Advanced Pharmacology NSG
533 Test 1// Advanced
Pharmacology NSG 533 EXAM
WITH QUESTIONS AND
ANSWERS LATEST UPDATE
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 cancer
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 - CORRECT ANSWExenatide - 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%
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