The Endocrine System - Pharm

A health care professional administers pramlintide (Symlin) at 0800 to a patient who has type 1 diabetes mellitus. At which of the following times should the patient expect the drug to exert its peak action?

0820 0820 Pramlintide, an amylin mimetic, peaks 20 min after administration. The health care professional should monitor the patient for indications of hypoglycemia, such as diaphoresis and tremors. 0900 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 1 hr after administration. Lispro insulin (Humalog) is an injectable hypoglycemic drug that can exert its peak action at that time. 1000 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 2 hr after administration. Regular insulin (Humulin R) is an injectable hypoglycemic drug that can exert its peak action at that time. 1100 Pramlintide, an amylin mimetic, is unlikely to cause severe hypoglycemia 3 hr after administration. Regular insulin (Humulin R) is an injectable hypoglycemic drug that can exert its peak action at that time.

A health care professional is caring for a patient who is taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should monitor for which of the following findings that indicates an adverse effect?

weight gain Joint pain Pioglitazone, a thiazolidinedione, is more likely to cause muscle pain than joint pain. Constipation Pioglitazone, a thiazolidinedione, is more likely to cause diarrhea than constipation. Weight gain Pioglitazone, a thiazolidinedione, can cause fluid retention. The health care professional should monitor weight or other indications of fluid retention or heart failure, including dyspnea, crackles, and wheezing. Dilated pupils Pioglitazone, a thiazolidinedione, is more likely to cause blurred vision than dilated pupils.

A health care professional is caring for a patient who is about to begin taking pioglitazone (Actos) to treat type 2 diabetes mellitus. The health care professional should explain to the patient the need to monitor which of the following laboratory tests? (Select all that apply.)

ALT LDL TSH is incorrect. Pioglitazone, a thiazolidinedione, is unlikely to alter T4 or TSH. Levothyroxine (Synthroid), a thyroid hormone replacement, is an endocrine-system drug that requires monitoring of T4 and TSH. ALT is correct. Pioglitazone can cause liver injury. The health care professional should monitor ALT at the start of therapy and every 3 to 6 months thereafter. The health care professional should tell the patient to report jaundice, dark-colored urine, or abdominal pain. LDL is correct. Pioglitazone can cause elevations in both high-density lipoproteins, which is a beneficial effect, and LDLs, which is a detrimental effect. The health care professional should monitor the patient's plasma lipid levels at baseline and periodically throughout drug therapy. CBC is incorrect. It is not necessary to monitor CBCs for patients who are taking pioglitazone . Hydrocortisone (Cortef), a glucocorticoid, is an endocrine-system drug that requires monitoring of CBCs. Creatinine clearance is incorrect. It is not necessary to monitor creatinine clearance for patients who are taking pioglitazone. Desmopressin (DDAVP), an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance.

Which of the following drugs should a health care professional have available for a patient who is experiencing an insulin overdose?

Glucagon (GlucaGen) Naloxone Naloxone, an opiate antagonist, treats opioid overdoses, not insulin overdoses. Diphenhydramine Diphenhydramine, a cholinergic antagonist and an antihistamine, treats drug-induced extrapyramidal symptoms. Diphenhydramine is ineffective for insulin overdoses. Acetylcysteine (Acetadote) Acetylcysteine, a mucolytic, treats acetaminophen overdoses, not insulin overdoses. Glucagon (GlucaGen) Glucagon, a hyperglycemic that can be given subcutaneously, IM, or IV, treats severe hypoglycemia from an insulin overdose in patients who are unconscious and for whom IV glucose is not readily available. If the patient does not respond to glucagon, the health care professional should administer a glucose solution IV.

When considering replacement therapy options for a patient who has chronic adrenocortical insufficiency, the primary care provider should choose which of the following drugs?

Hydrocortisone (Cortef) Somatropin (Genotropin) Somatropin, a growth hormone, treats growth hormone deficiencies, such as Turner's syndrome, not adrenocortical insufficiency. Hydrocortisone (Cortef) Hydrocortisone, a glucocorticoid, provides replacement therapy for acute and chronic adrenocortical insufficiency, such as Addison's disease.Hydrocortisone is identical to cortisol, the primary glucocorticoid the adrenal cortex generates. Glucagon (GlucaGen) Glucagon, a hyperglycemic, treats severe hypoglycemia from an insulin overdose, not adrenocortical insufficiency. Desmopressin (DDAVP) Desmopressin, an antidiuretic hormone, treats diabetes insipidus, not adrenocortical insufficiency.

A health care professional should question the use of levothyroxine (Synthroid) for a patient who has

a myocardial infarction bacterial skin infections. Patients who have bacterial skin infections may take levothyroxine, a thyroid replacement hormone. Fludrocortisone is an endocrine-system drug that requires cautious use with patients who have bacterial skin infections. diabetes insipidus. Patients who have diabetes insipidus may take levothyroxine, a thyroid replacement hormone. It requires cautious use in patients who have diabetes mellitus. immunosuppression. Patients who are immunosuppressed may take levothyroxine, a thyroid replacement hormone. Propylthiouracil (PTU) is an endocrine-system drug that requires cautious use with patients who are immunosuppressed. a myocardial infarction. Levothyroxine, a thyroid replacement hormone, can cause tachycardia, palpitations, and hypertension, especially when the patient requires a dosage adjustment; therefore, it is contraindicated for patients who have recently had a myocardial infarction.

A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus plans to undergo angiography using iodine-containing contrast dye. The health care professional should recognize that an interaction between metformin and the IV contrast dye can increase the patient's risk for which of the following?

acute renal failure Hypokalemia Metformin, a biguanide, is unlikely to cause hyperkalemia when used with iodine-containing contrast dye. Regular insulin (Humulin) is an endocrine-system drug that can cause hypokalemia. Hyperglycemia Metformin, a biguanide, is unlikely to cause hyperglycemia when used with iodine-containing contrast dye. Glucagon (GlucaGen) is an endocrine-system drug that can cause hyperglycemia. Acute renal failure Metformin, a biguanide, can interact with iodine-containing contrast dye, causing acute renal failure and lactic acidosis. The health care professional should withhold metformin for 48 hr prior to and following the procedure. The health care professional should also monitor the patient for indications of acute renal failure or lactic acidosis, such as reduced urine output, hyperventilation, and abdominal pain. Acute pancreatitis Metformin, a biguanide, is unlikely to cause acute pancreatitis when used with iodine-containing contrast dye. Exenatide (Byetta) is an endocrine-system drug that can cause can cause acute pancreatitis.

When talking to a patient who is about to begin glipizide (Glucotrol) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions?

avoid drinking alcohol Avoid drinking alcohol. Alcohol can interact with glipizide, a sulfonylurea, causing a reaction similar to disulfiram (Antabuse), manifesting as nausea, palpitations, and flushing. Alcohol also increases the drug's hypoglycemic effects. The health care professional should tell the patient to avoid drinking alcohol. Sit or stand for 30 min after taking the drug. Glipizide, a sulfonylurea, is unlikely to cause esophagitis. However, it can cause GI distress with heartburn. Urinate every 4 hr. Glipizide, a sulfonylurea, is unlikely to cause urinary retention. However, it can cause diarrhea. Patients who develop this adverse reaction should maintain hydration by drinking plenty of electrolyte-rich fluids. Take the drug 2 hr after a meal. Glipizide, a sulfonylurea, helps control hyperglycemia from type 2 diabetes mellitus. The patient should take the drug 30 min before the first meal of the day.

A health care professional is caring for a patient who is about to begin insulin glargine (Lantus) therapy. The health care professional should recognize the need for additional precautions because the patient also takes which of the follow types of drugs?

beta blockers Oral contraceptives Oral contraceptives do not specifically interact with insulin. Exenatide (Byetta), another endocrine-system drug, slows the absorption of oral contraceptives. Calcium supplements Calcium supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine (Synthroid), another endocrine-system drug. Beta blockers Patients who take insulin and also take beta blockers are at risk for failing to promptly recognize the symptoms of hypoglycemia because they mask symptoms such as tachycardia and tremors. They also increase hypoglycemic effects. Iron supplements Iron supplements do not specifically interact with insulin. They do, however, reduce the absorption of levothyroxine (Synthroid), another endocrine-system drug.

When talking with a patient who is about to begin repaglinide (Prandin) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions?

do not drink more than 1 L of grapefruit juice per day Do not drink more than 1 L of grapefruit juice per day. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide, a meglitinide. The health care professional should tell the patient to avoid drinking large amounts of grapefruit juice. Carry a high-protein snack at all times. Drink 16 oz of water after taking the drug. It is unnecessary to drink 16 oz of water after taking repaglinide, a meglitinide. However, the drug can cause vomiting and diarrhea. Patients who develop these effects should maintain hydration by drinking plenty of electrolyte-rich fluids. Use ginseng to reduce nausea. The health care professional should tell the patient to avoid ginseng and garlic because these herbal supplements can increase the hypoglycemic effects of repaglinide, a meglitinide.

A health care professional is caring for a patient who is about to begin acarbose (Precose) therapy to treat type 2 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about the drug?

eat more iron-rich foods Eat more iron-rich foods. Acarbose, an alpha-glucosidase inhibitor, can cause iron-deficiency anemia. The health care professional should tell the patient to increase his intake of iron-rich foods, such as red meat, spinach, and grains, and monitor the patient's CBC. Avoid drinking grapefruit juice. Grapefruit juice is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide (Prandin), a meglitinide. Increase fiber intake. Acarbose, an alpha-glucosidase inhibitor, is unlikely to cause constipation. It can cause diarrhea and flatulence. Metformin (Glucophage) can worsen the GI effects of the drug. Avoid drinking green tea. Green tea is unlikely to alter the effects of acarbose, an alpha-glucosidase inhibitor. Green tea can increase the hypoglycemic effects of pioglitazone (Actos), another endocrine-system drug.

A health care professional is caring for a patient who is about to begin taking radioactive iodine-131 (Iodotope) to treat Graves' disease. Which of the following instructions should the health care professional include when talking with the patient about the drug?

expect full effects in 2 to 3 months Take the drug once daily for 5 days. Patients take radioactive iodine-131, an antithyroid drug, only once, although an ineffective response can require one or more subsequent doses several months later. Expect a bitter, acid-like taste. Preparations of radioactive iodine-131, an antithyroid drug, are odorless and tasteless. Restrict fluid intake after taking the drug. Patients should drink plenty of fluids after taking radioactive iodine-131, an antithyroid drug, especially if the dosage is high. Expect full effects in 2 to 3 months. The full therapeutic effects of radioactive iodine-131, an antithyroid drug, take 2 to 3 months, and with successful treatment, hypothyroidism can result.

A health care professional is caring for a patient who is about to begin levothyroxine (Synthroid) therapy to treat hypothyroidism. Which of the following instructions should the health care professional include when talking with the patient about taking the drug?

expect life-long therapy with the drug Take levothyroxine with food to increase absorption. Food reduces the absorption of levothyroxine, a thyroid replacement hormone. The health care professional should tell the patient to take it on an empty stomach, at least 30 min before eating. Take levothyroxine with an antacid to reduce GI effects. Antacids reduce the absorption of levothyroxine, a thyroid replacement hormone. The health care professional should tell the patient to allow 4 hr between doses of the drugs. Expect life-long therapy with the drug. Therapy with levothyroxine, a thyroid replacement hormone, usually continues for life because there are no other therapies that can restore thyroid function. Carry a carbohydrate snack at all times. Levothyroxine, a thyroid replacement hormone, does not cause hypoglycemia, so this precaution is not necessary. Patients who are taking hypoglycemics, such as exenatide (Byetta), should carry a carbohydrate snack at all times to treat hypoglycemia.

A patient who is taking propylthiouracil (PTU) contacts the health care professional to report weight gain, drowsiness, and depression. The health care professional should suspect which of the following adverse reactions to the propylthiouracil?

hypothyroidism Thyrotoxicosis Propylthiouracil, an antithyroid drug, treats thyrotoxicosis, or hyperthyroidism. Indications of thyrotoxicosis include anxiety, palpitations, and weight loss. Hypothyroidism Propylthiouracil, an antithyroid drug, can cause hypothyroidism, manifesting as drowsiness, depression, weight gain, edema, and bradycardia. The health care professional should request that the primary care provider prescribe a lower dosage of the drug for the patient. Lactic acidosis Propylthiouracil, an antithyroid drug, is unlikely to cause lactic acidosis. Sitagliptin (Januvia) is an endocrine-system drug that can cause lactic acidosis, manifesting as muscle aches, sleepiness, malaise, and hyperventilation. Radiation sickness Propylthiouracil, an antithyroid drug, is unlikely to cause radiation sickness. Radioactive iodine-131 (Iodotope) is an endrocrine-system drug that can cause radiation sickness, manifesting as hematemesis, epistaxis, and intense N/V.

A health care professional is caring for a patient who is about to begin pramlintide (Symlin) therapy to treat type 1 diabetes mellitus. Which of the following instructions should the health care professional include when talking with the patient about using the drug?

inject pramlintide before meals Mix pramlintide with insulin. Pramlintide, an amylin mimetic, supplements the effects of insulin and oral hypoglycemic drugs. However, patients should not mix it in the same syringe with insulin. Inject pramlintide before meals. The patient should inject pramlintide, an amylin mimetic, 20 min before a meal that contains at least 30 g of carbohydrates. Take pramlintide at bedtime. Patients should take pramlintide, an amylin mimetic, three times per day. Metformin (Glucophage), a biguanide, is an endocrine-system drug that patients take orally once per day, with their evening meal. Inject pramlintide into the upper arm. Patients should inject pramlintide, an amylin mimetic, subcutaneously into the abdomen or thigh, not into the upper arm.

When talking with a patient who is about to begin exenatide (Byetta) therapy to treat type 2 diabetes mellitus, the health care professional should include which of the following instructions? (Select all that apply.)

inject the drub subcutaneously expect the peak effect in 2 hr use the drug as a supplement to an oral hypoglycemic Inject the drug subcutaneously is correct. The patient should inject exenatide, an incretin mimetic, into the subcutaneous tissue of the thigh, upper arm, or abdomen. Expect the peak effect in 2 hr is correct. Levels of exenatide peak 2 hr after administration and then decrease gradually, with a half-life of 2.4 hr. Use the drug as a supplement to an oral hypoglycemic is correct. Exenatide supplements the action of an oral hypoglycemic, such as a sulfonylurea or metformin (Glucophage). Inject the drug 1 hr after a meal is incorrect. The patient should inject exenatide twice per day up to 60 min prior to the morning and evening meals, not after a meal. Discard used pens 10 days after the first use is incorrect. The patient may keep prefilled exenatide injector pens in use at room temperature up to 30 days.

A patient who is taking metformin (Glucophage) to treat type 2 diabetes mellitus contacts the health care professional to report muscle pain. The health care professional should suspect which of the following adverse reactions?

lactic acidosis Lactic acidosis Metformin, a biguanide, can cause lactic acidosis, which is a life-threatening complication, manifesting as muscle aches, sleepiness, malaise, and hyperventilation. The patient should stop taking the drug and seek medical care immediately. Anticholinergic effects Metformin, a biguanide, is unlikely to cause anticholinergic effects, but it can cause nausea, diarrhea, and anorexia. The health care professional should inform the patient that these effects should diminish with continued therapy. Extrapyramidal symptoms Metformin, a biguanide, is unlikely to cause extrapyramidal symptoms, but it can cause dizziness and fatigue. Hypophosphatemia Metformin, a biguanide, is unlikely to cause hypophosphatemia, but it can cause vitamin B12 or folic acid deficiencies, manifesting as weakness, fatigue, pallor, or a reddened tongue.

A health care professional is talking to a patient about self-injecting Regular insulin (Humulin). The health care professional should tell the patient to rotate injection sites to prevent which of the following?

lipohypertrophy Rapid absorption Rotating insulin injection sites does not prevent rapid absorption. Using the same injection site, specifically the abdomen, speeds absorption, while using the thigh, allows for the slowest absorption. Intradermal injection Rotating insulin injection sites does not affect the risk of intradermal injection because the appropriate areas for insulin injection contain adequate subcutaneous tissue in most patients. Injection pain Rotating insulin injection sites is unlikely to affect injection pain. The depth of the injection affects pain; deeper IM injections are more painful and are also inappropriate for insulin injection. Lipohypertrophy Lipohypertrophy, also called lipodystrophy, is a proliferation of fat at the sites of repeated insulin injections. It affects skin sensitivity and appearance. To prevent it, the patient should rotate injection sites, keeping them at least 1 inch apart, and avoid using the same spot within the same month.

A patient who is taking glipizide (Glucotrol) to treat type 2 diabetes mellitus contacts the health care professional to report feeling shaky, hungry, and fatigued. The health care professional should tell the patient to do which of the following?

perform a fingerstick blood glucose check Drink 16 oz of water. Glipizide, a sulfonylurea, can cause diarrhea. Patients who develop this adverse reaction should maintain hydration by drinking plenty of fluids. However, the patient's symptoms indicate a different adverse reaction to the drug. Perform a fingerstick blood glucose check. Glipizide, a sulfonylurea, can cause hypoglycemia, which can manifest as diaphoresis, shakiness, hunger, and fatigue. The health care professional should tell the patient to check her blood glucose level, and if it indicates hypoglycemia, consume a snack of 15 to 20 g of carbohydrates, retest in 15 to 20 min, and repeat if her blood glucose level is still low. Take another glipizide tablet. Glipizide, a sulfonylurea, treats hyperglycemia from type 2 diabetes mellitus. Patients do not take it PRN, but on a fixed, once-daily dosing schedule. It would be inappropriate to double the dosage within the same 24-hr period, even if the patient were experiencing hyperglycemia. Lie down and rest. Lying down and resting can help the patient feel less fatigued, but these actions do not address the adverse reaction the patient is having to glipizide, a sulfonylurea.

A primary care provider should prescribe a lower dose of sitagliptin (Januvia) for a patient who has type 2 diabetes mellitus and who also has which of the following?

renal impairment Thyroid disease Patients who have thyroid disease may take sitagliptin, a gliptin. Glipizide (Glucotrol) is an endocrine-system drug that requires cautious use with patients who have thyroid disease. Bronchitis Patients who have bronchitis may take sitagliptin, a gliptin. The drug requires cautious use with patients who have a history of pancreatitis. Heart failure Patients who have heart failure may take sitagliptin, a gliptin. Metformin (Glucophage) is an endocrine-system drug that is contraindicated for patients who have heart failure. Renal impairment Sitagliptin, a gliptin, requires cautious use with patients who have renal dysfunction and low creatinine clearance because the kidneys eliminate the drug virtually intact. The primary care provider should prescribe a lower dose for this patient or prescribe a different hypoglycemic drug.

A health care professional is caring for a patient who is taking repaglinide (Prandin) 15 to 30 min before each meal to treat type 2 diabetes mellitus. The patient asks the health care professional what to do if he skips a meal. Which of the following is the appropriate response?

skip the dose Double the dose before the next meal. Taking a double dose of repaglinide, a meglitinide, before the next meal puts the patient at risk for hypoglycemia. Take half the dose. Taking half the dose of repaglinide, a meglitinide, without the meal puts the patient at risk for hypoglycemia. Skip the dose. To avoid a sudden and serious drop in blood glucose level, the patient should skip the dose of repaglinide, a meglitinide, whenever he skips a meal, and try to avoid skipping meals. Take the usual dose. Taking the full dose of repaglinide, a meglitinide, without the meal puts the patient at risk for hypoglycemia.

A health care professional is caring for a patient who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The health care professional should tell the patient to report which of the following adverse effects? (Select all that apply.)

sore throat muscle pain bradycardia rash Sore throat is correct. Propylthiouracil, an antithyroid drug, can cause agranulocytosis. The health care professional should monitor the patient's CBC, and tell the patient to report fever or sore throat. Muscle pain is correct. Propylthiouracil can cause arthralgia and myalgia. The health care professional should tell the patient to report these effects and take over-the-counter analgesics for pain relief. Insomnia is incorrect. Propylthiouracil is more likely to cause drowsiness than insomnia. Bradycardia is correct. Propylthiouracil can cause hypothyroidism, manifesting as bradycardia, drowsiness, and weight gain. The health care professional should tell the patient to report these effects. Rash is correct. Propylthiouracil can cause urticaria or a skin rash. The health care professional should tell the patient to report these effects.

A health care professional is caring for a patient who is about to begin taking somatropin (Genotropin). The health care professional should explain the need to monitor which of the following laboratory tests? (Select all that apply.)

urine calcium blood glucose Blood amylase is incorrect. Somatropin, a growth hormone, is unlikely to alter serum amylase levels. Sitagliptin (Januvia), an antithyroid drug, is an endocrine-system drug that requires monitoring of serum amylase levels because it can cause pancreatitis. Creatinine clearance is incorrect. Somatropin is unlikely to alter creatinine clearance. Desmopressin (DDAVP), an antidiuretic hormone, is an endocrine-system drug that requires monitoring of creatinine clearance. Urine calcium is correct. Somatropin can cause hypercalciuria. The health care professional should monitor the patient's urine calcium, and tell the patient to report flank pain, urinary frequency, or hematuria. Blood glucose is correct. Somatropin can cause hyperglycemia. The health care professional should monitor the patient's blood glucose levels, and tell the patient to report polyphagia, polydipsia, and polyuria. CBC is incorrect. Somatropin is unlikely to alter the patient's CBC. Radioactive iodine-131 (Iodotope), an antithyroid drug, is an endocrine-system drug that requires monitoring CBC.

To determine the effectiveness of desmopressin (DDAVP), a health care professional should monitor a patient's

urine output peripheral pulses. Desmopressin, an antidiuretic hormone, is unlikely to alter peripheral pulses, although vasopressin, another antidiuretic hormone, can cause vasoconstriction and angina pectoris. Desmopressin does not alter hemodynamics. urine output. Desmopressin, an antidiuretic hormone, treats diabetes insipidus. The health care professional should monitor the patient's fluid intake and urine output along with urine and serum osmolality and blood pressure. skin integrity. Desmopressin, an antidiuretic hormone, is unlikely to alter skin integrity. Propylthiouracil (PTU), an antithyroid drug, is an endocrine-system drug that requires integumentary monitoring because it can cause a rash. blood glucose. Desmopressin, an antidiuretic hormone, is unlikely to alter serum glucose, although it can cause hyponatremia. The health care professional should monitor the patient's serum sodium levels.

When talking with a patient about taking fludrocortisone to treat adrenocortical insufficiency, the health care professional should tell the patient to do which of the following to reduce the risk of adverse reactions? (Select all that apply.)

weigh yourself daily report weakness or palpitations have your blood pressure checked regularly Weigh yourself daily is correct. Fludrocortisone, a mineralocorticoid, can cause fluid and electrolyte imbalances, such as hypernatremia. Tracking weight on a daily basis can help identify weight gain and edema; reporting it can expedite any essential interventions. Report weakness or palpitations is correct.Fludrocortisone can cause hypokalemia. The health care professional should monitor the patient's potassium levels, and tell her to report muscle weakness or palpitations. Have your blood pressure checked regularly is correct. Fludrocortisone can cause fluid retention and hypertension. The health care professional should monitor the patient's fluid balance and blood pressure to expedite any essential interventions. Eat more iron-rich foods is incorrect. Fludrocortisone does not cause iron-deficiency anemia, although it can cause thrombocytopenia. Avoid drinking grapefruit juice is incorrect. Grapefruit juice is unlikely to alter the effects of fludrocortisone. More than 1 L of grapefruit juice per day can increase the hypoglycemic effects of repaglinide (Prandin), another endocrine-system drug.