NSG533 NSG 533 (Latest Update) Advanced Pathophysiology Guide Questions & Answers Grade A 100% Correct (Verified Solutions)- Wilkes.pdf

NSG 533 Advanced Pharmacology Exam| Complete Review
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Questions and Verified Answers m m m m




m 100% Correct | Grade A+
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1. EP is a 38-year-
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old female patient that comes in for diabetes education and management. S
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he was diagnosed 12 years ago and states lately she is not able to control h
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er diet although she continues a 1600 calorie diet with appropriate daily carb
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ohydrate intake (per dietitian prescription) and walks 40 minutes every day of
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the week. She states compliance with all medications. She denies any histo
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ry of hypoglycemia despite being able to identify signs and symptoms and d
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escribe appropriate treatment strategies.
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PMH T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid cancer
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FmHx Noncontributorym




SHx ( m




) Smoking, alcohol use, past marijuana use while in high school Me
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dications Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily, ser
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traline 100 mg daily, multivitamin daily
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,Vitals BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
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Laboratory test results Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN-
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Answer Exenatide - m m




m Exenatide (Bydureon) once weekly has been able to demonstrate weight loss
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and decrease A1C% by 0.7% to 1.2% in clinical trials; however it is contraindic
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ated for EP due to the self-reported history of thyroid cancer.
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Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hy-
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m perkalemia which could be made worse by this drug. The package insert does not
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dicate a specific potassium concentration cut off to no longer use this medication; h
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wever, there are better choices in this patient.
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Sitagliptin - m




m Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinica
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l trials and currently the patient does not have any cautionary objective measures
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o not use this medication. DPP-IV inhibitors are weight neutral. DPP-
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IV inhibitors can be used in patients taking sulfonylureas; however, it may be reco
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mmended to reduce or stop the sulfonylurea dose.
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Acarbose - m




m Acarbose (Precose) is not recommended for initial management and is associat
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,ed with significant GI side effects. More information would be needed regarding f
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asting and post- m m




prandial numbers. In addition, adding acarbose would only lower A1c by 0.8% at
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best and therefore would not achieve the desired A1C goal of <7%
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2. JR is a 68-year-
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old African American man with a new diagnosis of T2DM. He was classified as
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having prediabetes (at risk for developing diabetes) 5 years before the diagn
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osis and has a strong family history of type 2 diabetes. JR's blood pressure
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was 150/92 mm Hg. His laboratory results revealed an A1C of 8.1%, normal c
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holesterol panel, and normal renal/hepatic function were noted with today's l
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aboratory test results. m m




Past medical history Hypertension (diagnosed 4 y ago) Hyperlipidemia (diag-
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nosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
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, Family history Type 2 diabetes m m m m




Medication HCTZ 25 mg daily, simvastatin 10 mg daily Aller m m m m m m m m m




gies SMZ/TMP m




Vitals BP 150/92 mm Hg P 78 beats/min RR 12 rpm Waist Circumference 46 in
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Weight 267 lb Height 5 2 6 3 BMI 43.1 kg/m 2
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Despite improvements in the past six weeks due to lifestyle changes and e
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xercise, drug therapy is to be started for JR's diabet
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Answer Metformin is the drug of choice recommended for most patients with dia
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betes in addition to lifestyle modifications assuming no contraindications or intol
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erabilities are present upon m m m




evaluation. Metformin has also shown to provide positive weight neutral/loss effects
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in obese patients. It is crucial to know the renal status of patients commencing met
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formin therapy to limit the risk of lactic acidosis (JR is without contraindication). Sin
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ce his entry A1C is >7.5%, dual therapy is indicated. There are several potential ch
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oices. The second step can be a dipeptidyl peptidase-
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4 inhibitor, it can be a glucagon-like peptide-1 (GLP-
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1) receptor agonist, it can be a TZD, it can be a sulfonylurea agent, it can be a SGL
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T2 inhibitor, or it could be basal insulin. Anything next can be tried depending on wh
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