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Use the John Jones case study to answer the following question.
Which glucose level equates with a Hgb A1C of 8.1%?
~204 mg/dl
~160 mg/dl
~175 mg/dl
~183 mg/dl
The correct answer is ~183mg/ dl. See page 400, Table 48.4, Hemoglobin A1c levels and their corresponding eAG levels for complete information.
Use the John Jones case study to answer the following question.
John calls the office and reports that he is scheduled for diagnostic testing that requires IV contrast for imaging. He inquires if there are concerns with undergoing this procedure while taking his medications. What instructions should be given to John regarding his metformin regimen?
Don’t take the metformin the day of the procedure and for 48 hours afterward.
Take the metformin the morning of the procedure but don’t take it for 48 hours afterward.
Don’t take the metformin the day of the procedure but resume the following day.
Metformin must be withheld on the day of the procedure and for 48 hours afterward. Serum creatinine levels should be normal before resuming metformin.
Use the John Jones case study to answer the following question.
Which of the following lab test should be evaluated before prescribing metformin?
Complete blood count (CBC)
Complete metabolic profile (CMP)
Lipid Panel
Urinalysis
CMP provides a baseline evaluation for both hepatic and renal function which should be evaluated throughout treatment with metformin.
Use the John Jones case study to answer the following question.
Which behavior in John’s social history poses a potential concern with initiating metformin?
His diet largely consists of fast-food meals. He drinks sweet tea with every meal.
He reports drinking “a few beers on the weekend during football season”.
He drinks 3-4 cups of coffee per day.
Metformin is contraindicated in alcoholics. Although it does not sound as if John is an alcoholic, further questioning is needed, and the discussion should be documented. Metformin taken by alcoholics increases the risk of lactic acidosis so John should be educated on this risk along with signs and symptoms of lactic acidosis.
Use the John Jones case study to answer the following question.
Metformin works by decreasing and .
glucogenesis; incretin secretion
incretin secretion; insulin production
Correct Answer
glucogenesis; insulin resistance
insulin resistance; incretin secretion
Metformin decreases glucogenesis and insulin resistance.
Use the John Jones case study to answer the following question.
Using the ADA Standards of Medical Care in Diabetes-2020, which of the following medications should be prescribed for John?
Canagliflozin
Glyburide
Dulaglutide
Metformin
According to the ADA Standards of Medical Care in Diabetes-2020, Metformin is the first-line medication to prescribe for patients with a HgbA1C >6.5%.
American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/10
Use the John Jones case study to answer the following question.
Which of the following statements best describes John’s status?
He has diabetes and requires pharmacological intervention.
He does not have diabetes.
He has diabetes but does not require pharmacological intervention.
He has pre-diabetes.
DM Diagnostic Criteria on pg 398 reviews the four criteria to diagnose DM which is the precursor to pharmacological intervention. These criteria include:
• Fasting plasma glucose ≥126 mg/dLa Or
• Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes Or
• Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200 mg/dLc Or
• Hemoglobin A1c 6.5% or higher;
Use the John Jones case study to answer the following question.
John’s triglycerides are 260 mg/dl and his HDL is 35mg/dl. Referring to the ADA Standards of Medical Care in Diabetes-2020, what is the correct action to take at this time?
Increase John’s atorvastatin to 20mg per day.
Leave John’s atorvastatin as is and re-check lipids when A1C is re-checked.
Increase John’s atorvastatin to 40 mg per day.
Stop John’s atorvastatin since he is now being treated for diabetes.
According to the ADA Standards of Medical Care in Diabetes-2020, the correct action is to intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women).
John's treatment includes lifestyle changes as well as metformin which aligns with practice guidelines. John’s atorvastatin should remain as currently prescribed with monitoring of lipid profile and A1C.
Use the John Jones case study to answer the following question.
What is the recommended interval for monitoring John’s HgbA1C?
1-month
6-weeks
3-months
6-months
The HgbA1C is a 3-month average of glucose; therefore, it should be re-checked in 3 months after starting treatment. Checking this lab value beforehand will provide a mixed result of glucose before and after treatment. Monitoring blood sugar between the beginning of treatment with metformin and a 3 month follow up, fasting finger stick blood sugars should be done.
Use the John Jones case study to answer the following question.
Which of John’s behaviors should be addressed to encourage lifestyle changes and decrease A1C levels? Select all that apply.
He drinks 3-4 cups of coffee per day.
Sits at a desk several hours a day.
Weight 235lbs
His diet largely consists of fast-food meals. He drinks sweet tea with every meal.
Family history is significant for diabetes.
Correct Answer
BP 130/90
The combination of moderate exercise and weight loss reduces the risk for the development of type 2 diabetes and improves outcomes for patients with type 2 diabetes (Rosenthal & Burchum, 2021).
Use the Alfonso Giuliani case study to answer the following question.
Which lab test is necessary to evaluate before prescribing a sodium/glucose cotransporter-2 inhibitor (SGLT2i)?
CBC
LFTs
HgbA1C
CMP
A complete metabolic profile (CMP) is needed to evaluate GFR before prescribing a SGLT2i.
Use the Alfonso Giuliani case study to answer the following question.
Alfonso should be started on statin therapy to address his high total cholesterol and low HDL.
True
False
Statin therapy is recommended because of his known diabetes and 10-year risk ≥7.5%. If Alfonso’s LDL is
<70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk-benefits may be considered before starting statins.
Identify SGLT2i agents in the list below. Select all that apply.
linagliptin
dapagliflozin
alogliptin
sitagliptin
saxagliptin
canagliflozin
empagliflozin
The Food and Drug Administration (FDA has approved three SGLT2 selective inhibitors for mono, dual, and triple therapy: canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®)
Question 15
31.2%
37.6%
Correct Answer
46.5%
52.1%
Alfonso’s ASCVD Risk score is 46.5% according to ASCVD Risk Estimator-Plus tool, which estimates risk based on age, gender, presence of diabetes, treatment for hypertension, cholesterol values, and systolic pressure.
Use the Alfonso Giuliani case study to answer the following question.
Which of the following benefits from GLP-1 therapy are helpful to Alfonso? Select all that apply.
appetite suppression
weight loss
Correct Answer
low risk for hypoglycemia
blood pressure control
The benefits of GLP-1 therapy relevant to Alfonso include weight loss and suppression of appetite without causing hypoglycemia.
Question 17
Atorvastatin 10-20 mg
Correct Answer
Rosuvastatin 20-40 mg Correct Answer Atorvastatin 40–80 mg
Pravastatin 40-80 mg
High-intensity statin therapy options include Atorvastatin 40–80 mg and Rosuvastatin 20-40 mg. These are agents best suited for Alfonso. Treatment agents are identified under the evidence tab of the ASCVD Risk Calculator.
Use the Alfonso Giuliani case study to answer the following question.
Which of the following lab values are important to monitor while taking GLP-1 agents?
hemoglobin and hematocrit
Correct Answer
amylase and lipase
aspartate transaminase & alkaline phosphatase
magnesium and calcium
GLP-1 drugs may cause pancreatitis. GLP-1 drugs do not cause cellulitis, diverticulitis, and cholecystitis.
Question 19
exenatide
semaglutide
dulaglutide
lixisenatide
liraglutide
rosiglitazone
pioglitazone
albiglutide
GLP-1 receptor agonists include: albiglutide (Tanzeum) dulaglutide (Trulicity)
exenatide (Byetta) liraglutide (Victoza) lixisenatide (Adlyxin)
semaglutide (Ozempic, Rybelsus)
Use the Alfonso Giuliani case study to answer the following question.
Which of the following complications may be caused by GLP-1 agents?
diverticulitis
cholecystitis
pancreatitis Correct Answer cellulitis
GLP-1 drugs may cause pancreatitis. GLP-1 drugs do not cause cellulitis, diverticulitis, and cholecystitis.
Use the Alfonso Giuliani case study to answer the following question.
Considering Alfonso’s ASCVD risk score, which of the following diabetic drug classes should be considered in addition to metformin?
TZD
SGLT2i
Correct Answer
GLP-1
Sulfonylurea
According to the ADA Standards of Medical Care in Diabetes-2020, GLP-1 and SGLT2i drugs are recommended in conjunction with metformin when ASCVD risk predominates. Alfonso meets this criterion with an ASCVD risk score >40%.
American Diabetes Association. (2020). Figure 9.1 [Graph]. Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers. https://clinical.diabetesjournals.org/content/38/1/10
Question 22
0 / 2 pts
Use the Alfonso Giuliani case study to answer the following question. Which of the following types of statin therapy should be started for Alonso?
Correct Answer
High-intensity statin therapy
Low-intensity statin therapy
Moderate-intensity statin therapy
High-intensity statin is recommended for Alfonso because of his known diabetes and 10-year risk
≥7.5%. If Alfonso’s LDL is <70mg/dl (1.81 mmol/L), additional factors like lifestyle and risk-benefits may be considered before starting statins.
Use the Helen Smith case study to answer the following question.
Helen’s has abnormal thyroid values:
TSH 24 mU/L
Free T4 0.2 ng/dl
What condition do these tests indicate?
Hashimoto’s thyroiditis
Hypothyroidism
Grave’s Disease
Hyperthyroidism
Helen’s abnormal thyroid values are consistent with hypothyroidism due to decreased thyroid hormone levels. Hyperthyroidism and Grave’s Disease result from elevated thyroid hormone levels.
Hashimoto’s thyroiditis is an autoimmune condition of the thyroid that can not be diagnosed by TSH and Free T4.
What are the Black Box Warnings associated with NSAIDs? Select all that apply.
Increases risk for GI bleeding, ulceration, and perforation
Increases risk for cardiovascular thrombotic event
Increases all-cause mortality
Increases risk for serious skin reactions Black Box warning on NSAIDs:
Cardiovascular Thrombotic Event
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in treatment and may increase with duration of use; contraindicated for CABG perioperative pain
GI Bleeding, Ulceration, and Perforation
NSAIDs incr. risk of serious and potentially fatal GI adverse events incl. bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and without warning signs or symptoms; elderly pts and pts with hx of PUD or GI bleeding at greater risk for serious GI events
Use the Helen Smith case study to answer the following question.
Which of the following criteria support’s Helen’s diagnosis of DM? (Select all that apply)
Glucose: 189 mg/dL
T. Cholesterol 240 mg/dl [Show Less]