal/bolusstrategy
o Continuedsubcutaneousinsulin
• Howdoesmetforminwork?
o Inhibitsglucoseproductionintheliver
o Reducesglucoseabsorptioninthegut
o Sensitizesinsulinreceptorsintargettissues(fatandskeletalmuscle)thusincrease
glucose uptake and response to whatever insulin is available
• Whataresideeffects?BBwarning?
o GIeffects—diarrhea
o Lacticacidosis
• Howdoesalcoholeffect?
o Inhibitsthebreakdownoflacticacid
• WhatarethetherapeuticusesotherthanDM?
o Gestationaldiabetes
o PCOS
• Sulfonylureas
o Firstgeneration
▪ Chlorpropamide[Diabinese]
▪ Tolazamide[Tolinase]
3
