NR565 Final Exam 2 Versions: Diabetes, Thyroid, GERD, and More, Exams of Nursing

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NR565 / NR 565 Final Exam 2 VERSIONS QUESTIONS

WITH DETAILED ANSWERS

what 3 test confirm diabetes diagnosis A1C ≥ 6.5% Fasting Plasma Glucose (FPG) ≥ 126 mg/dL Oral Glucose Tolerance Test (OGTT) ≥ 200 mg/dLA1C when should insulin be considered when A1C is >10% or if there are symptoms of hyperglycemia at what time interval should glucose labs be rechecked every 3 months until goal is met and then every 6 months how do you prevent diabetic nephropathy Medications: ACE inhibitors or ARBs (renin-angiotensin system blockers). Glycemic Control: Maintain HbA1c targets. Blood Pressure Control: Goal of <140/90 mm Hg. what is the action in insulin Lowers blood glucose by facilitating cellular uptake of glucose into cells and managing the bodys metabolism of fats, proteins and carbs. pioglitazone is used to treat diabetes what are the contraindications of pioglitazone heart failure active bladder cancer liver disease which diabetic drug has a chance of causing pancereatitis DPP what are the adverse effects of Pioglitazone

Weight gain. Edema risk of heart failure. Increased risk of fractures. Bladder cancer risk. what is the MOA of Pioglitzaone Increases insulin sensitivity by activating PPAR-γ receptors in adipose tissue, muscle, and liver. drug class abbreviation of GLP- 1 (exendatide /byetta) Glucagon-like Peptide-1 Agonists. drug class abbreviation TZD Thiazolidinedione's drug class abbreviation of DPP-4i (januiva) Dipeptidyl Peptidase-4 Inhibitors. Drug class abbreviation of SGLT2i Sodium-Glucose Co-Transporter 2 Inhibitors. what drug class is considered before insulin biguanaide (metformin) what is the MOA of metformin Reduces hepatic glucose production. Enhances insulin sensitivity in muscle and fat tissue. what category is metformin category B so it is considered safe what are the side effects of metformin

helps with weight loss which diabetic medication comes with a concern of hypoglycemia Sulfonylureas Meglitinides Insulin. what 3 labs are used for diagnosing thyroid dx TSH Free T Total 3 what is the time frame for rechecking labs after starting synthroid 6 - 8 weeks after initiation or dose adjustment signs and symptoms of hypothyroidism Fatigue, weight gain, cold intolerance, dry skin, hair loss, constipation. signs sand symptoms of hyperthyroidism Weight loss heat intolerance anxiety tremors palpitations increased appetite. what medication treats thyroid storm beta blockers anti thyroid drugs(methimazole & PTU) corticosteroids fluids what is the first line treatment for hyperthyroidism

Methimazole what happens when hypothyroidism is not treated during pregnancy increased risk of miscarriage pre term birth developmental delays in child what medication is used for treating hyperthyroid symptoms beta blocks; propranolol for tachycardia & tremors what food/drugs interact with synthroid Calcium and iron supplements (reduce absorption). Soy products (may interfere with absorption). Antacids & ppi (containing aluminum or magnesium). coumadin & cathecholmines what thyroid medication can be taken in the 1st trimester of pregnancy PTU (Propylthiouracil) what thyroid treatment can be taken in 2nd & 3rd trimester of pregnancy methimazole what is a common side effect that warrants discontinuation of thyroid drug agranulocytosis what drug is used to treat hypothyroidism in infants & why is it important to treat it Synthroid- its important to treat early to prevent cognitive impairment how is synthroid administered its an oral drug that is taken on an empty stomach 30 - 60 mins before breakfast what are the adverse effects of synthroid tachycardia, weight loss & anxiety what lab is monitored when taking levothyroxine & how often TSH level should be checked every 6-8 weeks when initiating or adjust dose and then done annually what is the MOA of Methimazole Inhibits thyroid hormone synthesis by blocking the oxidation of iodine.

when treating GERD in older adults what medication should be avoided due to risk of fractures and infections PPI how do you treat GERD in pregnancy antacids sucralfate h2 blockers which cryoprotective agent would be used when treating GERD in pregnancy sucralfate when do you test for H pylori active peptic ulcer disease how do you treat h pylori what are some lifestyle modifications when treating PUD to support ulcer healing Avoid NSAIDs, alcohol, and smoking; eat smaller meals. what anti diarrheal is contrinidicated in children during or after chickenpox pepto/ bismuth due to risk of reye's syndrome what anti diarrheal is associated with gray/black stools & black tongue bismuth sabalicyate what is a prefered stool softner in pregnancy docusate or senna how does psyllium work what what should be assesed if a bowel movment is not produced Works by adding bulk; assess if bowel movement isn’t achieved after 2-3 days. what is gastroparaesis delayed gastric emptying how do you treat gastroparesis Metoclopramide what is the black box warning for metocloprimide

tardive dyskinsia what patient teaching is needed when taking metronidazole Avoid alcohol; potential for disulfiram-like reaction. (n/v HA and flushing) metallic taste in mouth darkened urine - harmless report numbness and tingling or seizures. symptoms of liver failure. avoid in pregnancy what is an example of GLP 1 incretin mimetic Exendatide (byetta) what medication prevents postprandial glucagon release and suppressed appetite GLP 1 (exendatie) GLP 1 ending tide what medication stimulates insulin release from pancreatic beta cella sulfonuryea what Tb medication requires Visual monitoring ethambutol what Tb medication has an adverse effect of turning bodily fluids like urine orange rifampin what Tb medication is used to treat a patient who has HIV riFABUTIN what is the first line treatment for active TB Pyrazinamide what medication is used for chronic idiopathic constipation, IBS, or opoid induced constipation lubiprostone what medication is used as lung term for IBD

liver function suicidal thoughts adverse effects of amnioglucosides nephrotoxicity & ototoxicity adverse effects of pyrazinamide hepatotxicity and gout what does infliximab treat moderate to sever chronic disease and ulcerative colitis what anticholinergic medication prevents and treats motion sickness by blocking Histamine 1 dimenhydrinate what medication is used for nausea and vomiting associated with chemotherapy and aids related anorexia cannabinoid what is an example of 5HT odansetron what is black cohosh used for symptoms of menopause what does euchina interact with immunosuppresive drugs Euchina is recommended for short term use such as at the onset of cold symptoms when taking EUCHINA be aware of ________ allergic reactions what is butterbur used for migraine prevention & allergic rhinitis what is the active ingredient in feverfew PARTHENOLIDE what does feverfew treat inflammation & migraine prevention

contrindications of feverfew pregnancy because it induces uterine contractions anticoagulants MOA of flaxseed Increases stool bulk. it contains fiber and omega 3 fatty acids that help improve heart health and reduce cholesterol levels MOA of ginger root prevents PROSTAGLANDINS & LEUKOTRINE SYNTHESIS which reduces inflammation & nausea side effects of kava liver toxicity CNS depression skin effects psychological effects what does kava treat anxiety what is peppermint used for GI relief & colds pro biotics side effects bloating & infection what products are resveratrol found in & why is it beneficial wine grapes blueberries peanuts dark chocolate that is why these have cardioprotective effects MOA of resveratrol acts as POLYPHENOL ANTIOXIDANT Which helps reduce stress & inflammation soy indication

act on the loop of henle in the kidneys to prevent reabsorption of SODIUM & CHLORIDE How is arterial BP regulated sympathetic nervous system increases the HR and vasoconstriction. RAAS system Baroreceptors detect changes in BP what does alendronate treat osteoporosis what does Raloxifine treat osteoporosis what is the 1 step therapy in treating asthma/COPD as needed SABA ( short acting beta agonist) asthma symptoms that are mild persistent last symptoms last >2 days/week but not daily asthma symptoms that are moderate persistent daily symptoms which affects activities asthma symptoms that are severe persistant Symptoms throughout the day frequent nighttime symptoms examples of SABA Drugs albuterol and levalbuterol examples of LABA Salmetrol & formoterol examples of inhaled corticosteroids fluticasone and budesonide what class of drug is used as needed SABA what are the benefits of SABA Rapid relief of bronchospasm in asthma and copd. what are the patients instruction when using SABA

use before exercise not more then every 4-6 hours what does it mean if a patient is using SABA more frequently Indicates poor control of asthma; may need a step-up in therapy. Using > times/week indicates poorly controlled asthma what are the benefits of LABA Long-term control of symptoms. preferred for pts with COPD. Prevents exercise induced bronchospasm what is the use for LABA in COPD helps with night time symptoms and improves lung function is theophylline recommended for COPD no what are the benefits of inhaled corticosteroids reduces inflammation & prevents exacerbations when are oral steroids indication prescribed for severe exacerbations of asthma & COPD when would Roflumilast be indicated for a COPD patient for severe COPD with chronic bronchitis & history of exacerbations what constitutes as drug resistant TB resistance to at least isoniazid or rifampin what is the recommended treatment length of Bupropion 7 - 12 weeks how do you help patients prevent TB resistance to drugs DOT program (directly observed therapy) how do you treat a pregnant women with TB isoniazid, rifampin, & ethambutol ( avoid streptomycin) TB treatment prophylaxis which drug class has no significant drug interactions anti histamines. (first generation may have sedative effects) what are examples of h2 Receptor antagonist

Metformin black box warning - ANSWER--lactic acidosis increased

with CKD, liver disease, severe infection, excessive alcohol intake,

shock, or hypoexmia

Biguanides (Metformin) Uses - ANSWER-Glycemic control

DM2 prevention

Gestational Diabetes

Polycystic Ovarian Syndrome (by lowering androgen levels)

Metformin side effects - ANSWER-Anorexia, GI upset, nausea,

diarrhea, B12 (peripheral neuropathy)/Folate deficiency (impair

CNS development in fetuses)

Which drug inhibits glucose production in the liver, reduces

glucose absorbtion in the gut and sensitizes insulin receptors to

increase glucose reuptake - ANSWER-Metformin

Metformin dosage - ANSWER-gi side effects lead to discontinuation

of treatment

500mg lowest dose daily, then 500 BID. Max dose 2000mg.

Safe for use during pregnancy

Metformin Therapy weight - ANSWER-does not cause weight gain.

appetite suppression. In presence and absence of nausea.

sulfon - ANSWER-glipizide, glyburide, glimepiride

sulfonyureas - ANSWER-MOA - stimulates release of insulin from

pancreas, long-term enhances insulin sensitivity. (pancreatic islet)

Contraindicated Sulfonyurea - ANSWER-pregnancy, lactating,

kidney, liver issues (causes compound effect)

glinides - ANSWER-action similar to sulfonylureas, increase insulin

secretion from the pancreas (shorter acting than sulfonylureas)

patients who are not responsive to glinides then also not

responsive to sulfonyurea

TZD educatoin - ANSWER-s/s heart failure or hypoglycemia

Negative feedback system in hypothyroidism - ANSWER-Production

of T3 and T3 by the hypothalamus and pituitary gland

TRH - ANSWER-from the hypothalamus controls the release of TSH

TSH (negative feedback loop) - ANSWER-acts as the gauge for the

hypothalamus to know if it needs more or less TRH and

subsequently more or less TSH

Acute symptoms of diabetes plus casual plasma glucose

concentration greater than or equal to 200 mg/dL.

Fasting plasma glucose greater than or equal to 126 mg/d (8hrs) -

ANSWER-Diabetes Mellitis

2 hour post-load plasma glucose in an oral glucose tolerance test

greater than or equal to 200 mg/dL. The test uses a glucose load

containing the equivalent of 75 g anhydrous glucose dissolved in

water. - ANSWER-Diabetes Mellitis (glucose tolerance test)

HgB A1c > or equal to 6.5 - ANSWER-Diabetes Mellitis Labs

Pre-Diabetes Glucose tolerance test - ANSWER-Plasma glucose 140

to 199 mg/dL (IGT) 2 hours post-ingestion of standard glucose load

(75 g) or

HgB A1c 5.7-6.4 - ANSWER-Prediabetes

Diabetes Treatment Step 1 - ANSWER-Lifestyle Changes

Metformin

Diabetes Treatment Step 2 - ANSWER-Step 1 (lifestyle and

metformin)

Second Drug

Diabetes Treatment Step 3 - ANSWER-Step 1+