NURS 676 Week 6 Quiz - Questions With Detailed

NURS 676 Week 6 Quiz - Questions With Detailed Solutions Benefits of transdermal estrogen Right Ans - • total dose of estrogen is greatly reduced (because the liver is bypassed).• Less N/V • Blood levels of estrogen fluctuate less • lower risk for DVT, pulmonary embolism, and stroke Type 1 diabetes diagnosis Right Ans - -fasting plasma glucose >/= 126 mg/dL -random plasma glucose >/= 200mg/dL PLUS symptoms

- Oral glucose tolerance test (OGTT): 2-h plasma glucose >/= 200mg/dL

-hemoglobin A1C 6.5 or higher Which cells produce insulin Right Ans - Beta cells of the islets of Langerhans in pancreas Type 1 diabetes management Right Ans - 1. diet

• self-monitoring of blood glucose (SMBG)
• Physical activity
• Insulin replacement

What is given to manage hypertension in diabetics Right Ans - ACEIs or ARBs -reduces risk for diabetic nephropathy what is given to manage dyslipidemia in diabetics Right Ans - Statins Type 1 diabetes complications Right Ans - Diabetic Ketoacidosis (DKA) heart disease, renal failure, blindness, neuropathy, amputations, impotence, stroke Diabetic Ketoacidosis (DKA) pathophysiology Right Ans - when insulin is not present to move glucose into cells for energy, the body begins to metabolize fat; fatty acid metabolism results in the formation of ketone 1 / 3

bodies; ketone bodies are acidic and produce metabolic acidosis, diuresis, and electrolyte loss Type 2 diabetes management Right Ans - 1. lifestyle changes PLUS metformin

• add a second drug (thiazolidinedione, DPP-4 inhibitor, SGLT-2 inhibitor, or

GLP-1 receptor agonist

• 3 drug combo
• Insulin & GLP-1 receptor agonist

Metformin Right Ans - Biguanide

MOA:

• inhibits glucose production in liver
• reduces glucose absorption in the gut
• sensitizes insulin receptors in target tissues--increases glucose uptake

NOT METABOLIZED

SE: GI, lactic acidosis

-Type II, prevention, PCOS, Gestational Meglitinides (Glinides) Right Ans - -stimulate pancreatic insulin release -shorter acting than sulfonylureas and are taken w/ each meal repaglinide and nateglinide Thiazolidinediones (TZDs) Right Ans - Glitazones

MOA:

-decrease insulin resistance, increasing glucose uptake by muscle and fat -decrease glucose production by liver

SE: hypoglycemia when there is excessive insulin, HF, bladder cancer,

fractures in women, ovulation Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Right Ans - Gliptins 2 / 3

• enhance actions of incretin hormones to stimulate glucose-dependent insulin

and suppress glucagon release by inhibiting DPP-4 -DPP-4 is an enzyme that inactivates incretin hormones

AE: hypoglycemia and pancreatitis

Incretin Hormones (GIP and GLP-1) Right Ans - (1) stimulate glucose- dependent release of insulin (2) suppress postprandial release of glucagon Glucagon Right Ans - increases glucose production in the liver sodium-glucose cotransporter 2 (SGLT-2) inhibitor Right Ans - "-gliflozin" SGLT-2 accounts for 90% of glucose reabsorption in the kidney blocks reabsorption of filtered glucose, increasing urinary excretion of glucose

AE: hypoglycemia, UTI, vulvovaginal infection, dehydration

glucagon-like peptide-1 (GLP-1) receptor agonist Right Ans - incretin mimetics -slow gastric emptying -stimulate glucose-dependent release o insulin -inhibit postprandial release of glucagon -suppress appetite

AE: hypoglycemia, renal impairment, fetal harm, pancreatitis

Sulfonylureas Right Ans - glipizide, glyburide, glimepiride -stimulate release of insulin from pancreatic islet >> bind with/block ATP-sensitive potassium channels in cell membrane, which causes influx of calcium, leading to insulin release

AE: hypoglycemia

C-peptide Right Ans - Product of proinsulin cleavage indicates pancreas is still making some insulin

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