A patient who has insulin-dependent type 2 diabetes reports ...

[Jkov05]

A patient who has insulin-dependent type 2 diabetes reports having difficulty keeping blood glucose within normal limits and has had multiple episodes of both hypoglycemia and hyperglycemia.
 
  As adjunct therapy to manage this problem, the primary care NP should prescribe: a. pramlintide (Symlin).
  b. repaglinide (Prandin).
  c. glyburide (Micronase).
  d. metformin (Glucophage).

Question 2

A patient who has hypertension is taking a thiazide diuretic. The patient has a serum uric acid level of 8 mg/dL. The primary care nurse practitioner (NP) caring for this patient should:
 
  a. prescribe colchicine.
  b. discontinue the thiazide diuretic.
  c. order a 24-hour urine collection.
  d. refer the patient to a rheumatologist.

[mmpiza]

Answer to Question 1

A
Pramlintide is indicated in patients with type 1 diabetes and insulin-dependent type 2 diabetes and is helpful for patients with wide glycemic swings. Repaglinide requires a functioning pancreas to be effective. Glyburide and metformin are first-line oral agents and are not indicated.

Answer to Question 2

C
Patients who have hypertension or who take thiazide diuretics are at increased risk for gout. An elevated uric acid level alone is not diagnostic, and a 24-hour urine collection should be ordered. Colchicine should not be prescribed until the diagnosis is confirmed. It is not necessary to discontinue the thiazide diuretic. A referral to a specialist is not indicated.

[Jkov05]

TYSM

[cici]

Excellent