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A 48-year-old woman with type II diabetes mellitus is having her insulin dosing adjusted by her primary care physician. She takes a combination of NPH and regular insulin twice daily, once in the morning and once in the evening. She measures her blood glucose levels before each dosing. Two months ago, at her most recent visit, it was noted that her morning blood glucose levels were consistently around 220, and her physician prescribed an increase in her evening NPH insulin dose. Since making that change, the patient has noticed that her morning blood glucose levels have been around 320. Which of the following adjustments would be most appropriate in this patient?
Decrease in evening NPH insulin dose

A 48-year-old female with a history of hypertension is admitted with a diagnosis of hyperthyroidism. Her treatment includes a thioamine drug that has to be administered several times daily. The major mechanism of action of this drug is
blockade of iodination and coupling of tyrosines in thyroglobulin to form thyroid hormones.

A 64-year-old woman with a history of hypertension, adult-onset diabetes mellitus, and chronic low back pain presents to the emergency department feeling weak, with fevers and increased urinary frequency. Her temperature is 101.7°F, blood pressure is 83/42, heart rate is 117, and respiratory rate is 40. Urine dipstick is positive for nitrites and leukocytes, and arterial blood gas analysis reveals a pH of 7.28, pCO2 of 22, and pO2 of 70. Blood cultures are drawn, a urine culture is sent, and the woman is admitted to the hospital with the diagnosis of presumed urosepsis. Which of the following medications is most likely to be contributing to her acid-base abnormality?
Metformin

A 42-year-old female is diagnosed with diabetes mellitus type 2. Her physician advises her about the benefits of weight reduction and exercise. In an attempt to reduce her HbA1C level from 9.6% to normal (<6%), he prescribes glimepiride. The effects of glimepiride on fasting blood glucose, plasma insulin, and long-term body weight are described best as
fasting blood glucose lowered, plasma insulin elevated, and long-term body weight slightly increased

A 56-year-old man is diagnosed with diabetes mellitus by his primary care physician after workup of an elevated blood sugar on routine laboratory testing. The patient has no history of renal insufficiency, liver dysfunction, cardiorespiratory disease, or alcohol abuse, and the physician decides to initiate therapy with metformin. Which of the following is the most common adverse reaction to metformin therapy?
Gastrointestinal symptoms

RJ has had type 2 diabetes for 10 years. His other medical problems include dyslipidemia, HTN, and retinopathy. He takes benazepril, simvastatin, and metformin. His BP is 120/70 mm Hg; LDL cholesterol 137 mg/dL; HgbA1c 7.8%. He had a dilated retinal eye exam 1.5 years ago. He has not had a pneumococcal vaccination and has never brought a urine sample into the lab. Which of the standards of care is in compliance according to the ADA guidelines?
Blood pressure

A 34-year-old previously healthy male repeatedly presents to the emergency department with unexplained episodes of hypoglycemia. Eventually, lab tests and scans are initiated in search for an insulinoma. The use of diazoxide is discussed to temporarily limit insulin release from pancreatic beta cells. The primary site of action of diazoxide in the figure of a pancreatic beta cell is
site D.

A 56-year-old man with adult-onset diabetes mellitus sees his primary care physician for a routine visit. Over the last few years, the patient’s blood glucose levels have been well controlled with sulfonylurea therapy. Early on in the course of treatment, the patient presented to the emergency department with an episode of hypoglycemia, but he has had no further episodes since then. The physician notes from the patient’s finger stick log that his blood glucose levels have been trending upwards over the last 6 months since his last visit, and his hemoglobin A1C is 8.2. The physician decides to add a thiazolidinedione to the patient’s regimen. What is the most worrisome side effect of thiazolidinediones?
Liver dysfunction

A 42-year-old obese male with type 2 diabetes is treated with an oral antidiabetic drug that lowers fasting blood glucose levels, increases plasma insulin levels, and promotes a moderate long-term increase in body weight. This drug is most likely to be
glimepiride

A 63-year-old woman with a history of type II diabetes mellitus and hypertension visits her primary care physician for a routine follow-up appointment. The patient’s blood glucose levels have been well controlled with glipizide over the last 15 years. Her hypertension has been more difficult to control, and her creatinine has been slowly rising. Her physician believes she is slowly progressing towards chronic renal failure because of her hypertension. In addition to modifying her antihypertensive regimen, the physician wants to change the patient’s oral hypoglycemic agent because of her declining renal function. Which of the following would be most appropriate as an oral hypoglycemic agent?
Change to repaglinide

A 32-year-old man with a history of obesity, hypertension, diabetes mellitus, depression, and back pain presents to his primary care physician because he and his wife are having difficulty conceiving a child. The patient describes a diminished libido and difficulty maintaining erections. His current medical regimen consists of lisinopril, hydrochlorothiazide, metformin, sertraline, and naproxen. He has been compliant with his medications, and over the last 2 years his blood pressure, blood sugars, back pain, and depression have all been well controlled. Laboratory testing demonstrates normal kidney function, normal liver function, normal thyroid function, and a serum prolactin of 330 ng/mL. Which of the patient’s medications is most likely to be the cause of his symptoms?
Sertraline

AK is a 55-year-old man diagnosed with diabetes 2 years ago. He has been following a diet and exercise program, but his HgbA1c is now 8.5%. BMI 20.2. Labs: Cr 1.6 mg/dL; LFTs WNL. Which of the following oral agents is most appropriate to initiate in this patient to obtain an HgbA1c of less than 7%?
Glipizide

A 54 year-old comes into the emergency department complaining of fatigue. He is breathing at 30 breaths per minute and says he is getting tired. An ABG and SMA-7 are done and show the following results:

ABG
pH 7.30
pCO2 34 mm Hg
pO2 99 mm Hg
HCO3 16 mEq/L
O2 sat 99%

SMA-7
Na 139 mEq/L
K 4.9 mEq/L
Cl 100 mEq/L
HCO3 16 mEq/L
BUN 22 mg/dL
Cr 1.4 mg/dL
Glucose 146 mg/dL

When asked about past medical history, the patient states he was diagnosed with type II diabetes mellitus six years ago. He has been taking medicine for it, but doesn’t know which one. Which medication is this patient most likely taking?

Metformin

A 40-year-old obese male with acanthosis nigricans and recurrent candidal infections of his axillary and groin regions has recently been diagnosed with type II diabetes mellitus. In treating this man, you want to take advantage of his endogenous insulin supply. Which of the following medication’s mechanism of action is to stimulate the production of insulin in the pancreas?
Glyburide

A 45-year-old male is being treated with a combination of drugs for diabetes type 2. His metabolic parameters are difficult to control. The drug in this patient’s treatment regimen that activates a tyrosine kinase as part of its mechanism of action is
insulin lispro

The ability to reduce insulin resistance is associated with which one of the following classes of hypoglycemic agents?
Thiazolidinediones.

In preparation for surgical removal of a goiter, a patient receives large doses of inorganic iodide. The purpose of this medication is to
reduce the size and vascularity of the thyroid gland.

The mechanism of action and profile of adverse effects of repaglinide most closely resemble the mechanism of action and profile of adverse effects of glimepiride. Sulfonylureas like glimepiride and meglitinides like repaglinide stimulate insulin by inhibiting a beta-cell potassium channel. Clinically, the profile of their adverse effects – namely, the risk of hypoglycemia – is also comparable.
exenatide

A 62-year-old male alcoholic being treated for non-insulin-dependent diabetes mellitus comes to the emergency department with a 1-hour history of nausea, vomiting, headache, hypotension, and profuse sweating. What is the most likely causative agent?
Chlorpropamide

A 42-year-old man with a history of type I diabetes mellitus is seen by his primary care physician 2 weeks after a routine visit for abnormal labs drawn at the patient’s visit. The patient is currently treated with a combination of NPH and regular insulin dosed twice daily. The patient’s creatinine had risen from 1.1 to 1.5, and his hemoglobin A1C was 8.1. The physician is worried about the possibility of diabetic nephropathy and recommends tight blood sugar control with daily ultralente insulin and three preprandial doses of regular insulin. What is one of the disadvantages to this latter approach?
Inconvenient number of injections

A 45-year-old female patient has fasting glucose levels of 147 mg/dL, and with a glucose tolerance test, you have confirmed the diagnosis of type II diabetes. You begin therapy with metformin, but her fasting glucose levels remain above 100 mg/dL. You elect to change her therapy to glyburide. This drug acts to
Increase insulin secretion

A woman takes an orally administered drug 30 min before each meal and must eat at that time to prevent hypoglycemia. Which mechanism is responsible for the therapeutic effect of this drug?
closing of potassium channels

At mealtimes, a patient with type 1 diabetes injects both insulin and a drug that slows gastric emptying. Which adverse effect may result form this drug?
nausea and anorexia

A woman takes an agent that activates PPAR-Y. which effect is produced by this drug?
insertion of glucose transporters in adipose tissue

An individual with diabetes injects an preparation that forms microprecipitates in subcutaneous tissue. Which structural modification is found in this insulin analogue?
addition of two arginine residues

A woman is placed on drug that increases insulin sensitivity and typically results in a loss of body weight. which adverse effect commonly results from taking this medication?
diarrhea

A man is given a drug to reduce thyroid gland size and vascularity before surgical thyroidectomy. which mechanism is responsible for its use in this setting?
Inhibition of thyroid hormone release

A woman with weight loss, nervousness, heat intolerance, and exophthalmos receives a drug that may induce a remission in her disease. Which serious adverse effect has been associated with this medication?
agranulocytosis

After total tyroidectomy, a woman is placed on a drug whose oral bioavailability is about 80%. which attribute is correctly associated with this drug?
partly converted to T3 in the body

After exposure to radioactive fallout containing 131I, which agent could be administered to prevent destruction of thyroid tissue?
potassium iodide

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy diabete mellitus diabetes caused by a relative or absolute deficiency of insulin and characterized by polyuria hyperglycemia abnormally high …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy A client is to receive glargine (Lantus) insulin in addition to a dose of aspart (NovoLog). When the nurse …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy What is the cause of type 1 diabetes? Autoimmune process–>beta cell destruction What is the drug therapy for type …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Your patient has been switched from valproic acid (Depakote) to gabepentin (Neurontin). Which of the following is a false …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Diabetes mellitus is a chronic metabolic disorder that presents with hyperglycemic blood sugar levels that persist more than normal. …

We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy Type 1 diabetes is also called Insulin -dependent or Juvenile The alpha cells of the pancreas secrete Glucagon WE …

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