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Correct OPTION is (b) Insulin aspart

Explanation: It was approved by the FDA in 2000. Insulin aspart has a rapid ONSET and short DURATION of glucose lowering activity. The amino acid, B28 of the parent chain, which is normally proline, is substituted with an aspartic acid residue making it short-acting insulin. This means this drug has to be taken just before meals.

The correct choice is (a) DETEMIR

To explain I would say: Detemir is marketed under the brand name Levemir and manufactured by Novo Nordisk. It is an INSULIN analogue in which a FATTY acid (myristic acid) is bound to the lysine amino acid at position B29. It is QUICKLY absorbed after which it binds to ALBUMIN in the blood through its fatty acid at position B29. It then slowly dissociates from this complex.

The correct choice is (d) Glargine

To elaborate: Glargine is manufactured by Aventis Pharmaceuticals and is marketed under the brand NAME Lantus. Insulin glargine has a SUBSTITUTION of glycine for asparagine at A21 and two arginines ADDED to the carboxy terminal of B chain. THUS its name is gl-arginine.

The CORRECT answer is (c) Glulisine

BEST explanation: Insulin glulisine has become available in 2006. It is best known by its BRAND name Apidra and is marketed by Sanofi-Aventis. The amino ACID asparagine at position B3 is replaced by lysine and the lysine in position B29 is replaced by glutamic acid, THUS it gets its name glulisine.

Right OPTION is (b) Insulin Aspart

Explanation: Insulin aspart was approved by the Food and Drug Administrations (FDA) in 2000 and is marketed by Novo Nordisk under the brand NAME NovoLog. The amino acid, B28 of the parent insulin peptide CHAIN, which is normally proline, is substituted with an ASPARTIC acid residue.

Correct option is (a) Lispro

Explanation: Insulin lispro was marketed by Eli LILLY under the brand name Humalog. Humalog has been available since 1966. LYSINE and PROLINE residues on the C-terminal end of the B-chain are REVERSED.

The correct OPTION is (b) Modified to act slower or faster

To EXPLAIN I would SAY: An insulin analog is a chemical COMPOUND that is made by deletion, substitution, the addition of amino acids or a chain to the parent insulin molecule. The parent chain of insulin has 51 amino acids. Too make it fast acting or slow acting or to increase its half-life researchers try to create different forms of insulin ANALOGUE.

Correct option is (a) Alpha-glucoside inhibitors

The explanation is: Alpha-glucoside Inhibitors are slow carbohydrate digestion and delay rate of GLUCOSE absorption. The patient has to take with the FIRST bite of the meal or after 15 min. ADJUNCT to DIET to decrease blood glucose levels. Example of such drugs is Acarbose(Precose), Miglitol (Glyset).

The correct ANSWER is (c) Biguanides

Explanation: Biguanides decreases the overproduction of glucose by the liver and makes INSULIN more EFFECTIVE in PERIPHERAL tissues. It is USED in obese diabetics. It does not stimulate insulin release. It is metabolized by the kidney, do not use with renal patients. Example of Metformin (Glucophage).

The correct option is (d) Meglitinide

Easy EXPLANATION: Meglitinide stimulates pancreatic cells to secrete more insulin. It should be taken just before meals, rapid onset, limited duration of action. Major ADVERSE effects are HYPOGLYCEMIA (low levels of blood sugar). Used in non-obese diabetics i.e. TYPE 2 diabetes. Example: Repaglinide.

The correct choice is (b) Sulfonylureas

The best I can EXPLAIN: Sulfonylureas STIMULATES pancreatic CELLS to SECRETE more insulin and increases the sensitivity of peripheral tissues to insulin. It is used to treat non-obese Type 2 diabetics. Example of the medicine in sulfonylureas class is Glipizide.

Correct CHOICE is (a) True

The best explanation: Clients with hypertension, HDL cholesterol < 35 mg/dL, and/or triglyceride level > 250 mg/dl have the risk factor for diabetes mellitus. History of diabetes in PARENTS or siblings can give US diabetes mellitus. Obesity, especially of the UPPER body, possesses a huge risk of diabetes mellitus.

The correct answer is (d) Kussmals respirations

Easy explanation: Kussmals breathing is blowing off carbon dioxide to reverse acidosis. This is done when kidneys are not removing excess acid from the BODY. Fever, cough, body ACHE are not a symptom for this DISEASE. Fruity breath, NAUSEA, abdominal pain, dehydration, lethargy, coma, polydipsia, polyuria, polyphagia are the symptoms of diabetes mellitus.

The CORRECT answer is (C) Less crave for food

To EXPLAIN: A person with diabetes will have hunger and will eat more since cells cannot UTILIZE the ongoing glucose concentration of the body. When there is no glucose or the body cannot utilize the glucose the stomach SIGNALS the brain for hunger and brain tells us we are hungry as a result diabetes patient feel hungry more often.

Right choice is (c) HUNGER

To elaborate: Polyphagia is the name given to a diabetes patient who is suffering from hunger, and EATS more often because his cells are not able to utilize GLUCOSE. The PATIENTS also suffer from chronic weight loss since the body tends to break down fat and protein to restore ENERGY source.

Right choice is (b) OSMOTIC diuretic like activity being a hyperglycaemic

The best I can explain: Polyuria is URINATION several times a day. This is a common symptom for all diabetes patient. Being hyperglycemia it acts as an osmotic diuretic thus INCREASES the renal fluid absorption and thus urination is maximum. Thirst from dehydration is polydipsia. Hunger is POLYPHAGIA.

Correct option is (a) Thirst from dehydration

To EXPLAIN I would say: Hyperglycaemia acts as an osmotic diuretic and thus increased the frequency of URINATION. This leads to thirst from dehydration and the PATIENT tends to DRINK a lot of WATER. Polyuria is frequent urination. Hunger and frequent eating is polyphagia. Polydipsia is thirst from dehydration.

The correct OPTION is (d) BETA CELL destruction

To explain I would SAY: Manifestation is the process of beta cell destruction which occurs very slowly. Hyperglycemia occurs when 80 – 90%of the beta cells are destroyed. This then triggers stressor event (e. G. illness).

The correct option is (a) The body becomes RESISTANT to insulin

To elaborate: Type 2 Diabetes is when the body becomes resistant to insulin, insulin is being produced but not being efficiently used up. It is a CONDITION where the body fails to respond to insulin properly. This is also known as “non-insulin dependent diabetes MELLITUS”. The most common cause will be excessive body WEIGHT.

Correct option is (a) The immune SYSTEM destroys beta cells and no more insulin is being PRODUCED

For explanation I would say: Type 1 Diabetes is when the immune system destroys beta cells and no more insulin is being produced. It is the result of pancreas fails to produce enough insulin due to the loss of beta cells. This is also known as “insulin-dependent diabetes mellitus”. The cause of the DISEASE is not known and MAY be an AUTOIMMUNE disease.

Right option is (c) Rx

Explanation: Rx or Recipe (translates as TAKING THOU). If a prescription is for amoxicillin this part of the prescription MAY read as RxAmoxicillin caps 250 mg or RxAmoxicillin syrup 125mg/5ml. The first part of the prescription lists the name of the medicine, formulation and the STRENGTH of the medicine.

Correct option is (b) SIG

The explanation is: Second PART of prescription are the instructions that go on the LABEL. Traditionally begins with Sig. This is short for Signa which means a mark or write. For amoxicillin this MAY be WRITTEN as Sig: i t.i.d. p.o.

The correct ANSWER is (a) Mitte

Explanation: Third part of the PRESCRIPTION specifies the quantity to be dispensed. Traditionally prefaced by Mitte or M: For amoxicillin may specify one WEEK’s supply M: 1 week supply. The largest quantity dispensed is 3 months’ supply except, for oral CONTRACEPTIVE which is 6 months’ supply.

Right choice is (a) True

Explanation: A doctor should list all MEDICINES including dose, ROUTE, and FREQUENCY CLEARLY on a prescription. 50% of misunderstanding happens with DRUG consumption due to miscommunications between the doctor and the patient. The doctor should also specify any changes to medicines and why they were started, stopped or the dose changed.

The CORRECT OPTION is (C) p.r.

Explanation: Whenever a drug has to be injected subcutaneously the doctor will write s.c. Many drugs when has to be given to kids will be given rectally. Since for kids INJECTION or orally can be difficult rectally is a better WAY.

The correct choice is (a) p.o.

The explanation is: Whenever a DRUG has to be INJECTED SUBCUTANEOUSLY the doctor will write s.c. whenever the drug has to be taken orally the doctor will write p.o., drugs such as paracetamol, pantoprazole, ETC. will be given orally. These drugs will have extra coating so that they do get dissolved by the acidic environment. For intramuscular the doctor will write i.m. for INTRAVENOUS the doctor will write i.v. for rectal administration, the doctor will write p.r.

The correct answer is (b) s.c.

To elaborate: Whenever a DRUG has to be INJECTED subcutaneously the doctor will write s.c. whenever the drug has to be TAKEN orally the doctor will write p.o. for intramuscular the doctor will write i.m. for intravenous the doctor will write i.v. for RECTAL administration, the doctor will write p.r.

Right ANSWER is (c) Nocte

Explanation: Various drug has various different timing of ADMINISTRATION such as early morning in empty stomach, after dinner, after lunch, etc. Thus when a doctor writes nocte on a prescription that CLEARLY TELLS that we should take the medicine at night. Mane means the medicine has to be taken in the morning. Midi means the drug has to be taken in the MIDDAY.

The correct ANSWER is (b) p.c.

The BEST I can explain: P.c. means after food. That means the PATIENT should take in the FULL stomach. When a doctor writes a.c. on prescription for a drug that means you should take it before food. P.r.n. means the drug can be taken as required. P.r means the dosage has to be given rectally.

The CORRECT option is (a) a.c.

To EXPLAIN: When a doctor WRITES a.c. on prescription for a DRUG that MEANS you should take it before food. P.c. means after food. P.r.n. means the drug can be taken as required. P.r means the dosage has to be given rectally.

Correct choice is (b) Midi

The explanation: Thus when a drug has to be TAKEN on the MIDDAY the doctor will WRITE midi INDICATING you should take the drug in the midday. Mane means take in the MORNING. Nocte means take at night.

Right answer is (a) Mane

Best explanation: Various drug has various DIFFERENT TIMING of administration such as early morning in empty stomach, after dinner, after LUNCH, etc. Thus when a dosage has to be taken in early morning DOCTORS write mane indication morning on the prescription. Midi means take on the midday. NOCTE means take at night.

The CORRECT option is (d) Once daily

The best explanation: The abbreviations for o.d. is once a day, t.d.s. MEANS twice a day, b.i.d. means twice a day, q.i.d. means for times a day. These abbreviations are used by a DOCTOR on a prescription such that with short writing a lot of information can be put TOGETHER.

Right choice is (C) Quantity to be dispensed

Easy explanation: The 3^rd part of the prescription SPECIFIES the quantity to be dispersed. That is the DOSAGE should be taken for how many days. Traditionally STARTS with M or Mitte. For example, M: 1 week’s supply. The LARGEST quantity of dispensed is 3 months’ supply and for oral contraceptive which is 6 months’ supply.

Correct CHOICE is (b) How to take the medicine

The explanation: The 2^nd part of the prescription is the instructions that go on the label. It BEGINS with the Sig which is the short of Signa which MEANS a mark or write. For example, if any DOCTOR is prescribing amoxicillin it may be written as Sig: i.t.i.p.o that means TWICE a day orally.

The correct ANSWER is (a) NAME of medicine

For explanation: A prescription has 3 parts. The 1^st part contains the name of the medicine, formulation which is to be TAKEN, STRENGTH of the medicine that is to be taken. For example, if the prescription is for amoxicillin the 1^st part will be Rx or RECIPE Amoxicillin caps 500 mg. in the 2^nd part more details of how to take the medicine will be given.

Right CHOICE is (a) How to take the medicines

Easy explanation: A prescription has 3 parts. The 1^st part CONTAINS the name of the medicine, FORMULATION which is to be taken, strength of the medicine that is to be taken. For EXAMPLE, if the prescription is for amoxicillin the 1^st part will be Rx Amoxicillin caps 500 mg. The 2^nd part has the INSTRUCTIONS that go on the label. And 3^rd part tells the quantity to be dispensed.

Correct answer is (c) Under 6 years of AGE

To explain: Y means the prescription belongs to the patient under 6 years of age. J means the patient is under 16 years of age. The A on the top of a prescription means adult. O means script for an oral contraceptive. All these MUST be CAREFULLY REPRESENTED on a prescription. If not, the age must be written on the prescription.

The CORRECT choice is (b) Under 16 years

The best explanation: J MEANS the PATIENT is under 16 years of age. The A on the TOP of a prescription means adult. O means script for an oral contraceptive. Y means the prescription belongs to the patient under 6 years of age. All these must be CAREFULLY represented on a prescription. If not the age must be written on the prescription.

Right option is (d) Script for oral contraceptive

To explain I would say: O MEANS script for an oral contraceptive. The A on the TOP of a prescription means adult. J means the patient is under 16 years of age. Y means the prescription BELONGS to the patient under 6 years of age. All these must be carefully REPRESENTED on a prescription. If not, the age must be written on the prescription.

Right answer is (a) ADULT

The explanation: The A on the top of a PRESCRIPTION means adult. O means script for an oral CONTRACEPTIVE. J means the patient is under 16 years of age. Y means the prescription BELONGS to the patient under 6 years of age. All these must be carefully represented on a prescription. If not the age must be written on the prescription.

Correct option is (a) Patient name

For explanation I would say: The name of the patient must be the 1^st thing written on a PRESCRIPTION followed by an ADDRESS and the MCI registration number of a doctor. All three THINGS must be clearly written on the prescription form. There is no need for a patient’s PARENT’s name. The illness should be described WELL.

Right answer is (b) False

The explanation: It is essential that the prescription is legible i.e. clear enough to read by the patients and by the shopkeepers. Most prescriptions in GENERAL Practice are now COMPUTER GENERATED. Recently this has been introduced for some prescriptions WRITTEN in hospital i.e. those written together with an electronic DISCHARGE summary.