NR 565 Advanced Pharmacology Fundamentals

Correct Answer:

C. enhances actions of incretin hormones to stimulate glucose dependent insulin and suppress glycogen release

Explanation of Correct Answer

DPP-4 inhibitors work by blocking the enzyme dipeptidyl peptidase-4, which normally degrades incretin hormones such as GLP-1 and GIP. By prolonging incretin activity, these drugs enhance glucose-dependent insulin secretion from pancreatic beta cells and suppress glucagon release from alpha cells. This mechanism improves postprandial glucose control without significant risk of hypoglycemia. Unlike metformin or SGLT-2 inhibitors, DPP-4 inhibitors act specifically through incretin hormone pathways.

Correct Answer:

B. Insulin

Explanation of Correct Answer

Insulin is the medication most likely to cause hypoglycemia because it directly lowers blood glucose by promoting cellular uptake and storage of glucose. When insulin doses exceed what the body requires, or if food intake is insufficient, blood sugar can drop to dangerously low levels. Hypoglycemia is the most significant adverse effect of insulin therapy, making careful monitoring and patient education on recognizing symptoms essential in diabetes management.

Correct Answer:

D. Levalbuterol

Explanation of Correct Answer

Levalbuterol, a short-acting beta-2 agonist (SABA), is the first-line therapy for both asthma and COPD when initiating treatment. SABAs provide rapid bronchodilation by relaxing airway smooth muscle, making them effective for immediate relief of acute symptoms like wheezing and shortness of breath. Long-term controller therapies, such as inhaled corticosteroids (budesonide) or long-acting beta agonists (salmeterol), may be added later depending on disease severity, but initial management always begins with a rescue inhaler like levalbuterol.

Correct Answer:

A. Ethambutol

Explanation of Correct Answer

Ethambutol is part of the standard first-line therapy for tuberculosis and is considered safe for use in pregnancy. It is commonly combined with isoniazid and rifampin, and sometimes pyrazinamide, to ensure effective treatment while minimizing fetal risk. Pyridoxine (B6) is a supplement used with isoniazid but is not itself a TB drug. Rifapentine and rifabutin are avoided in pregnancy due to insufficient safety data. Therefore, ethambutol is the correct choice.

Correct Answer:

C. Sertraline

Explanation of Correct Answer

Sertraline, a selective serotonin reuptake inhibitor (SSRI), can accelerate the metabolism and absorption of levothyroxine, leading to altered thyroid hormone levels. Patients taking both drugs may require dose adjustments of levothyroxine to maintain therapeutic TSH levels. In contrast, iron supplements and proton pump inhibitors like pantoprazole reduce absorption, and digoxin does not directly influence levothyroxine absorption. Careful monitoring is necessary when SSRIs and thyroid replacement therapy are used together.

Correct Answer:

B. Dulaglutide

Explanation of Correct Answer

Dulaglutide is a GLP-1 receptor agonist that mimics the actions of the incretin hormone GLP-1. By binding to GLP-1 receptors, it enhances glucose-dependent insulin secretion, inhibits glucagon release, and slows gastric emptying, which improves satiety and contributes to weight loss. This makes it effective for type 2 diabetes management and sometimes obesity. Unlike DPP-4 inhibitors such as sitagliptin, GLP-1 receptor agonists directly activate the receptor rather than just prolonging endogenous incretin action.

Correct Answer:

A. less than 8%

Explanation of Correct Answer

For older adults with diabetes, the A1C goal is generally less stringent than in younger populations. An A1C of less than 8% is recommended to balance glycemic control with the risks of hypoglycemia and medication side effects, which can be more harmful in older patients. Individualization is key, but this target helps reduce complications while prioritizing safety and quality of life in aging patients with comorbidities or limited life expectancy.

Correct Answer:

A. Glucocorticoids

Explanation of Correct Answer

Long-acting beta agonists (LABAs) must always be prescribed in combination with inhaled glucocorticoids when managing asthma. LABAs provide prolonged bronchodilation but, when used alone, are associated with an increased risk of asthma-related deaths. Inhaled corticosteroids control the underlying airway inflammation, reducing this risk and improving overall disease management. Therefore, combination therapy ensures both immediate bronchodilation and long-term inflammation control, making it the standard of care for persistent asthma.

Correct Answer:

B. Colace

Explanation of Correct Answer

Colace (docusate sodium) is considered safe for use in breastfeeding patients. It is a stool softener that works by increasing water and fat penetration into the stool, making it easier to pass without significant systemic absorption, thus posing minimal risk to the infant. Senna may cause loose stools in infants, mineral oil can interfere with absorption of fat-soluble vitamins, and while Miralax (PEG 3350) is generally safe, Colace is preferred due to its long-standing safety record in breastfeeding.