,10/17/24, 8:06 AM Advanced Pharmacology NSG 533/NSG 533 advanced pharm exam 2 Latest 2024/2025 guide with complete solution/Advan…
EP is a 38-year-old Exenatide - Exenatide (Bydureon) once weekly has
female patient that been able to demonstrate weight loss and decrease
comes in for diabetes A1C% by 0.7% to 1.2% in clinical trials; however it is
education and contraindicated for EP due to the self-reported
management. She was history of thyroid cancer.
diagnosed 12 years ago Dapagliflozin - Dapagliflozin (Farxiga) is
and states lately she is contraindicated in this patient due to hyperkalemia
not able to control her which could be made worse by this drug. The
diet although she package insert does not indicate a specific
continues a 1600 calorie potassium concentration cut off to no longer use
diet with appropriate this medication; however, there are better choices in
daily carbohydrate intake this patient.
(per dietitian Sitagliptin - Sitagliptin (Januvia) is able to obtain an
prescription) and walks A1C goal of less than 7% based on clinical trials and
40 minutes every day of currently the patient does not have any cautionary
the week. She states objective measures to not use this medication. DPP-
compliance with all IV inhibitors are weight neutral. DPP-IV inhibitors
medications. She denies can be used in patients taking sulfonylureas;
any history of however, it may be recommended to reduce or stop
hypoglycemia despite the sulfonylurea dose.
being able to identify Acarbose - Acarbose (Precose) is not
signs and symptoms and recommended for initial management and is
describe appropriate associated with significant GI side effects. More
treatment strategies. information would be needed regarding fasting and
PMH: T2DM, HTN, post-prandial numbers. In addition, adding
obesity, depression, s/p acarbose would only lower A1c by 0.8% at best and
thyroidectomy due to therefore would not achieve the desired A1C goal of
thyroid cancer <7%
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
, 10/17/24, 8:06 AM Advanced Pharmacology NSG 533/NSG 533 advanced pharm exam 2 Latest 2024/2025 guide with complete solution/Advan…
JR is a 68-year-old Metformin is the drug of choice recommended for
African American man most patients with diabetes in addition to lifestyle
with a new diagnosis of modifications assuming no contraindications or
T2DM. He was classified intolerabilities are present upon evaluation.
as having prediabetes (at Metformin has also shown to provide positive
risk for developing weight neutral/loss effects in obese patients. It is
diabetes) 5 years before crucial to know the renal status of patients
the diagnosis and has a commencing metformin therapy to limit the risk of
strong family history of lactic acidosis (JR is without contraindication).
type 2 diabetes. JR's Since his entry A1C is >7.5%, dual therapy is
blood pressure was indicated. There are several potential choices. The
150/92 mm Hg. His second step can be a dipeptidyl peptidase-4
laboratory results inhibitor, it can be a glucagon-like peptide-1 (GLP-1)
revealed an A1C of 8.1%, receptor agonist, it can be a TZD, it can be a
normal cholesterol panel, sulfonylurea agent, it can be a SGLT2 inhibitor, or it
and normal renal/hepatic could be basal insulin. Anything next can be tried
function were noted with depending on what suits the circumstance
today's laboratory test DPP4 inhibitors are weight neutral bet relatively
results. benign side effect profile. Sitagliptin has been
Past medical history: associated with case reports of pancreatitis, so this
Hypertension (diagnosed specific agent should be avoided. $$$
4 y ago) Hyperlipidemia GLP-1 analog and has data to support an A1C
(diagnosed 2 y ago) reduction necessary to gain glycemic control and
Pancreatitis (idiopathic) may assist with weight loss goals for this patient.
(acute hospitalization 3 y New information suggests these agents may
ago) provide benefits in those with ASCVD. JR has a past
Family history: Type 2 history of pancreatitis and GLP-1 analogs are not
diabetes recommended due to this contraindication
Medication: HCTZ 25 mg TZDs have data to support an A1C reduction
daily, simvastatin 10 mg necessary to gain glycemic control, but are
daily associated with weight gain, negative effects on
Allergies: SMZ/TMP lipids and increased risk of fracture. Until recently,
Vitals: BP: 150/92 mm Hg TZDs have also been linked to increased CV events
P: 78 beats/min RR: 12 and use has fallen out of favor
rpm Waist Circumference: Sulfonylureas provide excellent A1C lowering, but
46 in Weight: 267 lb are also associated with weight gain. They also have
Height: 5 ′ 6 ″ BMI: 43.1 the potential to cause hypoglycemia, so patient
kg/m 2 education is crucial. Because of his allergies to
"sulfa", use would be contr
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller CodedNurse. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.99. You're not tied to anything after your purchase.
