What is the mechanism of action of penicillin? What is the mechanism of action of the macrolides (erythromycin, azithromycin, clarithromycin)?

What is the mechanism of action of the quinolones? Name a beta-lactam drug which may be used safely in patients allergic to beta-lactam agents. Name a second generation cephalosporin generally active against Bacteroides fragilis (an anaerobe). Indicated as first-line treatment for infections caused by methicillin-resistant staph. spp. Drugs able to cause decreased neuromuscular transmission Oral electrolyte interaction with tetracycline Meaning of MIC 90 Meaning of MBC Two classes of drugs that bind to the 30 S ribosome

Describe and differentiate the three different mast cell mediators that contribute to the inflammatory response in asthma What factors can affect the delivery of drug via the aerosol route? What is the major pharmacokinetic difference between albuterol and salmeterol? What impact does this difference have on treatment of the asthmatic patient? Why is ipratropium bromide a more efficacious anticholinergic agent than atropine for the treatment of respiratory disease? When should inhaled corticosteroids be used in the treatment of asthma? What are some major side effects to the chronic use of systemic corticosteroids in the treatment of respiratory diseases? Which drugs are listed as Quick-Relief Medications for the treatment of asthma? Why are they classified this way?

Which drugs are listed as Long-Term Control Medications for the treatment of asthma? Why are these drugs classified this way? When should theophylline be used in asthmatic patients? When should it be used in COPD patients? Why are leukotriene inhibitors effective agents for treating asthmatic patients? Name three important steps on which to instruct a patient in using a metered dose inhaler. State the differences in treatment for asthma and COPD.

Explain the pathophysiologic classification of pain? How can pain be classified according to duration? What does each letter in the PQRST assessment tool stand for? Name the three steps in the World Health Organizations step care model to pain treatment What drugs should be used to treat mild pain? Moderate pain? Severe pain? What is the major side effect with acetaminophen use? Differentiate between non-selective cycloxygenase inhibitors and selective cyclooxygenase inhibitors. Why are NSAIDS potentially nephrotoxic? GI toxic? What is the mechanism of action of opioid analgesic drugs? What are the common peripheral effects of opioid analgesics and how can they be potentially treated? State common differences with morphine and fentanyl.

Match the following drugs to their appropriate drug class. a) Sulfonylurea b) Biguinide c) Meglitinide d) Alpha glucosidase inhibitor e) Thiazolidinediones
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. rosiglitazone glipizide metformin acetohexamide acarbose chlorpropamide nateglinide tolbutamide pioglitazone glimepiride miglitol glyburide repaglinice tolazemide

What are the goals for nutrition therapy in a patient with diabetes? Why is the quality and quantity of food intake by a patient with diabetes important? Why is exercise important in a patient with type 2 diabetes? How does a patient with type1 or type 2 diabetes need to adjust insulin therapy to account for changes in exercise and dietary habits?

Review the place in therapy for 2-, 3- and 4- injections/day insulin therapy. How are they similar and different from each other? When and what kind of insulin is given at B-L-S-HS for each regimen? What are advantages and disadvantages of each regimen?
review the different types of insulin and compare and contrast regarding their onset of action, time to peak and duration of action.

Choose all the side effects from column B that match each drug in column A. Drugs listed in column A may have more than one side effect. Pick ALL the side effects from column B that match each drug.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Column A metformin glipizide pioglitazone chlorpropamide acetohexamide glyburide neteglinide rosiglitazone acarbose tolbutamide Column B hypoglycemia lactic acidosis cardiovascular toxicity in UGDP trial weight loss liver toxicity GI side effects uricosuric activity hyponatremia weight gain edema

How often should a patient with diabetes have their HbA1c tested? Discuss the role of self monitoring of blood glucoses in the management of patients with diabetes. How often should patients measure blood glucose? What is the recommended preventative and therapeutic measures for each of the following possible complication of diabetes? Gastroporesis Retinopathy Nephropathy Neuropathy Foot Care Cardiovascular Disease Hypertension Hyperlipidemia

A 54 year old African American woman with type 2 diabetes mellitus, hypertension and mixed dyslipidemia presents to clinic for routine follow up. Her medications are as follows: NPH 50 U qam, 25 U qhs Reg 20 U before breakfast and supper Lisinopril 20 mg qday Hydrochlorothiazide 25 mg qd Simvastatin 40 mg qd Aspirin 325 mg qd

VS: BP 125/72 HR 82 and regular T-98.4 F RR 10 Fasting blood glucose in clinic: 186 mg/dl Labs: TC 184 mg/dL TG 210 mg/dL LDL 99 mg/dL HDL 44 mg/dL HbA1c 10.4% AST/ALT within normal limits Screatinine 0.9 mg/dL Urine Albumin:Creatinine 40 mg/gm Home blood glucose records indicate the following averages (range) Fasting Prelunch Presupper HS 163 (110-204) 88 (65-110) 210 (140-260) 120 (80-150) Based on this information, make a recommendation on this patient's drug therapy management. 1. Identify any problems with the current therapy 2. Define your goals of therapy 3. Recommend a treatment plan including patient education and follow up.

A 19 year old male patient is visiting the diabetes clinic today for adjustment of his insulin regimens. He has had type 1 diabetes since he was 14 years old and had been stable on his insulin regimen throughout high school. Now that he is in his freshman year of college his nutrition and exercise habits have changed. His current regimen is 20 units of NPH before breakfast, 10 units of regular insulin before dinner and another 20 units of NPH before bedtime. He is very good about measuring his blood glucoses and shows you his diary. The readings are as follows for the past week: day 1 day 2 day 3 day 4 day 5 day 6 day 7 breakfast 100 95 87 110 125 140 92 lunch 70 55 50 60 58 72 80 dinner 149 155 170 199 165 180 145

How would you modify his current insulin regimen to help better manage his diabetes?

For each case, decide if the patient has: a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Impaired glucose tolerance

e. Impaired fasting glucose f. None of the above 1. 76 year old male with FBG of 144 and complaining of frequency in urination and dry mouth 2. 12 year old female with FBG of 80. 3. 56 year old female with FBG 120 4. 66 year old male with blood glucose of 156 2 hours after an oral glucose tolerance test. 5. 28 year old pregnant patient with FBG reading of 166 at 25 weeks gestation 6. 16 year old male with FBG of 400, with ketones in his urine

Fill in the ADA goals in the following table for glycemic control in patients
with diabetes mellitus.

Normal Goal for patients with diabetes Whole blood values Average preprandial glucose (mg/dL) Average bedtime glucose (mg/dL) Plasma values Average preprandial glucose (mg/dL) Average bedtime glucose (mg/dL) HbA1c <100 <110 ? ?

Additional action suggested

<110 <120

? ?

<6

Complete the table concerning the available oral antidiabetic agents

Drug Class Sulfonylureas Biguanides Mechanism of ActionDecrease in HbA1c Adverse Effects Advantages/ Disadvantages

Alpha Glucosidase Inhibitors Thiazolidinediones Meglitinides AD is a 54 year old male with history of DM 2, hypercholesterolemia, and myocardial infarction. His current medications include ASA 325 mg, glyburide 5 mg qd, and simvastatin 20 mg qd. His BP is 165/96, HR 90, wt 240 lb, ht 6 '. 42 yo male with HT x 10 years. He does not smoke and FLP is normal. ECG shows RRR with left ventricular hypertrophy. His serum creatinine is 1.8 mg/dL. His BP has been difficult to control, review of his chart shows it has been elevated on every visit over the past 2 years. Today his BP is 172/100. He is currently receiving clonidine 0.4 mg bid and verapamil 240 mg qd.

42 year old female with no other medical problems is here to followup her BP today and it is 148/96 (this is second check). She is 210 lb and 5'3". She takes Ortho/Novum 1/35 qd. Does not smoke or drink alcohol. GH is a 62 year old female with diabetes mellitus type 2 and hypertension. She takes metformin 850 mg bid, lisinopril 20 mg qd, and ASA 81 mg qd. Her BP is 120/80. Her DM is considered to be controlled with a glycosylated hemoglobin = 7.2 mg/dL. She has been trying to follow the low cholesterol/fat diet for several months but does not exercise. Her FLP continues to be LDL = 3.8 mmol/L, HDL = 1.2 mmol/L, and TG = 5.6 mmol/L. AL is a 54 year old male patient with history of myocardial infarction x 2. He has hypertension but his BP is 120/72 on lisinopril 40 mg qd and he does not smoke. He also receives ASA 81 mg qd and simvastatin 20mg qd. His baseline FLP showed LDL = 4.1 mmol/Land HDL = 1.4 mmol/L. After 3 months of therapeutic lifestyle changes such as walking and watching his diet his FLP shows LDL = 3.7 mmol/L and HDL= 1.5 mmol/L. His triglycerides are 4.9 mmol/L. 56 year old female who's BP is 158/82 on lisinopril 10 mg qd. She quit smoking 2 years ago. Her fasting lipid profile results include TC = 4.6 mmol/L, TG = 4.6, HDL 0.97 mmol/L, and LDL = 2.7 mmol/L. No evidence of CHD. 66 yo male with a 30 pack year history of smoking cigarettes. His TC = 6.6 mmol/L TG = 6/4 mmol/L, HDL = 1.2 mmol/L and LDL = 4.1 mmol/L. BP is 172/98 and he is not on any medications. No evidence of CHD. Recommend a treatment strategy for each patient.