Advanced Pharmacology Final Already Passed

A patient with a history of DM2 (Hb A1C = 8.5) and recent hospitalizations due to hypoglycemia and pancreatitis is seen at the clinic. What pharmacological changes the APRN must consider? A) Stop Glyburide and Start on Metformin B) Stop Sitagliptin and Start on Glyburide C) Stop all agents, and start Lispro D) Stop Exenatide and start Sitagliptin {Ans: A) Stop Glyburide and Start on Metformin}Alzheimer's treatment {Ans: • Cholinesterase Inhibitors • Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne) • Mainly affects cholinergic neurons. • Only mild to moderate • They are cholinesterase inhibitors: more conduction issues; bradycardia (CI to certain patients) • Increase vagal tone, FALL RISK • N/D, weight loss and anorexia • Memantine • NMDA antagonist • Used for moderate to severe • Glutamate agonizes NMDA and this is bad. Glutamate Excitatory NT; too much Calcium influx leading cell to die. • NMDA: affects pt ability to learn and memory. • Positive neuroprotective effects by Inhibiting glutamate from binding to NMDA receptors. • Antipsychotics, Antidepressants, (AVOID Benzodiazepines) • Recommended Order if Treatment for AD • First line • Cholinesterase inhibitors (CIs): once-daily CIs will be most likely first-line agents for mild to moderate AD. • Memantine: