Question 1

A patient who had been taking the oral antidiabetic agents glyburide and metformin is now prescribed only Glucovance.The patient asks why only one drug is needed.What is your best response?

Accepted Answer

Glucovance is composed of glyburide and metformin in commonly used dosages to increase the convenience of antidiabetic therapy with both drugs.

Question 2

How does acarbose (Precose)prevent blood glucose levels from rising too high?

Accepted Answer

Acarbose is an alpha-glucosidase inhibitor.Drugs from this class work by slowing the digestion of dietary starches and other carbohydrates by inhibiting an enzyme that breaks them down into glucose.The result of this action is that blood glucose does not rise as far or as fast after a meal.

Question 3

A patient who has been prescribed sitagliptin (Januvia)calls the clinic and reports swelling of the face,lips,and tongue.What is your best response?

Accepted Answer

The patient has symptoms of angioedema,an allergic reaction to the drug.The swelling can continue and eventually block the patient's airway.This is an emergency situation and the patient needs immediate attention.Once this reaction occurs with a drug,the patient should not take the drug or any other drug from the same class again.

Question 4

Which blood laboratory test result is most important to check before administering the first prescribed dose of miglitol (Glyset)to a patient?

Accepted Answer

Miglitol is an alpha-glucosidase inhibitor.Drugs from this class can cause liver impairment.They should not be prescribed for anyone who already had a change in liver function.A common test of liver function is blood levels of lactate dehydrogenase.Normal lactate dehydrogenase levels range between 115 and 225 IU/L.

Question 5

Which fasting blood glucose level indicates that the antidiabetic drug prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?

Accepted Answer

The most common target range of fasting blood glucose levels for a patient with type 2 diabetes is 70 to 110 mg/dL.The 40 mg level represents hypoglycemia,which is not the intention of therapy and can cause neurologic problems.Levels of 120 and 160 are considered hyperglycemia.

Question 6

A patient who has been prescribed exenatide (Byetta)reports a weight loss of 11 lb in the last month.What is your best action?

Accepted Answer

The actions of exenatide include reducing the sensation of hunger and slowing the rate that food leaves the stomach.Both of these actions help the patient eat less and lose weight,a desired outcome for patients with type 2 diabetes.An 11 lb weight loss in 1 month is not excessive and no action needs to be taken at this time.

Question 7

Which assessment precaution is most important to teach a patient who is prescribed pioglitazone (Actos)as his or her only antidiabetic drug?

Accepted Answer

Pioglitazone is a drug from the thiazolidinedione class.Drugs from this class are associated with heart failure.An early symptom of heart failure is fluid retention leading to weight gain.A weight gain of more than 3 lb in 1 week is an indication of fluid retention.

Question 8

A patient who usually takes metformin (Glucophage)was switched to insulin immediately following an angiogram.Which patient finding indicates it is safe for the patient to switch back to metformin?

Accepted Answer

Metformin can cause renal impairment when the patient is also exposed to radio-opaque dyes and some anesthetic agents.This can happen up to 48 hours after the exposure.The drug can be restarted after 48 hours if the kidney function,as measured by an adequate urine output,is normal.

Question 9

When teaching a patient newly diagnosed with type 2 diabetes who is prescribed to take miglitol (Glyset)as antidiabetic therapy,which instruction is most important?

Accepted Answer

Miglitol is an oral antidiabetic drug from the alpha-glucosidase inhibitor class.Its action is to slow the digestion of starches and other carbohydrates in the intestinal tract.In order to be effective,it must be taken at the beginning of a meal.

Question 10

A patient with type 2 diabetes and heart failure who is prescribed metformin extended release (Glucophage XR)once daily now has muscle aches,drowsiness,low blood pressure,and a slow irregular heartbeat.What is your best action?

Accepted Answer

The muscle aches,drowsiness,low blood pressure,and a slow irregular heartbeat are symptoms of lactic acidosis,an adverse reaction to metformin.The drug should be stopped and the prescriber notified so that steps can be taken to reduce the acidosis.

Question 11

A patient is to receive 15 units of NPH insulin and 20 units of regular insulin in the same syringe.In what order should you perform the steps to prepare this injection?
a.Make sure the syringe is free from air bubbles.
b.Check the syringe for a volume of insulin that is 35 units.
c.Clean the rubber stoppers of each bottle with separate alcohol swabs.
d.Check to make sure the concentration and types of insulin are correct.
e.Draw up 20 units of air and inject it into the regular insulin (short-acting insulin)bottle with the bottle in its normal,upright position.
f.Draw up 15 units of air and inject it into the NPH bottle with the bottle in its normal,upright position.
g.Place the same needle with the syringe attached into the NPH bottle,invert the bottle,and withdraw 15 units of NPH insulin into the same syringe with the regular insulin.
h.Without removing the needle,turn the bottle upside down and withdraw 20 units of regular insulin,then withdraw the needle from the bottle.

Accepted Answer

The answer of A patient is to receive 15 units...

Question 12

By which action do the sodium-glucose cotransport inhibitors lower blood glucose levels?

Accepted Answer

The sodium-glucose cotransport inhibitors inhibit the reabsorption of filtered glucose in the kidney so that more is removed from the body in the urine.It has no action on liver glucose or glycogen,and does not increase insulin receptor sensitivity.

Question 13

A patient who has been taking metformin (Glucophage)for a year is seen in the clinic and has all of the following laboratory results.Which result do you report to the prescriber immediately?

Accepted Answer

BUN levels are one measure of kidney health.The normal range is 10 to 20 mg/dL.An elevated BUN may indicate kidney problems or dehydration.Metformin can cause kidney problems,and the risk for lactic acidosis is increased in any patient taking metformin who has impairment of kidney function.The prescriber must be aware of the situation and explore the possibility of kidney impairment further.The drug may need to be changed to a different class of antidiabetic drug.

Question 14

Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?

Accepted Answer

Oral antidiabetic drugs are not insulin.Most just help the patient use his or her naturally produced insulin more efficiently,although some drugs also prevent glucose from entering the blood too quickly.

Question 15

A patient who is prescribed glyburide (DiaBeta)asks if having a glass of wine once a week is okay.What is your best response?

Accepted Answer

Under normal circumstances,blood glucose levels will not be affected by moderate use of alcohol when diabetes is well controlled.When using insulin,two alcoholic beverages for men and one for women can be ingested in addition to the normal meal plan.Because alcohol can induce hypoglycemia,it should be ingested with or shortly after a meal.Although alcohol can lead to or worsen liver problems and should not be taken with drugs that affect the liver,glyburide does not appear to cause liver problems.

Question 16

What precaution do you teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?

Accepted Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs)potentiate the hypoglycemic effects of sulfonylurea agents.Patients should avoid these drugs altogether or use them with great caution.

Question 17

A patient is prescribed repaglinide (Prandin)3 mg.The drug available is repaglinide 0.5 mg/tablet.How many tablets do you administer to the patient for a correct dose?
_____ tablet(s)

Accepted Answer

The answer of A patient is prescribed repaglinide (Prandin)3 mg.The...

Question 18

A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia)has all the following health problems.For which problem do you check with the prescriber to make certain rosiglitazone is an appropriate drug choice?

Accepted Answer

Rosiglitazone carries a black box warning because it can cause heart failure in some patients.Patients most at risk are those who have had a previous myocardial infarction.Although heart failure can worsen asthma,it is not worsened by rosiglitazone,nor does the drug cause hypertension or glaucoma.

Question 19

A patient with type 2 diabetes is prescribed nateglinide (Starlix).Which statement indicates that the patient has a correct understanding of this therapy?

Accepted Answer

Nateglinide causes beta cells of the pancreas to undergo depolarization and release a small amount of preformed insulin.The peak action occurs in about 20 minutes after ingestion.To have the best action and prevent hypoglycemia,patients are instructed to take the drug within 15 minutes before eating.

Question 20

Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?

Accepted Answer

None of the oral antidiabetic drugs should be used by breastfeeding women because they enter the breast milk and induce side effects in the infant.Those drugs that cause hypoglycemia,such as the sulfonylureas,are especially dangerous to the infant and can lead to permanent brain damage.

Quiz 13: Drug Therapy for Diabetes

A patient who had been taking the oral antidiabetic agents glyburide and metformin is now prescribed only Glucovance.The patient asks why only one drug is needed.What is your best response?

How does acarbose (Precose) prevent blood glucose levels from rising too high?

A patient who has been prescribed sitagliptin (Januvia) calls the clinic and reports swelling of the face,lips,and tongue.What is your best response?

Which blood laboratory test result is most important to check before administering the first prescribed dose of miglitol (Glyset) to a patient?

Which fasting blood glucose level indicates that the antidiabetic drug prescribed for a patient with type 2 diabetes is effective at maintaining target blood glucose levels?

A patient who has been prescribed exenatide (Byetta) reports a weight loss of 11 lb in the last month.What is your best action?

Which assessment precaution is most important to teach a patient who is prescribed pioglitazone (Actos) as his or her only antidiabetic drug?

A patient who usually takes metformin (Glucophage) was switched to insulin immediately following an angiogram.Which patient finding indicates it is safe for the patient to switch back to metformin?

When teaching a patient newly diagnosed with type 2 diabetes who is prescribed to take miglitol (Glyset) as antidiabetic therapy,which instruction is most important?

A patient with type 2 diabetes and heart failure who is prescribed metformin extended release (Glucophage XR) once daily now has muscle aches,drowsiness,low blood pressure,and a slow irregular heartbeat.What is your best action?

By which action do the sodium-glucose cotransport inhibitors lower blood glucose levels?

A patient who has been taking metformin (Glucophage) for a year is seen in the clinic and has all of the following laboratory results.Which result do you report to the prescriber immediately?

Why are oral antidiabetic drugs not effective in the management of type 1 diabetes?

A patient who is prescribed glyburide (DiaBeta) asks if having a glass of wine once a week is okay.What is your best response?

What precaution do you teach a patient who is prescribed to take an oral sulfonylurea agent to maintain control of blood glucose levels?

A patient is prescribed repaglinide (Prandin)3 mg.The drug available is repaglinide 0.5 mg/tablet.How many tablets do you administer to the patient for a correct dose? _____ tablet(s)

A patient newly diagnosed with type 2 diabetes who is prescribed rosiglitazone (Avandia) has all the following health problems.For which problem do you check with the prescriber to make certain rosiglitazone is an appropriate drug choice?

A patient with type 2 diabetes is prescribed nateglinide (Starlix) .Which statement indicates that the patient has a correct understanding of this therapy?

Why are sulfonylurea oral antidiabetic drugs not recommended for women who are breastfeeding?