Advanced Pharmacology NSG 533 Exam 2024/2025
Study online at https://quizlet.com/_fu0ost
1. EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able
to control her diet although she continues a 1600 calorie diet with appropriate
daily carbohydrate intake (per dietitian prescription) and walks 40 minutes
every day of the week. She states compliance with all medications. She denies
any history of hypoglycemia despite being able to identify signs and symptoms
and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid can-
cer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN: Exenatide
- Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in
clinical trials; however it is contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made worse
by this drug. The package insert does not indicate a specific potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
the patient does not have any cautionary objective measures to not use this medication. DPP-IV inhibitors are weight
neutral. DPP-IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce or
stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is associated with significant GI side
effects. More information would be needed regarding fasting and post-prandial numbers. In addition, adding acarbose
would only lower A1c by 0.8% at best and therefore would not achieve the desired A1C goal of <7%
2. JR is a 68-year-old African American man with a new diagnosis of T2DM. He
was classified as having prediabetes (at risk for developing diabetes) 5 years
before the diagnosis and has a strong family history of type 2 diabetes. JR's
blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of
8.1%, normal cholesterol panel, and normal renal/hepatic function were noted
, Advanced Pharmacology NSG 533 Exam 2024/2025
Study online at https://quizlet.com/_fu0ost
with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diag-
nosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46
in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet: Metformin is the drug of choice
recommended for most patients with diabetes in addition to lifestyle modifications assuming no contraindications or
intolerabilities are present upon evaluation. Metformin has also shown to provide positive weight neutral/loss effects
in obese patients. It is crucial to know the renal status of patients commencing metformin therapy to limit the risk of
lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second step can be a
dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can
be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal insulin. Anything next can be tried depending
on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associated with case
reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist with weight
loss goals for this patient. New information suggests these agents may provide benefits in those with ASCVD. JR has a
past history of pancreatitis and GLP-1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated with weight gain,
negative effects on lipids and increased risk of fracture. Until recently, TZDs have also been linked to increased CV events
and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have the potential to
cause hypoglycemia, so patient education is crucial. Because of his allergies to "sulfa", use would be contr
3. A patient with type 1 diabetes reports taking propranolol for hypertension.
What concern does this information present for the provider?: A patient with Type 1
, Advanced Pharmacology NSG 533 Exam 2024/2025
Study online at https://quizlet.com/_fu0ost
DM is insulin dependent for glucose control and at high risk for hypoglycemic episodes. Propanolol causes prolonged
hypoglycemic episodes. Needs to switch to ACE or ARB.
4. A provider teaches a patient who has been diagnosed with hypothyroidism
about a new prescription for levothyroxine. Which statement by the patient
indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider
first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothy-
roxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothy-
roxine.": D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she can
take half of a prescribed medication.
5. MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large
meal and alcohol he experiences significant GI distress. He takes an OTC heart-
burn remedy. Within a minute or two he develops what he will later describe
as "belching, nausea and a bad bloated feeling". Several of the ulcers began to
bleed and he becomes profoundly hypotensive from the blood loss and is taken
to the ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that
it appears as if the lesions had been literally stretched apart causing additional
tissue damage. What did the patient most likely take (i.e. what was the OTC
remedy)?: I would accept Alka-Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2,
that can cause gastric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation.
Tums, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid such as
production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear the ulcers open.
6. On your way to this examination, you experience the vulnerable feeling that
an attack of acute diarrhea is imminent! If you stop at a drug store, which
anti-diarrheal drugs could you buy without a prescription even though it is
chemically related to the strong opioid analgesic meperidine (but acts only on
the peripheral opioid receptor)?: Loperamide
Study online at https://quizlet.com/_fu0ost
1. EP is a 38-year-old female patient that comes in for diabetes education and
management. She was diagnosed 12 years ago and states lately she is not able
to control her diet although she continues a 1600 calorie diet with appropriate
daily carbohydrate intake (per dietitian prescription) and walks 40 minutes
every day of the week. She states compliance with all medications. She denies
any history of hypoglycemia despite being able to identify signs and symptoms
and describe appropriate treatment strategies.
PMH: T2DM, HTN, obesity, depression, s/p thyroidectomy due to thyroid can-
cer
FmHx: Noncontributory
SHx: (−) Smoking, alcohol use, past marijuana use while in high school
Medications: Metformin 850 mg tid, glipizide 20 mg bid, lisinopril 20 mg daily,
sertraline 100 mg daily, multivitamin daily
Vitals: BP 128/82 mg Hg; P 72 beats/min; BMI 31 m/kg2
Laboratory test results: Na 134 mEq/L, K 5.4 mEq/L, Cl 106 mEq/L, BUN: Exenatide
- Exenatide (Bydureon) once weekly has been able to demonstrate weight loss and decrease A1C% by 0.7% to 1.2% in
clinical trials; however it is contraindicated for EP due to the self-reported history of thyroid cancer.
Dapagliflozin - Dapagliflozin (Farxiga) is contraindicated in this patient due to hyperkalemia which could be made worse
by this drug. The package insert does not indicate a specific potassium concentration cut off to no longer use this
medication; however, there are better choices in this patient.
Sitagliptin - Sitagliptin (Januvia) is able to obtain an A1C goal of less than 7% based on clinical trials and currently
the patient does not have any cautionary objective measures to not use this medication. DPP-IV inhibitors are weight
neutral. DPP-IV inhibitors can be used in patients taking sulfonylureas; however, it may be recommended to reduce or
stop the sulfonylurea dose.
Acarbose - Acarbose (Precose) is not recommended for initial management and is associated with significant GI side
effects. More information would be needed regarding fasting and post-prandial numbers. In addition, adding acarbose
would only lower A1c by 0.8% at best and therefore would not achieve the desired A1C goal of <7%
2. JR is a 68-year-old African American man with a new diagnosis of T2DM. He
was classified as having prediabetes (at risk for developing diabetes) 5 years
before the diagnosis and has a strong family history of type 2 diabetes. JR's
blood pressure was 150/92 mm Hg. His laboratory results revealed an A1C of
8.1%, normal cholesterol panel, and normal renal/hepatic function were noted
, Advanced Pharmacology NSG 533 Exam 2024/2025
Study online at https://quizlet.com/_fu0ost
with today's laboratory test results.
Past medical history: Hypertension (diagnosed 4 y ago) Hyperlipidemia (diag-
nosed 2 y ago) Pancreatitis (idiopathic) (acute hospitalization 3 y ago)
Family history: Type 2 diabetes
Medication: HCTZ 25 mg daily, simvastatin 10 mg daily
Allergies: SMZ/TMP
Vitals: BP: 150/92 mm Hg P: 78 beats/min RR: 12 rpm Waist Circumference: 46
in Weight: 267 lb Height: 5 ′ 6 ″ BMI: 43.1 kg/m 2
Despite improvements in the past six weeks due to lifestyle changes and
exercise, drug therapy is to be started for JR's diabet: Metformin is the drug of choice
recommended for most patients with diabetes in addition to lifestyle modifications assuming no contraindications or
intolerabilities are present upon evaluation. Metformin has also shown to provide positive weight neutral/loss effects
in obese patients. It is crucial to know the renal status of patients commencing metformin therapy to limit the risk of
lactic acidosis (JR is without contraindication).
Since his entry A1C is >7.5%, dual therapy is indicated. There are several potential choices. The second step can be a
dipeptidyl peptidase-4 inhibitor, it can be a glucagon-like peptide-1 (GLP-1) receptor agonist, it can be a TZD, it can
be a sulfonylurea agent, it can be a SGLT2 inhibitor, or it could be basal insulin. Anything next can be tried depending
on what suits the circumstance
DPP4 inhibitors are weight neutral bet relatively benign side effect profile. Sitagliptin has been associated with case
reports of pancreatitis, so this specific agent should be avoided. $$$
GLP-1 analog and has data to support an A1C reduction necessary to gain glycemic control and may assist with weight
loss goals for this patient. New information suggests these agents may provide benefits in those with ASCVD. JR has a
past history of pancreatitis and GLP-1 analogs are not recommended due to this contraindication
TZDs have data to support an A1C reduction necessary to gain glycemic control, but are associated with weight gain,
negative effects on lipids and increased risk of fracture. Until recently, TZDs have also been linked to increased CV events
and use has fallen out of favor
Sulfonylureas provide excellent A1C lowering, but are also associated with weight gain. They also have the potential to
cause hypoglycemia, so patient education is crucial. Because of his allergies to "sulfa", use would be contr
3. A patient with type 1 diabetes reports taking propranolol for hypertension.
What concern does this information present for the provider?: A patient with Type 1
, Advanced Pharmacology NSG 533 Exam 2024/2025
Study online at https://quizlet.com/_fu0ost
DM is insulin dependent for glucose control and at high risk for hypoglycemic episodes. Propanolol causes prolonged
hypoglycemic episodes. Needs to switch to ACE or ARB.
4. A provider teaches a patient who has been diagnosed with hypothyroidism
about a new prescription for levothyroxine. Which statement by the patient
indicates a need for further teaching?
a. "I should not take heartburn medication without consulting my provider
first."
b. "I should report insomnia, tremors, and an increased heart rate to my
provider."
c. "If I take a multivitamin with iron, I should take it 4 hours after the levothy-
roxine."
d. "If I take calcium supplements, I may need to decrease my dose of levothy-
roxine.": D. Calcium may reduce levothyroxine absorption. Further education is needed if the patient feels she can
take half of a prescribed medication.
5. MC has undiagnosed multiple gastric ulcers. Shortly after consuming a large
meal and alcohol he experiences significant GI distress. He takes an OTC heart-
burn remedy. Within a minute or two he develops what he will later describe
as "belching, nausea and a bad bloated feeling". Several of the ulcers began to
bleed and he becomes profoundly hypotensive from the blood loss and is taken
to the ED. Endoscopy confirms multiple bleeds; the endoscopist remarks that
it appears as if the lesions had been literally stretched apart causing additional
tissue damage. What did the patient most likely take (i.e. what was the OTC
remedy)?: I would accept Alka-Selzer. I contains NaHCO3 (as well as ASA). In the presence of HCL it Liberates CO2,
that can cause gastric distention, belching and nausea. The reaction is fairly swift allowing little time for dissipation.
Tums, its primary ingredient calcium carbonate which when taken cause a reaction with the stomach acid such as
production of carbon dioxide gas which can cause bloating and the stomach to stretch to tear the ulcers open.
6. On your way to this examination, you experience the vulnerable feeling that
an attack of acute diarrhea is imminent! If you stop at a drug store, which
anti-diarrheal drugs could you buy without a prescription even though it is
chemically related to the strong opioid analgesic meperidine (but acts only on
the peripheral opioid receptor)?: Loperamide
