NURS 5334 / NURS5334 ADVANCED PHARMACOLOGY EXAM 3 STUDY GUIDE. QUESTIONS WITH ANSWERS.

NURS 5334 EXAM 3

1. What drugs are used to treat gestational diabetes?
   Metformin and Insulin
2. What A1C value indicates diabetes mellitus? Pre-DM?
   6.5% or greater is considered diabetes
   5.7-6.4% pre-diabetes
3. What fasting and random values indicate DM?
   Fasting plasma glucose—126 or greater is diabetes
   Random (casual) plasma glucose—anything greater than 200 is diabetes
4. What are complications of insulin therapy?
   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
5. Drug interactions?
   Hypoglycemic agents
    Can intensify the hypoglycemia included by insulin
    Examples: sulfonylureas, glinides, alcohol
   Use with caution with hyperglycemic agents
    Examples: thiazide and glucocorticoids and sympathomimetics
6. What effect do beta blockers have on insulin?
    delay awareness of and response to hypoglycemia by masking the signs that are
   associated with stimulation of sympathetic nervous system
    Impair glycogenolysis
    Prevent the bodies counter-regulatory response
7. What are other therapeutic uses besides DM?
    Hyperkalemia
    Aids in diagnosis of GH deficiency
    Diabetic ketoacidosis
8. Insulin dosage must be coordinated with what?
   Carbohydrate intake
9. What is B/P goal in diabetic?
   To be controlled, within normal 120/80
10. What medication can be given to decrease risk of diabetic nephropathy?
    ACE inhibitor or ARB
11. What role does exercise play in treatment of both type 1 and type 2 DM?
     Exercise increases cellular responsiveness to insulin and increases glucose
    tolerance
     150 minute per week of moderate intensity exercise is recommended
12. What are the 4 steps in the 4-step approach?
    Step 1—diagnosis
     Lifestyle changes plus metformin
    Step 2
     Lifestyle changes plus metformin and a second drug (sulfonylurea, TZD or a
    DPP4 inhibitor, a sodium glucose cotransporter or SGLT-2 inhibitor, a glucagonlike peptide 1, or a GLP-1 receptor agonist or basal insulin
     Second drug choice made considering efficacy, the hypoglycemia risk of the
    patient, the patient tolerability, and weight-related considerations (some help
    weight loss, some cause weight gain), cost
    Step 3
     Three drug combination
     Metformin
     Plus 2 other drugs from step 2
    Decided based on a drug and patient specific considerations
    Step 4
     If 3 drug combination that includes basal insulin fails after 3-6 months, more
    complex insulin regimen
     Usually in combination with one or more non-insulin medications
13. When a patient is on insulin therapy what are the blood glucose goals before
    meals? At bedtime?
     Before meals—70-130
     Bedtime—100-140
14. What is the A1C goal? When is goal below 7 not appropriate?
     7% or below
     Those with severe hypoglycemia risk, limited life expectancy, advanced micro
    vascular or macro vascular complications—not below 7
15. What are the short acting insulins? Intermediate? Long acting?
    Short duration: Rapid acting
     Insulin lispro [Humalog]
     Insulin aspart [NovoLog]
     Insulin glulisine [Apidra]
    Short duration: Slower acting
     Regular insulin [Humulin R, Novolin R]
    Intermediate duration
     Neutral protamine Hagedorn (NPH) insulin
     Insulin detemir [Levemir]
    Long duration
     Insulin glargine
16. When are short duration insulins used?
     Administered in association with meals to control the post-prandial rise in blood
    glucose between meals and at night
17. When are intermediate insulins needed?
     Administer 2-3 times daily to provide glycemic control between meals and during
    the night
18. How long is duration of glargine? Levemir? Degludec?
     Glargine—up to 24 hour