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Questions and Answers
A patient with a history of alcoholism and cirrhosis presents with type 2 diabetes. Which oral hypoglycemic agent is most likely contraindicated due to the risk of exacerbating liver damage?
A patient with a history of alcoholism and cirrhosis presents with type 2 diabetes. Which oral hypoglycemic agent is most likely contraindicated due to the risk of exacerbating liver damage?
- Acarbose
- Pioglitazone (correct)
- Sitagliptin
- Metformin
A patient with type 2 diabetes develops severe nausea, diarrhea, and signs of dehydration during metformin treatment. Lab results reveal elevated serum lactate levels. Which complication is most likely occurring?
A patient with type 2 diabetes develops severe nausea, diarrhea, and signs of dehydration during metformin treatment. Lab results reveal elevated serum lactate levels. Which complication is most likely occurring?
- Lactic Acidosis (correct)
- Hyperosmolar Hyperglycemic State (HHS)
- Hypoglycemia
- Diabetic Ketoacidosis (DKA)
An elderly patient with type 2 diabetes and a history of frequent falls is prescribed a sulfonylurea. What is the most concerning adverse effect to monitor for in this patient population?
An elderly patient with type 2 diabetes and a history of frequent falls is prescribed a sulfonylurea. What is the most concerning adverse effect to monitor for in this patient population?
- Gastrointestinal Upset
- Hypoglycemia (correct)
- Edema
- Weight Gain
A patient with type 2 diabetes and a history of heart failure is prescribed rosiglitazone. Which adverse effect requires immediate attention and discontinuation of the medication?
A patient with type 2 diabetes and a history of heart failure is prescribed rosiglitazone. Which adverse effect requires immediate attention and discontinuation of the medication?
A patient with type 2 diabetes is started on sitagliptin. What is the primary mechanism by which sitagliptin improves glycemic control?
A patient with type 2 diabetes is started on sitagliptin. What is the primary mechanism by which sitagliptin improves glycemic control?
A patient with type 2 diabetes is prescribed repaglinide. When should the patient be instructed to take this medication in relation to meals?
A patient with type 2 diabetes is prescribed repaglinide. When should the patient be instructed to take this medication in relation to meals?
A patient with hypothyroidism is started on levothyroxine. After several weeks, the patient reports palpitations, weight loss, and insomnia. What adjustment to the medication is most likely required?
A patient with hypothyroidism is started on levothyroxine. After several weeks, the patient reports palpitations, weight loss, and insomnia. What adjustment to the medication is most likely required?
A patient with gastroesophageal reflux disease (GERD) who has chronic kidney disease is prescribed an antacid. Which antacid component should be avoided in this patient population?
A patient with gastroesophageal reflux disease (GERD) who has chronic kidney disease is prescribed an antacid. Which antacid component should be avoided in this patient population?
A woman who is 8 weeks pregnant complains of frequent heartburn. Which medication is contraindicated during pregnancy due to its abortifacient properties?
A woman who is 8 weeks pregnant complains of frequent heartburn. Which medication is contraindicated during pregnancy due to its abortifacient properties?
A patient with a history of C. difficile infection develops GERD and is prescribed a proton pump inhibitor (PPI) for long-term management. What monitoring is most important for this patient, considering their medical history?
A patient with a history of C. difficile infection develops GERD and is prescribed a proton pump inhibitor (PPI) for long-term management. What monitoring is most important for this patient, considering their medical history?
An elderly patient with Alzheimer's disease is prescribed donepezil. What is the primary mechanism of action of this medication in managing cognitive symptoms?
An elderly patient with Alzheimer's disease is prescribed donepezil. What is the primary mechanism of action of this medication in managing cognitive symptoms?
A patient with Parkinson's disease is prescribed levodopa/carbidopa. Which of the following should the provider monitor to assess the effectiveness and potential side effects of this drug?
A patient with Parkinson's disease is prescribed levodopa/carbidopa. Which of the following should the provider monitor to assess the effectiveness and potential side effects of this drug?
A patient with Parkinson's disease develops livedo reticularis (a skin rash) while taking amantadine. What is the appropriate course of action?
A patient with Parkinson's disease develops livedo reticularis (a skin rash) while taking amantadine. What is the appropriate course of action?
A patient with moderate Alzheimer's disease is prescribed memantine. What is the primary mechanism of action of memantine in managing this condition?
A patient with moderate Alzheimer's disease is prescribed memantine. What is the primary mechanism of action of memantine in managing this condition?
A patient is started on carbamazepine for trigeminal neuralgia. What baseline laboratory test is most critical to obtain before initiating therapy?
A patient is started on carbamazepine for trigeminal neuralgia. What baseline laboratory test is most critical to obtain before initiating therapy?
A patient with epilepsy is treated with valproate. What potential adverse effect requires immediate discontinuation of the drug?
A patient with epilepsy is treated with valproate. What potential adverse effect requires immediate discontinuation of the drug?
A patient with epilepsy is prescribed phenytoin and develops gingival hyperplasia. Which intervention is most appropriate?
A patient with epilepsy is prescribed phenytoin and develops gingival hyperplasia. Which intervention is most appropriate?
A patient experiencing chronic constipation is recommended to use a bulk-forming laxative. What key instruction should the patient receive regarding its use?
A patient experiencing chronic constipation is recommended to use a bulk-forming laxative. What key instruction should the patient receive regarding its use?
A patient with an overactive bladder is started on oxybutynin. Which pre-existing condition would be a contraindication for this medication?
A patient with an overactive bladder is started on oxybutynin. Which pre-existing condition would be a contraindication for this medication?
A woman of childbearing age is prescribed ethinyl estradiol/norethindrone for contraception. Which pre-existing medical condition is an absolute contraindication to the use of this medication?
A woman of childbearing age is prescribed ethinyl estradiol/norethindrone for contraception. Which pre-existing medical condition is an absolute contraindication to the use of this medication?
A male patient is prescribed sildenafil for erectile dysfunction. Which medication is contraindicated with sildenafil due to the risk of severe hypotension?
A male patient is prescribed sildenafil for erectile dysfunction. Which medication is contraindicated with sildenafil due to the risk of severe hypotension?
A male patient is prescribed finasteride for benign prostatic hyperplasia (BPH). What key information regarding adverse effects should the patient be counseled on?
A male patient is prescribed finasteride for benign prostatic hyperplasia (BPH). What key information regarding adverse effects should the patient be counseled on?
A patient with type 2 diabetes taking metformin reports persistent abdominal discomfort. What is the most appropriate initial intervention?
A patient with type 2 diabetes taking metformin reports persistent abdominal discomfort. What is the most appropriate initial intervention?
An elderly patient with type 2 diabetes on a sulfonylurea is found unresponsive. A blood glucose check reveals a level of 40 mg/dL. What is the most appropriate immediate intervention?
An elderly patient with type 2 diabetes on a sulfonylurea is found unresponsive. A blood glucose check reveals a level of 40 mg/dL. What is the most appropriate immediate intervention?
A patient with hypothyroidism is started on levothyroxine but continues to experience symptoms despite adequate TSH suppression. What should be evaluated next?
A patient with hypothyroidism is started on levothyroxine but continues to experience symptoms despite adequate TSH suppression. What should be evaluated next?
A patient with gastroesophageal reflux disease (GERD) is prescribed omeprazole for long-term use. What potential long-term effect requires monitoring, particularly in elderly patients?
A patient with gastroesophageal reflux disease (GERD) is prescribed omeprazole for long-term use. What potential long-term effect requires monitoring, particularly in elderly patients?
An Alzheimer's patient taking donepezil experiences new-onset bradycardia. What is the most appropriate course of action?
An Alzheimer's patient taking donepezil experiences new-onset bradycardia. What is the most appropriate course of action?
A patient with Parkinson's disease develops dyskinesias while taking levodopa/carbidopa. What adjustment to the medication regimen might be considered?
A patient with Parkinson's disease develops dyskinesias while taking levodopa/carbidopa. What adjustment to the medication regimen might be considered?
A patient with epilepsy who is taking carbamazepine develops hyponatremia. What is the most appropriate course of action?
A patient with epilepsy who is taking carbamazepine develops hyponatremia. What is the most appropriate course of action?
Which medication is most likely to cause gingival hyperplasia as a significant adverse effect?
Which medication is most likely to cause gingival hyperplasia as a significant adverse effect?
A patient with constipation is recommended to use an osmotic laxative like lactulose. What is the primary mechanism of action of this type of laxative?
A patient with constipation is recommended to use an osmotic laxative like lactulose. What is the primary mechanism of action of this type of laxative?
A patient taking ethinyl estradiol/norethindrone complains of breakthrough bleeding. What should she be advised to do?
A patient taking ethinyl estradiol/norethindrone complains of breakthrough bleeding. What should she be advised to do?
A patient taking finasteride for BPH reports decreased libido and erectile dysfunction. What is the most appropriate initial step in managing this side effect?
A patient taking finasteride for BPH reports decreased libido and erectile dysfunction. What is the most appropriate initial step in managing this side effect?
A patient with type 2 diabetes is newly prescribed acarbose. What dietary instruction is most important for this patient?
A patient with type 2 diabetes is newly prescribed acarbose. What dietary instruction is most important for this patient?
A patient with type 2 diabetes asks about potential adverse effects of metformin. What symptom should the patient be told to watch for that would warrant immediate medical attention?
A patient with type 2 diabetes asks about potential adverse effects of metformin. What symptom should the patient be told to watch for that would warrant immediate medical attention?
A patient with hypothyroidism taking levothyroxine complains of palpitations. What potential drug interaction requires assessment?
A patient with hypothyroidism taking levothyroxine complains of palpitations. What potential drug interaction requires assessment?
Which medication presents the greatest risk of causing hypoglycemia when used as monotherapy?
Which medication presents the greatest risk of causing hypoglycemia when used as monotherapy?
Which of the following should be avoided in a patient with renal failure?
Which of the following should be avoided in a patient with renal failure?
A patient is taking Donepezil/Aricept. What is a serious adverse effect that requires immediate treatment?
A patient is taking Donepezil/Aricept. What is a serious adverse effect that requires immediate treatment?
Flashcards
Metformin: Mechanism of Action?
Metformin: Mechanism of Action?
Increases insulin sensitivity, reduces hepatic glucose production & increases peripheral glucose uptake.
Metformin: Primary Indication?
Metformin: Primary Indication?
Type 2 diabetes mellitus
Metformin: Contraindications?
Metformin: Contraindications?
Renal impairment, metabolic acidosis, severe infection, dehydration
Metformin: Common Adverse Effects?
Metformin: Common Adverse Effects?
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Metformin: Monitoring Parameters?
Metformin: Monitoring Parameters?
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Alpha-glucosidase Inhibitors: Action?
Alpha-glucosidase Inhibitors: Action?
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Alpha-glucosidase Inhibitors: Indication?
Alpha-glucosidase Inhibitors: Indication?
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Alpha-glucosidase Inhibitors: Avoid in?
Alpha-glucosidase Inhibitors: Avoid in?
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Alpha-glucosidase Inhibitors: Side Effects?
Alpha-glucosidase Inhibitors: Side Effects?
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Alpha-glucosidase Inhibitors: Monitor?
Alpha-glucosidase Inhibitors: Monitor?
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Sulfonylureas: Primary Action?
Sulfonylureas: Primary Action?
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Sulfonylureas: Main Indication?
Sulfonylureas: Main Indication?
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Sulfonylureas: When to Avoid?
Sulfonylureas: When to Avoid?
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Sulfonylureas: Key Adverse Effects?
Sulfonylureas: Key Adverse Effects?
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Sulfonylureas: What to Monitor?
Sulfonylureas: What to Monitor?
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Thiazolidinediones: Action?
Thiazolidinediones: Action?
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Thiazolidinediones: Indication?
Thiazolidinediones: Indication?
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Thiazolidinediones: When to Avoid?
Thiazolidinediones: When to Avoid?
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Thiazolidinediones: Side Effects?
Thiazolidinediones: Side Effects?
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Thiazolidinediones: Monitored How?
Thiazolidinediones: Monitored How?
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DPP-4 Inhibitors: Action?
DPP-4 Inhibitors: Action?
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DPP-4 Inhibitors: Indication?
DPP-4 Inhibitors: Indication?
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DPP-4 Inhibitors: Avoid When?
DPP-4 Inhibitors: Avoid When?
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DPP-4 Inhibitors: Common Side Effects?
DPP-4 Inhibitors: Common Side Effects?
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DPP-4 Inhibitors:Monitored How?
DPP-4 Inhibitors:Monitored How?
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Meglitinides- Action?
Meglitinides- Action?
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Meglitinides-Indication?
Meglitinides-Indication?
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Meglitinides-Avoid in?
Meglitinides-Avoid in?
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Meglitinides- Side effects?
Meglitinides- Side effects?
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Meglitinides-Monitor?
Meglitinides-Monitor?
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Levothyroxine: Action
Levothyroxine: Action
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Levothyroxine: Indication?
Levothyroxine: Indication?
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Levothyroxine: Avoid?
Levothyroxine: Avoid?
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Levothyroxine: Side Effects?
Levothyroxine: Side Effects?
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Levothyroxine: Monitor?
Levothyroxine: Monitor?
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Antacids: Action?
Antacids: Action?
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Antacids: Indication?
Antacids: Indication?
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Antacids: Avoid?
Antacids: Avoid?
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Antacids: Side Effects?
Antacids: Side Effects?
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Antacids: Monitor?
Antacids: Monitor?
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Study Notes
Biguanide/Metformin
- Increases insulin sensitivity
- Reduces hepatic glucose production
- Increases peripheral glucose uptake
- Indicated for Type 2 diabetes mellitus
- Should not be used in individuals with renal impairment, metabolic acidosis, severe infection, or dehydration
- Can cause gastrointestinal upset such as nausea and diarrhea
- Rare but serious adverse effect is lactic acidosis
- Monitor renal function (serum creatinine), liver function, and vitamin B12 levels
Alpha-glucosidase Inhibitors (Acarbose, Miglitol)
- Inhibits intestinal enzymes that break down complex carbohydrates into glucose
- Delays glucose absorption
- Indicated for Type 2 diabetes mellitus
- Contraindicated in inflammatory bowel disease, chronic intestinal diseases, and renal impairment
- Can cause flatulence, diarrhea, and abdominal pain
- Monitor blood glucose levels and liver function
Sulfonylureas (1st and 2nd Generation)
- Stimulates insulin release from pancreatic β-cells
- Indicated for Type 2 diabetes mellitus
- Avoid in Type 1 diabetes, diabetic ketoacidosis, and sulfa allergy
- Can cause hypoglycemia and weight gain
- Should have blood glucose levels monitored
Thiazolidinediones (Pioglitazone, Rosiglitazone)
- Increases insulin sensitivity by activating PPAR-γ receptors
- Indicated for Type 2 diabetes mellitus
- Contraindicated in heart failure and active liver disease
- Can cause edema, weight gain, risk of fractures, and heart failure
- Monitor liver function, heart function, and weight
Dipeptidyl Peptidase-4 Inhibitors (Sitagliptin, Saxagliptin)
- Inhibits DPP-4, prolonging the action of incretin hormones
- Increases insulin release
- Indicated for Type 2 diabetes mellitus
- Should not be prescribed if there is renal impairment; dose adjustment is required
- Can cause headache, upper respiratory tract infections, and, rarely, pancreatitis
- Monitor renal function
Meglitinides (Repaglinide, Nateglinide)
- Stimulates insulin release from pancreatic β-cells
- Indicated for Type 2 diabetes mellitus
- Avoid in Type 1 diabetes and diabetic ketoacidosis
- Adverse effects include hypoglycemia and weight gain
- Monitor blood glucose levels
Levothyroxine
- Synthetic form of thyroid hormone
- Replaces deficient thyroid hormone
- Indicated for hypothyroidism
- Contraindicated in hyperthyroidism and acute myocardial infarction
- Can cause palpitations, weight loss, anxiety, and insomnia (in excess)
- Monitor thyroid function (TSH, Free T4) and heart rate
Antacids (Aluminum Hydroxide, Magnesium Hydroxide, Calcium Carbonate, Sodium Bicarbonate, Magaldrate Combo)
- Neutralizes gastric acid
- Indicated for gastroesophageal reflux disease (GERD) and peptic ulcer disease
- Contraindicated in renal failure (in some cases)
- Aluminum causes constipation, magnesium causes diarrhea, and calcium causes hypercalcemia
- Monitor electrolyte levels
Misoprostol
- Prostaglandin analog
- Increases mucous production and reduces acid secretion
- Can prevent NSAID-induced gastric ulcers
- Can induce labor
- Contraindicated in pregnancy because it causes abortion
- Can cause diarrhea, abdominal cramps, and uterine rupture
- Monitor pregnancy status and GI symptoms
Omeprazole
- It is a proton pump inhibitor (PPI)
- inhibits gastric acid secretion
- Indicated for GERD and peptic ulcers
- Should not be used if there is hypersensitivity to omeprazole
- Can cause headache, diarrhea, and increases the risk of C. difficile infection with long-term use
- Monitor GI symptoms, calcium and vitamin B12 levels (with long-term use)
Donepezil/Aricept
- Is an acetylcholinesterase inhibitor
- Increases acetylcholine levels in the brain
- Indicated for Alzheimer’s disease
- Contraindicated for hypersensitivity to donepezil
- Can cause nausea, diarrhea, and bradycardia
- Monitor cognitive function and heart rate
Levodopa/Carbidopa
- Levodopa isConverted to dopamine
- Carbidopa prevents its breakdown before reaching the brain
- Indicated for Parkinson’s disease
- Contraindicated if narrow-angle glaucoma, recent MAOI use
- Can cause dyskinesias, nausea, orthostatic hypotension
- Monitor motor symptoms and blood pressure
Levodopa
- Converts to dopamine in the brain
- Increases dopamine levels
- Indicated for Parkinson’s disease
- Contraindicated if narrow-angle glaucoma, recent MAOI use
- Can cause dyskinesias, nausea, orthostatic hypotension
- Monitor motor symptoms and blood pressure
Amantadine
- Increases dopamine release and inhibits dopamine reuptake
- Indicated for Parkinson’s disease, influenza A prophylaxis
- Contraindicated if severe renal impairment
- Can cause confusion, dizziness, livedo reticularis (skin rash)
- Monitor renal function and mental status
Galantamine
- Is an acetylcholinesterase inhibitor
- Increases acetylcholine in the brain
- Indicated for Alzheimer’s disease
- Contraindicated if hypersensitivity to galantamine
- Can cause nausea, diarrhea, and bradycardia
- Monitor cognitive function and heart rate
Rivastigmine
- Is an acetylcholinesterase inhibitor
- Increases acetylcholine in the brain
- Indicated for Alzheimer’s disease and Parkinson’s disease dementia
- Contraindicated for hypersensitivity to rivastigmine
- Can cause nausea, diarrhea, and bradycardia
- Monitor cognitive function and heart rate
Memantine
- Is an NMDA receptor antagonist
- Reduces glutamate excitotoxicity
- Indicated for moderate to severe Alzheimer’s disease
- Contraindicated if hypersensitivity to memantine
- Can cause dizziness, confusion, and headache
- Monitor cognitive function and renal function
Carbamazepine
- Inhibits voltage-gated sodium channels
- Stabilizes neuronal membranes
- Indicated for epilepsy, bipolar disorder, and trigeminal neuralgia
- Contraindicated if bone marrow suppression, hypersensitivity to carbamazepine
- Can cause drowsiness, dizziness, and hyponatremia
- Monitor CBC, liver function, and sodium levels
Valproate
- Inhibits voltage-gated sodium channels and increases GABA activity
- Indicated for epilepsy and bipolar disorder
- Should not be prescribed to individuals with hepatic disease and urea cycle disorders
- Can cause hepatotoxicity, pancreatitis, and tremor
- Monitor liver function, CBC, and serum valproate levels
Phenytoin
- Inhibits voltage-gated sodium channels
- Stabilizes neuronal membranes
- Indicated for epilepsy and status epilepticus
- Contraindicated if hypersensitivity to phenytoin and bradycardia
- Can cause gingival hyperplasia, ataxia, and rash
- Monitor serum phenytoin levels and liver function
Laxative Classes
- Bulk-forming (e.g., Psyllium)
- Absorbs water into the stool, making it easier to pass
- Indicated for constipation
- Contraindicated in intestinal obstruction
- Can cause bloating and abdominal cramping
- Monitor bowel movement frequency
- Surfactant (e.g., Docusate)
- Increases water absorption in the stool
- Indicated for constipation
- Contraindicated in intestinal obstruction
- Can cause abdominal cramping and diarrhea
- Monitor bowel movement frequency
- Stimulant (e.g., Bisacodyl, Senna)
- Stimulates peristalsis and water secretion into the intestines
- Indicated for acute constipation
- Contraindicated in intestinal obstruction and abdominal pain
- Can cause abdominal cramping and diarrhea
- Monitor bowel movement frequency
- Osmotic (e.g., Lactulose, PEG)
- Draws water into the bowel, increasing stool water content
- Indicated for constipation and hepatic encephalopathy
- Contraindicated in intestinal obstruction
- Can cause bloating and diarrhea
- Monitor bowel movement frequency and electrolytes
Oxybutynin
- Is an anticholinergic
- Inhibits bladder muscle contractions.
- Indicated for overactive bladder
- Contraindicated if glaucoma, urinary retention
- Can cause dry mouth, constipation, dizziness
- Monitor urinary symptoms and mental status
Ethinyl Estradiol/Norethindrone
- Is a combination of estrogen and progestin
- Inhibits ovulation
- Indicated for contraception, menstrual regulation
- Contraindicated for history of blood clots and breast cancer
- Can cause nausea, weight gain, and mood changes
- Monitor blood pressure and menstrual cycle
Norethindrone (Mini-Pills)
- Is a progestin-only contraception
- Prevents ovulation
- Indicated for contraception
- Contraindicated if history of blood clots and liver disease
- Can cause spotting, headache, and mood changes
- Monitor blood pressure and menstrual cycle
Sildenafil
- Phosphodiesterase-5 inhibitor
- Increases blood flow to the penis
- Indicated for erectile dysfunction, pulmonary hypertension
- Contraindicated if nitrate use
- Can cause headache, flushing, and visual disturbances
- Monitor blood pressure and cardiac symptoms
Finasteride
- 5-alpha-reductase inhibitor
- Reduces dihydrotestosterone levels
- Indicated for benign prostatic hyperplasia (BPH), male pattern baldness
- Contraindicated in pregnancy as it has teratogenic effects
- Can cause decreased libido and erectile dysfunction
- Monitor prostate-specific antigen (PSA) levels
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