Nokea
The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:
- A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia
- B. The initial dose of glargine is 2 to 10 units per day
- C. Patients who have been on high doses of NPH will need tests for insulin antibodies
- D. Obese patients may require more than 100 units per day
Correct Answer: A
Rationale: Switching to glargine reduces the dose by 20% to prevent hypoglycemia due to its steady action vs. NPH peaks.
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Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?
- A. He has arthritis and this will help with the inflammation and pain
- B. Aspirin has anti-platelet activity and prevents clots that cause heart attacks
- C. Aspirin acidifies the urine and he needs this for prostate health
- D. He has a history of GI bleed, and one aspirin a day is a safe dosage
Correct Answer: B
Rationale: Aspirin's antiplatelet effect reduces cardiovascular risk, a common recommendation for men over 50; arthritis or prostate aren't primary reasons.
Which of the following is an II generation sulfonylurea drugs, which are used for the treatment of diabetes mellitus type II:
- A. Chlorpropamide
- B. Tolazamide
- C. Tobutamide
- D. Glipizide
Correct Answer: D
Rationale: Glipizide is a second-generation sulfonylurea, more potent and with fewer side effects than first-generation drugs like chlorpropamide.
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to:
- A. Become a vegetarian because this disorder is associated with eating red meat.
- B. Stop taking the drug if abdominal cramps and diarrhea develop.
- C. Report muscle weakness or tenderness and dark urine to his provider immediately.
- D. Expect 'hot flash' sensations during the first 2 weeks of therapy.
Correct Answer: C
Rationale: Muscle symptoms and dark urine indicate rhabdomyolysis, requiring immediate reporting.
Isotonic lactated Ringer's solution is indicated in all of the following conditions EXCEPT:
- A. Dehydration
- B. Liver diseases
- C. Acute blood loss
- D. Lower GIT fluid loss
Correct Answer: B
Rationale: Lactated Ringer's can exacerbate liver disease due to impaired lactate metabolism.
Acetyl salicylate & phenobarbitone are better absorbed from stomach because they are
- A. Weak acids remain non-ionic in gastric pH
- B. Weak acids remain ionic in gastric pH
- C. Strong acids fully ionized in gastric pH
- D. Weak bases which are ionized at gastric pH
Correct Answer: A
Rationale: Weak acids like acetyl salicylate (aspirin) and phenobarbitone remain non-ionic in the acidic pH of the stomach, facilitating their absorption through passive diffusion across the gastric mucosa.