Pharmacology For Care Of The Family, Exams of Nursing

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NR 566 Pharmacology For Care Of The Family

(Summer 2022)

Question 2

2 / 2 pts

Question 3

2 / 2 pts

I understand the value of doing my own work and learning this skill to support my future independent practice as a nurse practitioner. I understand that while there may be opportunities beyond my faculty’s control to collaborate or share answers with peers, that it would not benefit my own personal and professional growth to do so. I agree to do my own work and take personal responsibility for my learning.

I do not.

I do.

Use the John Jones case study to answer the following question.

Which glucose level equates with a Hgb A1C of 8.1%?

~204 mg/dl

~160 mg/dl

~175 mg/dl

~183 mg/dl

The correct answer is ~ 183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding eAG levels for complete information.

Use the John Jones case study to answer the following question.

John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen?

Don’t take the metformin the day of the procedure and for 48 hours afterward.

Question 1

0 / 0 pts

No special instructions are needed.

Question 4

2 / 2 pts

Question 5

2 / 2 pts

Take the metformin the morning of the procedure but don’t take it for 48 hours afterward.

Don’t take the metformin the day of the procedure but resume the following day.

Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels should be normal before resuming metformin.

Use the John Jones case study to answer the following question.

Which of the following lab test should be evaluated before prescribing metformin?

Complete blood count (CBC)

Complete metabolic profile (CMP)

Lipid Panel

Urinalysis

CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout treatment with metformin.

Use the John Jones case study to answer the following question.

Which behavior in John’s social history poses a potential concern with initiating metformin?

His diet largely consists of fast-food meals. He drinks sweet tea with every meal.

He reports drinking ―a few beers on the weekend during football season‖.

Question 8

2 / 2 pts

Question 9

2 / 2 pts

Metformin

According to the ADA Standards of Medical Care in Diabetes-2020, Metformin is the first-line medication to prescribe for patients with a HgbA1C >6.5%.

American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes— 2020 Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/

Use the John Jones case study to answer the following question.

Which of the following statements best describes John’s status?

He has diabetes and requires pharmacological intervention.

He does not have diabetes.

He has diabetes but does not require pharmacological intervention.

He has pre-diabetes.

DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to pharmacological intervention. These criteria include:

• Fasting plasma glucose ≥126 mg/dLa Or
• Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or
• Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc Or
• Hemoglobin A1c 6.5% or higher;

Use the John Jones case study to answer the following question.

John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time?

Increase John’s atorvastatin to 20mg per day.

Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked.

Question 10

2 / 2 pts

Question 11

1 / 2 pts

Increase John’s atorvastatin to 40 mg per day.

Stop John’s atorvastatin since he is now being treated for diabetes.

According to the ADA Standards of Medical Care in Diabetes-2020, the correct action is to intensify lifestyle

therapy and optimize glycemic control for patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women).

John's treatment includes lifestyle changes as well as metformin which aligns with practice guidelines. John’s atorvastatin should remain as currently prescribed with monitoring of lipid profile and A1C.

Use the John Jones case study to answer the following question.

What is the recommended interval for monitoring John’s HgbA1C?

1-month

6-weeks

3-months

6-months

The HgbA1C is a 3-month average of glucose; therefore, it should be re-checked in 3 months after starting treatment. Checking this lab value beforehand will provide a mixed result of glucose before and after treatment. Monitoring blood sugar between the beginning of treatment with metformin and a 3 month follow up, fasting finger stick blood sugars should be done.

Use the John Jones case study to answer the following question.

Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply.

He drinks 3-4 cups of coffee per day.

Question 14

2 / 2 pts

Alfonso should be started on statin therapy to address his high total cholesterol and low HDL.

True

False

Statin therapy is recommended because of his known diabetes and 10-year risk ≥7.5%. If Alfonso’s LDL is <70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk-benefits may be considered before starting statins.

Identify SGLT2i agents in the list below. Select all that apply.

linagliptin

dapagliflozin

alogliptin

sitagliptin

saxagliptin

canagliflozin

empagliflozin

The Food and Drug Administration (FDA has approved three SGLT2 selective inhibitors for mono, dual, and triple therapy: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®)

Question 15

0 / 2 pts

Use the Alfonso Giuliani case study to answer the following question.

Use the ASCVD Risk Estimator-Plus calculator (Links to an external site.) to estimate Alfonso’s ASCVD Risk score. Which of the following scores is his ASCVD Risk score?

Question 16

1.33 / 2 pts

Correct Answer

Alfonso’s ASCVD Risk score is 46.5% according to ASCVD Risk Estimator-Plus tool, which estimates risk

based on age, gender, presence of diabetes, treatment for hypertension, cholesterol values, and systolic pressure.

Use the Alfonso Giuliani case study to answer the following question.

Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply.

appetite suppression

weight loss

Correct Answer

low risk for hypoglycemia

blood pressure control

The benefits of GLP-1 therapy relevant to Alfonso include weight loss and suppression of appetite without causing hypoglycemia.

Question 17

1.6 / 2 pts

Identify GLP- 1 agents in the list below. Select all that apply.

Question 20

1 / 2 pts

exenatide

semaglutide

dulaglutide

lixisenatide

liraglutide

rosiglitazone

pioglitazone

albiglutide

GLP-1 receptor agonists include:

albiglutide (Tanzeum)

dulaglutide (Trulicity)

exenatide (Byetta)

liraglutide (Victoza)

lixisenatide (Adlyxin)

semaglutide (Ozempic, Rybelsus)

Use the Alfonso Giuliani case study to answer the following question.

Question 21

1 / 2 pts

Which of the following complications may be caused by GLP-1 agents?

diverticulitis

cholecystitis

pancreatitis

Correct Answer

cellulitis

GLP-1 drugs may cause pancreatitis. GLP-1 drugs do not cause cellulitis, diverticulitis, and cholecystitis.

Use the Alfonso Giuliani case study to answer the following question.

Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin?

TZD

SGLT2i

Correct Answer

GLP-

Sulfonylurea

According to the ADA Standards of Medical Care in Diabetes-2020, GLP-1 and SGLT2i drugs are recommended in conjunction with metformin when ASCVD risk predominates. Alfonso meets this criterion with

an ASCVD risk score >40%.

American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes— 2020 Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/

Question 22

Question 25

1.6 / 2 pts

What are the Black Box Warnings associated with NSAIDs? Select all that apply.

Increases risk for GI bleeding, ulceration, and perforation

Increases risk for cardiovascular thrombotic event

Increases all-cause mortality

Increases risk for serious skin reactions

Black Box warning on NSAIDs:

Cardiovascular Thrombotic Event

NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in treatment and may increase with duration of use; contraindicated for CABG perioperative pain

GI Bleeding, Ulceration, and Perforation

NSAIDs incr. risk of serious and potentially fatal GI adverse events incl. bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and without warning signs or symptoms;

elderly pts and pts with hx of PUD or GI bleeding at greater risk for serious GI events

Use the Helen Smith case study to answer the following question.

Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply)

Glucose: 189 mg/dL

T.Cholesterol 240 mg/dl

Question 24

2 / 2 pts

polyuria

Question 26

0 / 2 pts

Question 27

0 / 2 pts

Correct Answer

Triglycerides 260 mg/dl

HgbA1C: 9.2%

nocturia

The following criteria support Helen’s diagnosis of DM, HgbA1C: 9.2%, Glucose: 189 mg/dL,

polyuria, nocturia, and triglycerides 260 mg/dl. Although the A1C is the definitive diagnostic value, the other

values also support this diagnosis when accompanied with an elevated A1C.

Use the Helen Smith case study to answer the following question.

If the standard starting dose of levothyroxine 1.6 mcg/kg/dose is prescribed for Helen, what is the correct dose?

200mcg

Correct Answer

175mcg

300mcg

150mcg

The correct dose is 175mcg/dose. Calculations are 1.6 mcg/kg/dose. Helen weighs 242 pounds; therefore the dose calculation is 1.6mcg/110kg (242 pounds) or =175.63. Therefore, the closest available dose to order would be a 175mcg tablet. This is a high dose to start for an older patient with cardiac disease so it would be appropriate to choose a lower starting dose for Helen and titrate up.

Use the Helen Smith case study to answer the following question.

ALT (alanine aminotransferase): 18 U/L

Question 29

2 / 2 pts

LDL 120mg/dl

AST (aspartate aminotransferase): 20

Hct 48%

Free T4 0.2 ng/dl

The following lab values require consideration for possible treatment as they are not within normal limits:

Total Cholesterol 240 mg/dl

HDL 35 mg/dl

LDL 120mg/dl

Triglycerides 260 mg/dl

TSH 24 mU/L

Free T4 0.2 ng/dl

Use the Helen Smith case study to answer the following question.

What is the daily maximum dose of levothyroxine?

700mcg/day

500mcg/day

300mcg/day

1000mcg/day

Levothyroxine has a maximum dose of 300 mcg/day.

Question 31

2 / 2 pts

Use the Helen Smith case study to answer the following question.

Which of the following medical conditions will determine Helen’s diabetes treatment regimen?

Obesity

Osteoarthritis

Dyslipidemia

Heart Failure

According to the ADA Standards of Medical Care in Diabetes-2020, specific treatment for patients with heart failure is warranted. Dyslipidemia, obesity, and osteoarthritis are not determining factors for treatment according to these guidelines.

American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes— 2020 Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/

Use the Helen Smith case study to answer the following question.

Which DM drug class is contraindicated in patients with heart failure?

Sulfonylurea

Biguanide

GLP-

TZD

The ADA Standards of Medical Care in Diabetes-2020notes that TZD drugs should be avoided in patients with heart failure.

Question 30

2 / 2 pts

Question 34

2 / 2 pts

Question 35

2 / 2 pts

Levothyroxine should be prescribed for Helen to address her thyroid levels. Levothyroxine is a hormone that

replaces the thyroid hormone that is normally produced by the body. Propylthiouracil and methimazole are both drugs to treat hyperthyroidism. Triiodothyronine is a T3 hormone that can be used in conjunction with levothyroxine to treat patients with Hashimoto’s thyroiditis.

Use the Helen Smith case study to answer the following question.

Medication lists should always be reviewed for evidence -based prescribing practices. Helen is taking Naproxen 500 mg PO every 12 hours.

What is the maximum dose of Naproxen per day (for 6 months)?

2000mg per day

1000mg per day

2500mg per day

1500mg per day

The maximum dose of Naproxen is 1500mg/day for 6 months.

Use the Helen Smith case study to answer the following question.

Which of the following agents should be prescribed for Helen? (Independent searching may be required to find the answer to this question)

Glipizide

Dapagliflozin

Glimepiride

Pioglitazone

Question 36

2 / 2 pts

Question 37

2 / 2 pts

―SGLT2 inhibitors are the most recent drug class approved by the FDA for treating type 2 DM (T2DM). They work by inhibiting SGLT2 transport proteins in the proximal convoluted tubule (PCT) in the kidney. Because these transporters account for nearly 90% of all filtered-glucose reabsorption in the body, they are excellent targets for blood-glucose control. SGLT2 inhibitors have been associated with HbA1c reductions of 0.5% to 1%,

making them effective second-line treatment options for T2DM‖ (Chim, Newaz, 2020, para. 3). Pioglitazone is a TZD, Glimepiride and Glipizide are both sulfonylureas.

Chim, C. & Newaz, S. (2020). SGLT2 Inhibitors and heart failure outcomes. US Pharmacist. 45(2): 18-22. https://www.ajmc.com/view/fda-approves-dapagliflozin-to-treat-heart-failure-breaking-new-ground-in-sglt2-

competition

Use the Helen Smith case study to answer the following question.

Which of the following drug classes should be prescribed for Helen?

GLP-

Biguanide

SGLTi

DPP-4i

According to the ADA Standards of Medical Care in Diabetes-2020, Helen should be started on a SGLTi.

Use the Helen Smith case study to answer the following question.

Which of the following is the recommended initial dose of levothyroxine for the general population?

1.2mcg/kg/dose daily

1.8 mcg/kg/dose daily

2.0 mcg/kg/dose daily