NR 566 / NR566 ADVANCED PHARMACOLOGY CARE OF THE FAMILY MIDTERM TESTBANK

Question 1. Both men & women experience bone loss with aging. The bones most likely to demonstrate significant loss are: 1. Cortical bones 2. Femoral neck bones 3. Cervical vertebrae 4. Pelvic bones Question 2. Bisphosphonates treat or prevent osteoporosis by: 1. Inhibiting osteoclastic activity 2. Fostering bone resorption 3. Enhancing calcium uptake in the bone 4. Strengthening the osteoclastic proton pump Question 3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs? 1. Selective estrogen receptor modulators 2. Aspirin 3. Glucocorticoids 4. Calcium supplements Question 4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, & amylase components, but the drug is prescribed in units of: 1. Lipase 2. Protease 3. Amylase 4. Pancreatin Question 5. Brands of pancreatic enzyme replacement drugs are: 1. Bioequivalent 2. About the same in cost per unit of lipase across brands 3. Able to be interchanged between generic & brand-name products to reduce cost 4. None of the above Question 6. When given subcutaneously, how long until neutral protamine Hagedorninsulin begins to take effect (onset of action) after administration? 1. 15 to 30 minutes 2. 60 to 90 minutes 3. 3 to 4 hours 4. 6 to 8 hours Question 7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs & symptoms of hypoglycemia include: 1. “Fruity” breath odor & rapid respiration 2. Diarrhea, abdominal pain, weight loss, & hypertension 3. Dizziness, confusion, diaphoresis, & tachycardia 4. Easy bruising, palpitations, cardiac dysrhythmias, & coma Question 8. Nonselective beta blockers & alcohol create serious drug interactions with insulin because they: 1. Increase blood glucose levels 2. Produce unexplained diaphoresis 3. Interfere with the ability of the body to metabolize glucose 4. Mask the signs & symptoms of altered glucose levels Question 9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true? 1. Optimal time of prepr&ial injection is 15 minutes. 2. Duration of action is increased when the dose is increased. 3. It is compatible with neutral protamine Hagedorn insulin. 4. It has no pronounced peak. Question 10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done: 1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia. 2. The initial dose of glargine is 2 to 10 units per day. 3. Patients who have been on high doses of NPH will need tests for insulin antibodies. 4. Obese patients may require more than 100 units per day. Question 11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose & limit complication risks. Which of the following statements is accurate based on research? 1. Premixed insulin analogues are better at lowering HbA1C & have less risk for hypoglycemia. 2. Premixed insulin analogues & the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. 3. Newer premixed insulins are better at lowering HbA1C & postpr&ial glucose levels than long-acting insulins. 4. Patients who are not controlled on oral agents & have postprial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. Question 12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: 1. Substitutes for insulin usually secreted by the pancreas 2. Decreases glycogenolysis by the liver 3. Increases the release of insulin from beta cells 4. Decreases peripheral glucose utilization Question 13. Prior to prescribing metformin, the provider should: 1. Draw a serum creatinine to assess renal function 2. Try the patient on insulin 3. Tell the patient to increase iodine intake 4. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions Question 14. The action of “gliptins” is different from other antidiabetic agents because they: 1. Have a low risk for hypoglycemia 2. Are not associated with weight gain 3. Close ATP-dependent potassium channels in the beta cell 4. Act on the incretin system to indirectly increase insulin production Question 15. Sitagliptin has been approved for: 1. Monotherapy in once-daily doses 2. Combination therapy with metformin 3. Both 1 & 2 4. Neither 1 nor 2 Question 16. GLP-1 agonists: 1. Directly bind to a receptor in the pancreatic beta cell 2. Have been approved for monotherapy 3. Speed gastric emptying to decrease appetite 4. Can be given orally once daily Question 17. Avoid concurrent administration of exenatide with which of the following drugs? 1. Digoxin 2. Warfarin 3. Lovastatin 4. All of the above Question 18. Administration of exenatide is by subcutaneous injection: 1. 30 minutes prior to the morning meal 2. 60 minutes prior to the morning & evening meal 3. 15 minutes after the evening meal 4. 60 minutes before each meal daily Question 19. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: 1. Tinnitus & decreased salivation 2. Fever & sore throat 3. Hypocalcemia & osteoporosis 4. Laryngeal edema & difficulty swallowing Question 20. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: 1. Excessive sedation 2. Tachycardia & angina 3. Weight gain 4. Cold intolerance Question 21. Which of the following is not an indication that growth hormone supplements should be discontinued? 1. Imaging indication of epiphyseal closure 2. Growth curve increases have plateaued 3. Complaints of mild bone pain 4. Achievement of anticipated height goals Question 22. Besides osteoporosis, IV bisphosphonates are also indicated for: 1. Paget’s Disease 2. Early osteopenia 3. Renal cancer 4. Early closure of cranial sutures Question 23. What is the role of calcium supplements when patients take bisphosphonates? 1. They must be restricted to allow the medication to work. 2. They must be taken in sufficient amounts to provide foundational elements for bone growth. 3. They must be taken at the same time as the bisphosphonates. 4. They only work with bisphosphonates if daily intake is restricted. Question 24. Which of the following statements about pancreatic enzymes is true? 1. Dosing may be titrated according to the decrease of steatorrhea. 2. The amount of carbohydrates in the meal drives the amount of enzyme used. 3. The amount of medication used is increased with a cystic fibrosis pulmonary flare. 4. The FDA & Internet-available formulations are bioequivalent. Question 25. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes? 1. Paget’s disease 2. Pulmonary cancers 3. Gallbladder surgery 4. Some bariatric surgeries Question 1 . Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type 1 diabetics have: 1. Autoantibodies to two tyrosine phosphatases 2. Mutation of the hepatic transcription factor on chromosome 12 3. A defective glucokinase molecule due to a defective gene on chromosome 7p 4. Mutation of the insulin promoter factor Question 2. Type 2 diabetes is a complex disorder involving: 1. Absence of insulin production by the beta cells 2. A suboptimal response of insulin-sensitive tissues in the liver 3. Increased levels of glucagon-like peptide in the postpr&ial period 4. Too much fat uptake in the intestine Question 3. Diagnostic criteria for diabetes include: 1. Fasting blood glucose greater than 140 mg/dl on two occasions 2. Postpr&ial blood glucose greater than 140 mg/dl 3. Fasting blood glucose 100 to 125 mg/dl on two occasions 4. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl Question 4. Routine screening of asymptomatic adults for diabetes is appropriate for: 1. Individuals who are older than 45 & have a BMI of less than 25 kg/m2 2. Native Americans, African Americans, & Hispanics 3. Persons with HDL cholesterol greater than 100 mg/dl 4. Persons with prediabetes confirmed on at least two occasions Question 5. Screening for children who meet the following criteria should begin at age 10 & occur every 3 years thereafter: 1. BMI above the 85th percentile for age & sex 2. Family history of diabetes in first- or second-degree relative 3. Hypertension based on criteria for children 4. Any of the above Question 6. Insulin is used to treat both types of diabetes. It acts by: 1. Increasing beta cell response to low blood-glucose levels 2. Stimulating hepatic glucose production 3. Increasing peripheral glucose uptake by skeletal muscle & fat 4. Improving the circulation of free fatty acids Question 7. Adam has type 1 diabetes & plays tennis for his university. He exhibits a knowledge deficit about his insulin & his diagnosis. He should be taught that: 1. He should increase his carbohydrate intake during times of exercise. 2. Each brand of insulin is equal in bioavailability, so buy the least expensive. 3. Alcohol produces hypoglycemia & can help control his diabetes when taken in small amounts. 4. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes. Question 8. Insulin preparations are divided into categories based on onset, duration, & intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset & duration of action? 1. Lispro 2. Glulisine 3. Glargine 4. Detemir Question 9. The drug of choice for type 2 diabetics is metformin. Metformin: 1. Decreases glycogenolysis by the liver 2. Increases the release of insulin from beta cells 3. Increases intestinal uptake of glucose 4. Prevents weight gain associated with hyperglycemia Question 10. Before prescribing metformin, the provider should: 1. Draw a serum creatinine level to assess renal function. 2. Try the patient on insulin. 3. Prescribe a thyroid preparation if the patient needs to lose weight. 4. All of the above Question 11. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications & metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: 1. Increase endogenous insulin secretion 2. Have a significant risk for hypoglycemia 3. Address the insulin resistance found in type 2 diabetics 4. Improve insulin binding to receptors Question 12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: 1. Better reduction in glucose levels than other classes 2. Less weight gain than sulfonylureas 3. Low risk for hypoglycemia 4. Can be given twice daily Question 13. Control targets for patients with diabetes include: 1. HbA1C between 7 & 8 2. Fasting blood glucose levels between 100 & 120 mg/dl 3. Blood pressure less than 130/80 mm Hg 4. LDL lipids less than 130 mg/dl Question 14. Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes: 1. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily. 2. Tight control is acceptable for older adults if they are without complications. 3. Plasma glucose levels are the same for children as adults. 4. Conventional therapy has a fasting plasma glucose target between 120 & 150 mg/dl. Question 15. Treatment with insulin for type 1 diabetics: 1. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight 2. Divides the total doses into three injections based on meal size 3. Uses a total daily dose of insulin glargine given once daily with no other insulin required 4. Is based on the level of blood glucose Question 16. When the total daily insulin dose is split & given twice daily, which of the following rules may be followed? 1. Give two-thirds of the total dose in the morning & one-third in the evening. 2. Give 0.3 units per kg of premixed 70/30 insulin with one-third in the morning & two-thirds in the evening. 3. Give 50% of an insulin glargine dose in the morning & 50% in the evening. 4. Give long-acting insulin in the morning & short-acting insulin at bedtime. Question 17. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: 2. Older adults 3. Those with no significant cardiovascular disease 4. Young children who are early in their disease