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Diabetes Care in the Pharmacy: Tech Talk, Immunization Insight, and Cognition Changes (And How to Handle Them) Pharmacist Post-testPharmacist Learning Objectives:DISCUSS diabetes mellitus and its current guidelines with an emphasis on SMBG and immunizationEXPLAIN treatment approaches, comorbidities, and risk-factors in patient-friendly languageANALYZE treatment for gaps in care or duplicate therapiesDIFFERENTIATE among new options for self-monitoring blood glucoseOlder adults with diabetes are at high risk of developing which of the following complications?Hepatic diseaseCancerCognitive impairment Which of the following is NOT a reversible cause of cognitive impairment?MedicationsSmokingMetabolic disturbances Communicating with older adults can often be more difficult than with their younger counterparts. Which of the following are potential barriers to communication in this population, especially those with cognitive impairment?Difficulty with word finding and fluencyPoorly developed vocabularyOften speak at an inaudible volumeWhich of the following is a method to improve communication with older adults? Use technical medical terminology Reduce distractions and maintain eye contactAsk multiple questions at a time for efficiencyPatient BG is well-known to your pharmacy clinic for management of his type 2 diabetes mellitus. He is currently managing his blood sugars with multiple oral antihyperglycemics and four insulin injections per day. He currently checks his blood sugar using a glucometer three to four times per day. BG reports he is tired of “all of the constant fingersticks” and asks if there are any other options for glucose monitoring. How would you respond to BG?No, patients with type 2 diabetes mellitus are not candidates for continuous glucose monitoringYes, patients managed with oral antihyperglycemics are perfect candidates for continuous glucose monitoringYes, patients requiring three or more insulin injections per day are potential candidates for continuous glucose monitoringA patient currently on insulin pump therapy asks if you could help him select the most appropriate CGM device. He would like to avoid all fingersticks, if possible. Which CGM device would be the most appropriate based on this patient’s preferences?Dexcom G6Medtronic GuardianFreestyle LibreWhich medication class is most commonly associated with higher risk of hypoglycemia in older adults? BiguanidesSGLT-2 InhibitorsSulfonylureasTJ is a 64-year-old African American male with diabetes who was recently discharged from the hospital after having a heart attack. After filling his medications post-discharge, you notice his prescriber did not write for a statin. Assuming no contraindications exist, which of the following statins would you recommend for TJ? Atorvastatin 10 mg daily Rosuvastatin 20 mg dailyPravastatin 80 mg daily Which of the following medication combinations is considered inappropriate and should not be used? Dulaglutide + insulin glargine Glipizide + metformin Saxagliptin + lixisenatideCU is a 70-year-old female who was recently diagnosed with heart failure with reduced ejection fraction (EF = 30%). She presents to your pharmacy today for a medication review. She reports being overwhelmed by all of her new medications for heart failure. Her current medications include lisinopril 10 mg daily, metoprolol XL 100 mg daily, atorvatstain 80 mg daily, aspirin 81 mg daily, metformin 1000 mg twice daily, pioglitazone 30 mg daily, sitagliptin 100 mg daily, and furosemide 20 mg daily as needed for edema. After review of her medications, which of the following medication recommendations do you have for CU’s provider? D/C pioglitzone and start empagliflozinChange sitagliptin to saxagliptin Decrease atorvastatin to 40 mg daily MN, a 66-year old female, presents at the counter requesting a pneumonia vaccine. You review her medical records to determine which pneumonia vaccine is most appropariate for her. You learn that she has type 2 diabetes, hypertension, and seasonal allergies. She denies tobacco abuse and has no known drug allergies. She lives at home with her daughter and son-in law. She reports receiving a dose of PPSV23 at age 60. Which of the following pneumonia vaccines is most appropriate for MN today? PCV13 x 1 dose today followed by PPSV23 8 weeks laterPPSV23 x 1 doseNeither. She needs to wait until she is 70 before receiving another dose of the pneumonia vaccine.Which of the following unvaccinated patients with diabetes is LEAST likely to require the hepatitis B vaccine series? A 70 year old male with type 2 diabetes on metformin therapy only not currently testing his blood sugars A 19 year old female with type 1 diabetes who injects her insulin four times per day A 54 year male with type 2 diabetes living in an assisted living facility who takes insulin glargine once daily along with metformin ................
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