Week 5 8 Final Exam: NR565 NR-

Week 5 – 8 Final Exam: NR565 / NR-

565 (Latest 2025 / 2026) Advanced Pharmacology Fundamentals | Questions with Verified Answers | 100% Correct | Grade A - Chamberlain

Week 5: insulin, hyper & hypo thyroidism

Question:

Ratio of basal insulin to rapid-acting insulin in total daily dose (TDD) of insulin?

Answer:

*Total daily insulin dose (TDD) calculation includes basal insulin

replacement and bolus insulin replacement. In all: 50% is basal dose and 50%

is rapid acting

*Daily dose - Total weight of patient in kilograms, multiplied by 0.6. Ex: 80kg

(184) x 0.6 units = 24; this means 24 units of the TDD is the basal insulin dose (long acting) (50%) and the other 24 units of rapid acting bolus/mealtime insulin (50%).

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Question:

Which drug class should be considered for diabetes prior to insulin?

Answer:

Patients should always be started at step 1 with lifestyle change and metformin, unless their A1C is greater than 9%, then should be placed on 2 PO medications

Question:

carbohydrate-to insulin ratio when calculating basal insulin

Answer:

Calculated using the 450 rule for regular insulin and the 500 rule for rapid

acting insulin. Ex for rapid acting: 500 divided by 48 = 10.4 (rounded to 10).

Therefore, the carb-to-insulin ratio is 1:10

*If the meal is 60 grams of carbs, 60 divided by 10 = 6 units for carb coverage

Question:

MOA GLP-1 (aka mimetics)

Answer:

*Cause an increase in insulin production and inhibit postprandial glucagon release and increase satiety.*may cause pancreatitis; therefore, monitoring of amylase and lipase *contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.

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Question:

MOA Biguanide (Metformin)

Answer:

*Decreases Glucose production by the liver and decreases insulin resistance *contraindicated in patients with renal disease, acidosis from hepatic disease, alcoholics, or in patients with hypoxia. Laboratory monitoring should include renal and hepatic function studies.*Increased risk of lactic acidosis

• metformin should be held with iv contrast (48 hours after) and normal

creatinine is needed before resumption

Question:

MOA Thiazolidinediones (TZD)

Answer:

• enhance insulin sensitivity in muscle tissue and reduce glucagon production

in the liver.

• taken daily with breakfast and can be combined with other diabetic agents.
• avoided in patients with congestive heart failure (CHF) as it causes water

retention, history of bladder cancer, active liver disease, type 1 DM, or pregnancy.

• Regular LFTs monitoring is also recommended due to the action of the drug

in the liver. May cause weight gain.

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Question:

MOA Sulfonylureas

Answer:

• stimulate beta cells of the pancreas to secrete more insulin.

• long half-life and a high risk of severe hypoglycemia.

• cause photosensitivity; therefore, patient education is needed regarding

sunscreen.

• avoided in patients with impaired hepatic or renal function.

Question:

MOA Dipeptidyl Peptidase-4 Inhibitors (DPP-4i)

Answer:

• inhibit DPP-4 activity and increase active incretin concentrations which

result in increased insulin secretion and decreased glucagon.

• may cause severe and disabling joint pain

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