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Week 1

• Question: Why are statins recommended in the evening instead of morning? (pg 561) After starting John on insulin, he calls the office saying he feels bad.  He said when he checked his blood sugar before calling it was 52 mg/dl.  What instructions should he be given?
• Question: What diabetic medications would be contraindicated in patients with heart failure? Which diabetic drug(s) may have beneficial effects in heart failure? (text has info on this but ADA 2020 guidelines has even more up to date info on this topic, so here is the page. See Recommendation 9.9 and 9.10) https://care.diabetesjournals.org/content/43/Supplement_1/S98
• Question: What lab do we need to check prior to starting metformin? (hint: which organ function needs to be evaluated?)
• What other potential adverse effects are there associated with metformin? (Micromedex in the library is a good source for this info)
• Question: The GLP1RA class drugs end with “-tide”. They are highly recommended as a second agent after metformin by both ADA and AACE/ACE guidelines. Per ADA guidelines…… continue…. According to the text, what effect does carbamazepine have on thyroid function tests? What is the difference b/w total and free T4?
• Question: Can you review in our text the sulfonylurea class? What is the MOA, what are some examples? What are the adverse effects? Thanks!!
• Question: If our patient had HF and Afib, he might be on digoxin. What medication for DM can decrease digoxin levels? (class and examples)
• Question: Jason- glad you recognized that contrast dye can be an issue for patients on metformin. 
• Can you read this (older, I know) article that explains why it is a concern rather than binding with contrast dye?
• Question: Can you review for us what the ADA criteria for diagnosis of T2DM are? 
• Question: If John’s A1C remains elevated and he does not have any indicators or at high-risk for ASCVD, CKD, or HF, a thiazolidinedione (TZD) could be prescribed (American Diabetes Association, 2020).  How do thiazolidinediones help control blood sugar?  Why is it important that there is little to no risk indicators for cardiovascular involvement when prescribing TZDs?
• Question: One class of diabetic drugs sometimes used is meglitinides.  What is an important teaching point about this drug for patients to make sure the drug is most effective?
• Question: What side effects are most common for GLP-1 receptor agonists?  What diseases would be contraindicated to have with the administration of GLP-1 receptor agonists?
• Question: If John is started on insulin and he still struggles to meet A1C goals, a sodium–glucose cotransporter 2 (SGLT2) inhibitor to insulin therapy has shown the ability to improve A1C levels while also aiding in decreasing body weight when compared with insulin therapy alone (American Diabetic Association, 2020). How do SFLT2 drugs work and what are some examples of drugs in that class?
  

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Week 2

• Question: The current IDSA guidelines (2019) recommend the following 3 options when treating CAP in a previously healthy patient…….
• Question: Can you tell us (from the text), what is the definition of drug-resistant TB?
• Question: From our text can you tell us the findings of the SMART trial regarding salmeterol use?
• Question: According to our text, what is the advantage of using transdermal nicotine over nicotine gum?
• Question: Theophylline is not used very often anymore but we may see it used by a specialist when inhaled therapy is insufficient. The reason is that this is a drug with a narrow therapeutic window- it is associated with toxicities including seizures. It is a drug that requires monitoring of drug levels.
• According to our text, are there any considerations regarding theophylline and type of diet?
• Question: If a woman is pregnant and taking INH, what supplement do we need to advise?
• Question: What type of medication is Spiriva? What is the generic name?
  

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Week 3

• Question: As we discuss medications for HTN this week let’s consider a pregnant women and women of childbearing age who might become pregnant. What classes are contraindicated for pregnant woman?
• Question: One of our reading topics this week is reduction of lipids. Can you tell us about fenofibric acid? What is it used for and how does it work? At what level of hypertriglyceridemia should it be considered to reduce the risk of pancreatitis?
• Question: Thanks! To help with our topic of lipid management this week, what lab test should we order if a patient on a statin develops muscle pain?
• Question: To help with our review of lipid therapies this week, will you tell us about ezetimibe (Zetia)? What is it MOA and is it a first line agent?
• Question: If a patient has heart failure why would we need to be cautious about prescribing calcium channel blockers? Which CCB have the strongest neg inotropic effect?
• Question: Can you review the discussion of angina which discusses imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs affect MOS? Which affect MOD?
• Question: What antihypertensive class is indicated in a patient with DM who has microalbuminuria? According to the text, what are conditions would this class be indicated for?
• Question: What is the dosing schedule for long acting isosorbide mononitrate and why?
• Question: According to our text, what lipid abnormality is most likely to benefit from omega 3 FA supplementation?
• Question: To help with this week’s study can you review from the text the causes of systolic heart failure?
• Question: What is the dosing schedule for ACEIs? (how many times per day are they taken?)
• Question: According to the text, what labs should be checked in a week after initiating an ACEI? Why?
• Question: What anti-arrhythmic medication in the reading this week requires pulmonary and thyroid function monitoring every 6 months? 
• Question: Can you review the classes of angina from our text?
• Question: From our text, can you review the statin strength from weakest to highest?