1. Therapeutics Tutoring
Sarah Darby
November 2, 2017

2. Lectures Covered
Diabetes continued
ARDs CF

3. Diabetes Which of the following is not a rapid acting insulin? Lispro
Detemir
Glulisine
Aspart

4. Diabetes
Which is not an advantage to using rapid- acting analog insulin over regular insulin?
More rapid onset of action
Convenient administration
Less variation in absorption
Less expensive

5. Diabetes Which product has no peak of its action? Glargine Lispro
Detemir

6. Diabetes
Which of the following is false about rapid- acting analog insulin?
It should be given 30 minutes before a meal.
It should be clear and colorless.
It can be mixed with NPH in the same syringe.
Pens are stable at room temperature for 28 days.

7. Diabetes Which patient should not use Afrezza? Lung cancer
History of VAP
Asthma
Smoker of ½ PPD

8. Diabetes Which pair is not matched correctly? Tresiba = degludec
Lantus = glargine
Levemir = detemir
Toujeo = liraglutide

9. Diabetes Where can insulin be safely injected? Outer thigh Abdomen
Back of arm
Love handles
All of the above

10. Diabetes
PK (56kg) is starting insulin therapy with 4 injections daily. If we want his total daily dose to be 0.5 units/kg/day, what should his basal insulin dose be?
7 units HS
14 units HS
28 units HS
56 units HS

11. Diabetes
KM (84kg) still has an A1C of 9.2% after being adherent on multiple oral medications. How do you start glargine?
4.2 units HS
12 units HS
22 units HS
25 units HS

12. Diabetes
KM (84kg) still has an A1C of 9.2% after being adherent on multiple oral medications. He started insulin glargine 12 units daily at his last visit. His BG diary shows fasting glucose levels of mg/dl. What do you recommend?
Increase 2-4 units.
Maintain therapy.
Decrease 2-4 units.
Discontinue.

13. Diabetes
WH (60kg) has been taking detemir for the past 3 months and has controlled her fasting blood glucose levels. However, she now needs to start before meal insulin. What do you recommend?
2 units TID AC
6 units TID AC
12 units TID AC
18 units TID AC

14. Diabetes
FT (60kg) has an A1C of 11.2% and is starting basal/bolus insulin along with metformin. Calculate his:
Total daily dose (0.5 units/kg/day):
Basal dose:
Bolus dose per meal:

15. Diabetes Basal Bolus Start 0.1-0.2 units/kg/d or 10 units
0.1 units/kg or 4 units
Adjust
Inc. 2-4 units or 10-15%
Inc. 1-2 units or 10-15%
Hypoglycemia
Dec. by 4 units or 10-20%
Dec. by 2-4 units or 10-20%

16. Diabetes Expected A1C changes Metformin 1-2% Sulfonylureas ~1-2%
Thiazolidinediones %
DPP-4 inhibitors %
SGLT-2 inhibitors %
GLP-1 agonists
1-1.5%
Insulin %

17. Diabetes Which of the following is not a sign of hypoglycemia?
Diaphoresis
Tachycardia
Abdominal pain
Dizziness

18. Diabetes
HT has T2DM and complains of feeling weak and shaky. He feels similar to previous episodes of hypoglycemia. What should he do?
Eat a high carb containing meal
Drink a can of diet soda
Check his blood glucose
Take an extra dose of metformin

19. Diabetes
HT has T2DM and complains of feeling weak and shaky. He feels similar to previous episodes of hypoglycemia. His BG is 64 mg/dl.
Eat 15g (snack) of carbs and recheck his BG in 15 minutes
Eat 15g (snack) of carbs and take a nap
Eat 65g (dinner) of carbs and recheck his BG in 15 minutes
Eat 65g (dinner) of carbs and stop using insulin.

20. Diabetes 3-4 glucose tablets 1 Tbsp of peanut butter 1 cup of milk
Which is an inappropriate choice for correcting hypoglycemia?
3-4 glucose tablets
1 Tbsp of peanut butter
1 cup of milk
½ cup of apple juice

21. Diabetes
RD has long-standing T2DM and uses MDI of insulin. His wife discovers him to be unconscious on the couch. This has happened before because RD no longer recognizes s/s of low BG. Which is treatment option is appropriate?
½ cup of orange juice
3 peppermint candies
3-4 glucose tablets
Glucagon injection

22. Diabetes
Which of the following is not an acute complication of diabetes?
DKA
HHS
Hypoglycemia
Peripheral neuropathy

23. Diabetes
A patient has had T2DM for 10 years and has recently developed numerous UTIs due to a high post-void residual volume. This is an example of autonomic neuropathy.
True
False

24. Diabetes
Which of the following is false regarding diabetic peripheral neuropathy?
Pts with T2DM should be screened at diagnosis
Pts with T1DM should be screened 10 years after diagnosis
The screening test should be performed with a 10g monofilament
Tight glycemic control can slow the progression of neuropathy

25. Diabetes
Which agent has a level A recommendation for the treatment of diabetic peripheral neuropathy?
Gabapentin
Amitriptyline
Pregabalin
Tramadol

26. Diabetes
Which of the following patients should be taking an ACE inhibitor or ARB?
33 yo female, T2DM, 2nd trimester of pregnancy
54 yo male, T2DM, no HTN
49 yo female, T2DM, no HTN, urine albumin 150mg/day
58 yo female, T2DM, HTN, urine albumin 320mg/day

27. Diabetes When this is elevated… Change this… BG before breakfast
Adjust nightly basal dose
BG before lunch
Adjust morning bolus dose
BG before dinner
Adjust lunch bolus dose
BG before bedtime
Adjust dinner bolus dose

28. CF Which of the following organs is not affected by cystic fibrosis?
Lungs
Musculoskeletal
Pancreas
Skin

29. CF
Which of the following is not appropriate for chronic infection suppression in cystic fibrosis?
Inhaled tobramycin
Inhaled azithromycin
Inhaled aztreonam
PO azithromycin

30. CF
Which of the following is true regarding antibiotic suppressive therapy?
It is usually cycled 28 days on and 28 days off.
Inhaled vancomycin is the DOC
Antibiotics have reduced clearance and should be used at lower doses.
E.coli is a common cause of respiratory infections in CF

31. CF Which is false regarding pancreatic enzymes?
Dosing is based on amylase.
They should be given with meals and snacks.
High doses may cause colonic strictures.
Side effects include cramping and diarrhea.

32. CF Which statement is false?
Ivacaftor increases the time the CFTR channel is open
Ivacaftor corrects the CFTR folding defect
Lumacaftor/Ivacaftor reduces pulmonary exacerbation rates.
The F508del causes misfolding and premature degradation of CFTR.

33. ARDS Which of the following is not a risk factor for ARDS? Pneumonia
Near drowning
Anticholinergic use in COPD
Inhalation injury

34. ARDS Which of the following is not an indirect risk factor for ARDS?
Sepsis
Pancreatitis
Drug overdose
Immunizations

35. ARDS
Which of the following is not present during the acute exudative phase of ARDS?
Pneumonia
Hypoxemia
Bilateral infiltrates on chest x-ray
Hyperventilation

36. ARDS Which agent showed some mortality benefit in ARDS in studies?
IV alprostadil
Cisatracurium
Antioxidants
Low dose methylprednisolone

37. Therapeutics Tutoring Questions?
Sarah Darby
November 2, 2017