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Nurs |! 5334 |! Exam |! 3 |! with |! precise |!
detailed |! answers
What |! drugs |! are |! used |! to |! treat |! gestational |! diabetes? |! - |! Correct |! answer |! ✔Metformin |! abd |! Insulin What |! A1C |! value |! indicates |! diabetes |! mellitus? |! Pre-DM? |! - |! Correct |! answer |! ✔6.5% |! or |! greater |! is |! considered |! diabetes |! o |! 5.7-6.4%pre-diabetes What |! fasting |! and |! random |! values |! indicate |! DM? |! - |! Correct |! answer |! ✔Fasting |! plasma |! glucose— 126 |! or |! greater |! is |! diabetes. |! Random |! (casual) |! plasma |! glucose—anything |! greater |! than |! 200 |! is |! diabetes What |! are |! complications |! of |! insulin |! therapy? |! - |! Correct |! answer |! ✔Hypoglycemia Can |! develop |! lipohypertrophy. |! Accumulation |! of |! subcutaneous |! fat |! that |! occurs |! when |! it |! is |! injected |! too |! frequently |! at |! the |! same |! site. |! Allergic |! reactions |! Characterized |! by |! red |! and |! intensely |! itchy |! welts, |! breathing |! becomes |! difficult |! If |! severe |! allergy |! develops: |! Desensitization |! procedure |! (small |! doses |! to |! larger |! doses). |! Hypokalemia |! Promotes |! the |! uptake |! of |! potassium |! cells |! and |! insulin |! activates |! a |! membrane- bound |! enzyme |! with |! sodium |! potassium |! and |! ATPase |! that |! pumps |! potassium |! into |! the |! cells |! and |! sodium |! out
insulin |! drug |! interactions |! - |! Correct |! answer |! ✔o |! Hypoglycemicagents |! Can |! intensify |! the |! hypoglycemia |! included |! by |! insulin |! Examples: |! sulfonylureas, |! glinides, |! alcohol |! o |! Usewithcautionwithhyperglycemicagents |! Examples: |! thiazide |! and |! glucocorticoids |! and |! sympathomimetics What |! effect |! do |! beta |! blockers |! have |! on |! insulin? |! - |! Correct |! answer |! ✔delay |! awareness |! of |! and |! response |! to |! hypoglycemia |! by |! masking |! the |! signs |! that |! are |! associated |! with |! stimulation |! of |! sympathetic |! nervous |! system o |! Impairglycogenolysis o |! Prevent |! the |! bodies |! counter-regulatory |! response What |! are |! other |! therapeutic |! uses |! besides |! DM? |! - |! Correct |! answer |! ✔Hyperkalemia |! o |! Aids |! in |! diagnosis |! of |! GH |! deficiency |! o |! Diabeticketoacidosis Insulin |! dosage |! must |! be |! coordinated |! with |! what? |! - |! Correct |! answer |! ✔Carbohydrate |! intake What |! is |! B/P |! goal |! in |! diabetic? |! - |! Correct |! answer |! ✔o |! To |! be |! controlled, |! within |! normal |! 120/ What |! medication |! can |! be |! given |! to |! decrease |! risk |! of |! diabetic |! nephropathy? |! - |! Correct |! answer |! ✔ACE |! inhibitor |! or |! ARB
When |! a |! patient |! is |! on |! insulin |! therapy |! what |! are |! the |! blood |! glucose |! goals |! before |! meals? |! At |! bedtime? |! - |! Correct |! answer |! ✔Beforemeals—70- o |! Bedtime—100- What |! is |! the |! A1C |! goal? |! When |! is |! goal |! below |! 7 |! not |! appropriate? |! - |! Correct |! answer |! ✔7%or |! below |! o |! Those |! with |! severe |! hypoglycemia |! risk, |! limited |! life |! expectancy |! ,advanced |! microvascular |! or macrovascular |! complications—not |! below |! 7 What |! are |! the |! short |! acting |! insulins? |! Intermediate? |! Long |! acting? |! - |! Correct |! answer |! ✔Shortduration:Rapidacting |! Insulin |! lispro |! [Humalog] |! Insulin |! aspart |! [NovoLog] |! Insulin |! glulisine |! [Apidra] |! o |! Shortduration:Sloweracting |! Regular |! insulin |! [Humulin |! R, |! Novolin |! R] |! o |! Intermediateduration |! Neutral |! protamine |! Hagedorn |! (NPH) |! insulin |! Insulin |! detemir |! [Levemir] |! o |! Longduration |! Insulin |! glargine When |! are |! short |! duration |! insulins |! used? |! - |! Correct |! answer |! ✔Administered |! in |! association |! with |! meals |! to |! control |! the |! post-prandial |! rise |! in |! blood |! glucose |! between |! meals |! and |! at |! night When |! are |! intermediate |! insulins |! needed? |! - |! Correct |! answer |! ✔Administer |! 2-3 |! times |! daily |! to |! provide |! glycemic |! control |! between |! meals |! and |! during |! the
night How |! long |! is |! duration |! of |! glargine? |! Levemir? |! Degludec? |! - |! Correct |! answer |! ✔Glargine—up |! to |! 24 |! hours |! o |! Levemir |! Low |! dose |! (0.2 |! units/kg)—12 |! hours |! High |! doses |! (0.4 |! units/kg)—20-24 |! hours o |! Degludec—up |! to |! 42 |! hours What |! are |! routes |! of |! administration? |! Which |! can |! be |! inhaled? |! - |! Correct |! answer |! ✔SQ |! injection |! IV |! infusion. |! Inhalation—Afrezza, |! meal |! time |! insulin Typical |! insulin |! dosing |! for |! type |! 1? |! Type |! 2? |! - |! Correct |! answer |! ✔Total |! doses |! may |! range |! from |! 0.1 |! unit/kg |! body |! weight |! to |! more |! than |! 2.5 |! units/kg |! Type |! Initial |! doses |! typically |! range |! from |! 0.5-0.6 |! units/kg |! per |! day |! Type |! Initial |! doses |! range |! from |! 0.2-0.6 |! units/kg |! per |! day |! Dosage |! increased |! or |! decreased |! according |! to |! carb |! intake, |! activity What |! are |! the |! 3 |! dosing |! schedules? |! - |! Correct |! answer |! ✔o |! Twice |! daily |! dosing |! o |! Intensive |! basal/bolus |! strategy |! o |! Continued |! subcutaneous |! insulin How |! does |! metformin |! work? |! - |! Correct |! answer |! ✔o |! Inhibits |! glucose |! production |! in |! the |! livero |! Reduces |! glucose |! absorption |! in |! the |! guto |! Sensitizes |! insulin |! receptors |! in |! target |! tissues |! (fat |! and |! skeletal |! muscle) |! thus |! increase glucose |! uptake |! and |! response |! to |! whatever |! insulin |! is |! available
Main |! side |! effect? |! - |! Correct |! answer |! ✔Promote |! insulin |! release
|! Hypoglycemia |! Weight |! gain How |! does |! cimetidine |! effect? |! Beta |! blocker? |! - |! Correct |! answer |! ✔Cimetidine— intensifies |! the |! response |! Beta |! blockers—diminish |! the |! benefits |! by |! suppressing |! the |! insulin |! release Meglitinides |! (Repaglinide |! and |! Nateglinide) |! - |! Correct |! answer |! ✔o |! MOA— stimulate |! pancreatic |! insulin |! release o |! Drug/Drug |! interaction—gemfibrozil Thiazolidinediones |! (glitazones) |! - |! Correct |! answer |! ✔Reduce |! glucose |! levels |! primarily |! by |! decreasing |! insulin |! resistance o |! Only |! indication |! is |! type |! 2 |! diabetes, |! mainly |! as |! an |! add-on |! to |! metformin o |! Rosiglitazone |! [Avandia]: |! Restricted |! use o |! Pioglitazone |! [Actos] o |! Can |! they |! be |! used |! in |! patient |! with |! CHF? |! No Alpha-glucosidase |! inhibitors |! (Acarbose |! or |! Precose; |! Miglitol |! (glyset))
What |! races |! are |! these |! more |! effective |! in? |! - |! Correct |! answer |! ✔Latinos |! and |! African |! Americans DPP-4 |! inhibitors |! (gliptins) |! - |! Correct |! answer |! ✔MOA—promote |! glycemic |! control |! by |! enhancing |! the |! actions |! of |! the |! incretin |! hormones |! and they |! stimulate |! glucose |! dependent |! release |! of |! insulin |! Suppress |! your |! post-prandial |! release |! of |! glucagon What |! is |! the |! % |! of |! A1C |! reduction? |! - |! Correct |! answer |! ✔0.5% How |! does |! colesevelam |! work |! in |! treatment |! of |! DM? |! Bromocriptine? |! - |! Correct |! answer |! ✔Colesevelam—bile |! acid |! sequestrant |! used |! to |! lower |! cholesterol |! and |! helps |! lower |! blood glucose |! Many |! with |! diabetes |! also |! have |! high |! cholesterol |! so |! 2 |! birds-1 |! stone o |! Bromocriptine—adjunct |! to |! diet |! and |! exercise |! (0.5% |! reduction) Injectables: o |! Amylin |! memetics? |! - |! Correct |! answer |! ✔Pramlintide |! Side |! effects—hypoglycemia |! when |! used |! with |! insulin |! Drug/Drug—insulin o |! GLP-1 |! receptor |! agonists |! (or |! incretin |! mimetics) |! Can |! cause |! medullary |! thyroid |! cancer
What |! effect |! does |! iodine |! have |! on |! thyroid? |! - |! Correct |! answer |! ✔o |! When |! iodine |! availability |! is |! low |! production |! of |! thyroid |! hormones |! decrease Why |! is |! normal |! thyroid |! function |! important |! in |! first |! trimester |! of |! pregnancy? |! How |! much |! does requirement |! unusually |! increase |! in |! pregnant |! women |! taking |! thyroid |! supplements? |! - |! Correct |! answer |! ✔o |! Fetus |! is |! unable |! to |! produce |! its |! own |! hormones, |! without |! can |! result |! in |! permanent neuropsychologic |! deficits o |! Usually |! increases |! as |! much |! as |! 50% When |! is |! fetal |! thyroid |! gland |! full |! functional? |! - |! Correct |! answer |! ✔o |! 16 |! weeks If |! not |! treated, |! what |! does |! hypothyroidism |! cause |! in |! an |! infant? |! - |! Correct |! answer |! ✔o |! Large |! protruding |! tongue, |! potbelly, |! and |! dwarfish |! stature o |! The |! development |! of |! the |! nervous |! system, |! bones, |! and |! teeth |! is |! impaired When |! should |! treatment |! be |! stopped? |! How |! long? |! - |! Correct |! answer |! ✔o |! At |! 3 |! years |! of |! age |! for |! 4 |! weeks, |! then |! TSH |! is |! checked o |! If |! rise—deficiency |! is |! permanent, |! thyroid |! replacement |! needed o |! If |! normalize—transient |! deficiency, |! no |! further |! replacement |! required How |! is |! Graves' |! Disease |! treated? |! - |! Correct |! answer |! ✔o |! Surgical |! removal, |! destruction |! of |! the |! thyroid |! tissue, |! suppression |! of |! the |! thyroid |! hormone synthesis |! and/or |! beta |! blockers
o |! Non-radioactive |! iodine |! can |! be |! used |! to |! distract |! the |! thyroid |! tissue Thyroid |! Storm? |! - |! Correct |! answer |! ✔o |! Hyperthermia, |! severe |! tachycardia, |! restlessness, |! agitation, |! tremor o |! Unconscious, |! hypotensive, |! heart |! failure o |! Cannot |! be |! identified |! by |! lab |! testing, |! not |! triggered |! by |! a |! rise |! in |! thyroid |! hormones o |! Treatment—methimazole, |! beta |! blocker, |! sedation, |! cooling, |! glucocorticoids, |! IV |! fluids Levothyroxine |! - |! Correct |! answer |! ✔o |! T o |! Long |! half |! life o |! How |! should |! this |! be |! taken? |! In |! the |! morning, |! at |! least |! 30 |! to |! 60 |! minutes |! before |! breakfast o |! Side |! effects—tachycardia, |! angina |! tremors o |! Drug/Drug |! Warfarin—intensify |! effects |! Drugs |! that |! reduce |! absorption |! H2 |! receptor |! blockers, |! PPIs, |! cholestyramine, |! colestipol, |! Maalox, |! Mylanta, calcium |! supplements, |! iron, |! magnesium, |! orlistat |! Accelerate |! metabolism |! Phenytoin, |! carbamazepine, |! rifampin, |! sertraline, |! phenobarbital |! Catecholamines—increase |! cardiac |! responses |! Increase |! requirements |! of |! insulin |! and |! digoxin
Methimazole—used |! in |! hyperthyroidism |! - |! Correct |! answer |! ✔o |! Cell |! form |! of |! therapy |! for |! Graves' |! disease o |! Adjunct |! to |! radiation |! therapy |! until |! the |! effects |! of |! radiation |! become |! manifested o |! Suppresses |! the |! thyroid |! hormone |! synthesis |! in |! preparation |! for |! thyroid |! gland |! surgery o |! Thyrotoxic |! crisis Propylthiouracil |! - |! Correct |! answer |! ✔o |! Inhibits |! thyroid |! hormone |! synthesis o |! Second |! line |! for |! graves o |! Short |! half-life o |! Full |! benefits—6 |! to |! 12 |! months o |! Uses—graves', |! adjunct |! therapy |! to |! radiation, |! preparation |! for |! thyroid |! gland |! surgery, thyrotoxic |! crisis o |! Adverse |! effects—agranulocytosis, |! severe |! liver |! damage o |! Pregnancy? |! Crosses |! the |! placenta |! less |! and |! concentrations |! in |! breastmilk |! are |! lower |! than methimazole Radioactive |! Iodine |! 131 |! (lugol |! solution) |! - |! Correct |! answer |! ✔o |! Effect |! on |! the |! thyroid |! is |! destruction |! of |! thyroid |! tissue |! by |! emission |! of |! beta |! particles o |! Advantages—low |! cost; |! spared |! the |! risk, |! discomfort, |! and |! experience |! of |! thyroid |! surgery;
death |! is |! extremely |! rare; |! no |! tissue |! other |! than |! thyroid |! is |! injured o |! Disadvantages—treatment |! is |! delated, |! taking |! several |! months |! to |! become |! maximal; treatment |! is |! associated |! with |! significant |! incidents |! of |! delayed |! hypothyroidism |! from destruction |! of |! thyroid |! tissue |! (need |! levothyroxine) o |! Diagnostic |! uses? |! Hyperthyroidism, |! hypothyroidism, |! and |! goiter o |! Pregnancy—contraindicated o |! What |! are |! indications |! for |! Lugol |! solution?
o |! Side |! effects? |! Brassy |! taste, |! burning |! sensation |! in |! the |! mouth |! and |! throat, |! soreness |! of |! the |! teeth and |! gums, |! frontal |! headache, |! coryza, |! salvation |! and |! skin |! eruptions |! - |! Correct |! answer |! ✔Adults |! with |! hyperthyroidism |! Patients |! who |! have |! not |! responded |! adequately |! to |! anti-thyroid |! drugs |! or |! subtotal thyroidectomy |! Thyroid |! cancer ~~~~~~~~~ |! Brassy |! taste, |! burning |! sensation |! in |! the |! mouth |! and |! throat, |! soreness |! of |! the |! teeth and |! gums, |! frontal |! headache, |! coryza, |! salvation |! and |! skin |! eruptions o |! Increase |! cardiovascular |! events, |! N/V, |! gallbladder |! disease, |! jaundice, |! headache |! and chloasma Therapeutic |! uses |! of |! Estrogen? |! - |! Correct |! answer |! ✔o |! Menopausal |! hormone o |! Female |! hypogonadism o |! Acne SERMS—Selective |! estrogen |! receptor |! modulators |! - |! Correct |! answer |! ✔o |! drugs |! that |! activate |! estrogen |! receptors |! in |! some |! tissues |! and |! block |! them |! in |! others Why |! were |! these |! developed? |! - |! Correct |! answer |! ✔Provide |! the |! benefits |! of |! estrogen |! protection |! against |! vaginal |! atrophy |! Reduction |! of |! LDL |! cholesterol, |! but |! avoiding |! the |! drawbacks What |! is |! Duavee? |! - |! Correct |! answer |! ✔Conjugated |! estrogens |! with |! bazedoxifene |! Combine |! estrogen |! with |! an |! estrogen |! agonist |! or |! antagonist |! Used |! for |! treatment |! of |! vasomotor |! symptoms |! and |! osteoporosis |! in postmenopausal |! women |! Bazedoxifene—reduces |! the |! risk |! of |! excessive |! growth |! of |! the |! uterine |! lining |! that |! is posed |! by |! the |! estrogen |! component What |! are |! noncontraceptive |! uses |! for |! progesterone? |! - |! Correct |! answer |! ✔o |! Postmenopausal |! hormone |! therapy o |! Dysfunctional |! uterine |! bleeding o |! Amenorrhea o |! Infertility o |! Prematurity |! prevention o |! Endometrial |! carcinoma |! and |! hyperplasia When |! is |! estrogen |! therapy |! (ET) |! alone |! indicated? |! Estrogen/Progesterone |! (EPT)? |! - |! Correct |! answer |! ✔o |! Estrogen |! alone—women |! who |! have |! had |! a |! hysterectomy o |! EPT—all |! other |! women What |! are |! benefits? |! Risks? |! - |! Correct |! answer |! ✔o |! Benefits |! Relief |! of |! vasomotor |! symptoms |! Management |! of |! urogenital |! atrophy |! Prevention |! of |! osteoporosis |! and |! related |! fractures |! Cardioprotection |! Prevention |! of |! colorectal |! cancer |! Positive |! effect |! on |! wound |! healing |! Tooth |! retention |! Glycemic |! control |! Physiologic |! doses |! of |! estrogen |! (with |! or |! without |! progestin) |! Oral |! contraceptives |! Etonogestrel |! implants |! Injectable |! medroxyprogesterone |! acetate |! Intrauterine |! devices |! Vaginal |! rings |! Transdermal |! patches |! Nonpharmacologic |! methods |! of |! contraception |! Surgical |! sterilization |! (tubal |! ligation, |! vasectomy) |! Mechanical |! devices |! (condom, |! diaphragm, |! cervical |! cap) |! Avoiding |! intercourse |! during |! periods |! of |! fertility |! (calendar |! method, temperature |! method, |! cervical |! mucus |! method) How |! should |! you |! select |! a |! method? |! - |! Correct |! answer |! ✔Consider |! effectiveness, |! safety, |! personal |! preference Oral |! contraceptives o |! MOA—inhibit |! ovulation o |! What |! are |! categories? |! Subgroups? |! - |! Correct |! answer |! ✔Classification |! (two |! main |! categories) |! Combination |! oral |! contraceptives |! (OCs) |! Estrogen |! and |! progestin |! Progestin-only |! OCs |! ("mini-pills") |! Three |! major |! subgroups |! of |! combination |! OCs |! Monophasic |! Biphasic |! Triphasic What |! are |! 3 |! estrogens |! in |! OCPs? |! Progesterone? |! 1st |! gen? |! 2nd |! gen? |! 3rd |! gen? |! 4th |! gen? |! - |! Correct |! answer |! ✔Estrogens—ethinyl, |! estradiol, |! estriol |! and |! estradiol |! valerate |! Progesterone—4 |! generations |! 1 st |! generation—ethynodiol |! diacetate |! and |! norethindrone |! 2 nd |! gen—levonorgestrel |! and |! norgestrel |! 3 rd |! gen—desogestrel |! and |! norgestimate |! 4 th |! gen—dienogest |! and |! drospirenone Combination |! Ocs o |! Adverse |! effects? o |! Noncontraceptive |! uses? o |! What |! drugs |! reduce |! the |! effects? o |! What |! drugs |! effects |! are |! decreased |! by |! OCs? o |! What |! are |! drugs |! whose |! effects |! are |! increased |! by |! Ocs? o |! What |! are |! unique |! properties |! of |! Beyaz |! and |! Safyral? |! Natazia? |! - |! Correct |! answer |! ✔Thyrombolytic |! disorders
