Deck 13: Drugs Used in the Treatment of Diabetes Mellitus

Question 1

Which antihypoglycemic medication has restricted use due to an increase in U.S.Food and Drug Administration (FDA)-reported cardiovascular events?

A)biguanide (Metformin)
B)rosiglitazone (Avandia)
C)acarbose (Precose)
D)sitagliptin (Januvia)

Answer 1

rosiglitazone (Avandia)

Question 2

As a physician assistant,you have the responsibility to educate patients and families regarding diabetes treatment.When you have a patient taking a biguanide,what specific information should you share regarding the intake of alcohol?

A)Drinking alcohol will increase the risk of hyperglycemia.
B)Drinking alcohol will increase the risk of hypoglycemia.
C)Drinking alcohol will have no effect.
D)Drinking alcohol is not tolerated while taking a biguanide.

Answer 2

Drinking alcohol will increase the risk of hypoglycemia.

Question 3

The primary physiological problem in T2DM includes:

A)Destruction of pancreatic beta cells.
B)Secondary disease such as pancreatitis.
C)Insulin resistance in tissues.
D)Decreased insulin production.

Answer 3

Decreased insulin production.

Question 4

You are currently caring for a 55-year-old male who was diagnosed with diabetes 9 months ago.You would consider him to be in glycemic control when his HbA1c is at which of the following levels:

A)6%.
B)8%.
C)10%.
D)12%.

Question 5

Which major organ is primarily involved in the etiology of T2DM?

A)Pancreas
B)Liver
C)Heart
D)Kidney

Question 6

Which of the following groups has not experienced a decrease in problems with vision secondary to diabetes?

A)Asian Americans
B)African Americans
C)All Caucasians
D)Native Americans

Question 7

A plasma glucose concentration of 115 mg/dL is indicative of which category?

A)Within normal range
B)Prediabetes
C)Overt diabetes

Question 8

You have just examined a 45-year-old,slightly obese female who you diagnosed with T2DM 1 to 2 months ago.Her remaining medical history is unremarkable.Your first line of treatment consisted of the ADA's diet and exercise.You notice her self-reported blood glucose levels have shown an occasional hypoglycemic episode.When she returns today,she is still not in glycemic control.Which step would you recommended next in the treatment of this patient?

A)Begin insulin therapy immediately
B)Begin a single pharmacological agent,metformin (Glucophage)
C)Begin a single pharmacological agent,a sulfonylurea
D)Begin treatment with two agents,metformin and a sulfonylurea

Question 9

You are caring for a patient with T2DM and are planning to add acarbose (Precose)to the medication regime.For what reason is it important to titrate the dosages of this medication?

A)To minimize hypoglycemic effect
B)To minimize gastrointestinal (GI)side effects
C)To minimize lactic acidosis
D)To minimize weight gain
E)To minimize weight loss

Question 10

You are caring for a 55-year-old male who is 5'9" and 225 lbs and was recently diagnosed with T2DM.He has no other comorbidities at this time and is on no medication.Today's visit is to discuss your suggested management of his problem.His recent HbA1c level was 6%.Based on this brief history,which of the following treatments are you most likely to suggest for this patient?

A)Begin oral hypoglycemic metformin
B)Begin with two different oral hypoglycemics
C)Start immediately on insulin,short and long acting
D)Treat with diet only
E)Begin oral hypoglycemic sulfonylureas

Question 11

Which of the following is considered a common side effect of sulfonylureas?

A)Occasional intolerance to heat
B)Headaches
C)Constipation
D)Weight gain
E)Weight loss

Question 12

What is the main reason that metformin does not usually cause hypoglycemia in patients with T2DM?

A)Metformin stimulates insulin release from pancreatic beta cells.
B)Metformin decreases glucose production in the liver.
C)Metformin suppresses glucagon production.
D)Metformin slows inactivation of peptide 1 and dipeptidyl-peptidase 4.

Question 13

The primary cause of type 1 diabetes mellitus (T1DM)is:

A)Overproduction of insulin by the pancreatic beta cells.
B)Overproduction of insulin by pancreatic alpha cells.
C)Overdestruction of insulin by pancreatic beta cells.
D)Overdestruction of insulin by pancreatic alpha cells.

Question 14

What percentage of Americans older than age 20 is at risk for complications from diabetes?

A)25%
B)35%
C)55%
D)75%

Question 15

When caring for a patient with diabetes,the most important therapeutic intervention is:

A)Insulin pump.
B)Rapid-acting insulin.
C)Lifestyle changes.
D)Prefilled insulin syringes.

Question 16

Which type of T1DM can have tyrosine phosphatase 1A-2 autoantibodies?

A)Immune mediated
B)Nonimmune mediated
C)Idiopathic mediated
D)Cytomegalovirus mediated

Question 17

Which patient newly diagnosed with T2DM would respond best to sulfonylureas?

A)A patient with mild to moderate fasting hyperglycemia
B)A patient with moderate to severe fasting hyperglycemia
C)A patient with an HbgA1C of 12%
D)All newly diagnosed T2DM patients

Question 18

Which sulfonylurea causes the most side effects?

A)tolbutamide (Orinase)
B)glyburide (DiaBeta)
C)glimepiride (Amaryl)
D)chlorpropamide (Diabinese)
E)tolazamide (Orinase)

Question 19

What is the mechanism of action for sulfonylureas?

A)Not fully known at this time
B)Decreasing carbohydrate absorption in the GI tract
C)Increasing insulin secretion from pancreatic beta cells
D)Slowing gastric emptying and suppressing glucagon production

Question 20

According to the American Diabetes Association (ADA)algorithm regarding use of insulin for type 2 diabetes mellitus (T2DM),if a patient's HgbA1c is not around 7% at the end of 3 months of therapy,which of the following actions would be considered appropriate?

A)Continue current insulin dose;recheck HbA1c in 1 month
B)Continue current insulin dose;recheck HbA1c in 3 months
C)Completely revamp insulin dose
D)Continue with same insulin but increase all doses,a.m.and p.m.
E)Continue with same insulin but decrease all doses,a.m.and p.m.

Question 21

When is the use of NovoLog,Apidra,or Humalog recommended in a diabetic patient?

A)When a patient needs coverage for 1 full day
B)When a patient eats at the same time the insulin is given
C)When a patient eats within 30 to 60 minutes of insulin administration
D)Twice daily before meals regardless of timeframe

Question 22

Which of the following is a common side effect seen in patients taking DPP-IV inhibitors?

A)Significant weight gain
B)Significant weight loss
C)Significant GI distress
D)Significant hypoglycemia
E)Significant chance of pancreatitis

Question 23

GLP-1 agonists are indicated to treat which type of patient?

A)Newly diagnosed patient with T2DM who has had no prior drug therapy
B)Newly diagnosed patient with T1DM who has not started insulin therapy
C)Newly diagnosed patient with T1DM whose postprandial glucose remains elevated
D)Established T2DM patient whose postprandial glucose remain elevated with metformin
E)Established T1DM patient whose postprandial glucose remains elevated

Question 24

A patient with T2DM is 35 years old and has two children,but does not currently desire to enlarge her family and is therefore on oral contraceptives.She has been taking pioglitazone (Actos)without problems.Which recommendation is most important for you to discuss with the patient at this time?

A)She should use a higher dose oral contraceptive.
B)She does not need to alter her oral contraceptive dose.
C)She may increase her chance of conceiving a child with Down's syndrome.
D)She will not have problems if she adds metformin to her medication regimen.
E)She will not have problems if she adds glimepiride to her medication regimen.

Question 25

Which of the following demonstrates the primary differences between meglitinides and sulfonylureas?

A)Meglitinides have the propensity to cause weight loss;sulfonylureas cause weight gain.
B)Meglitinides are longer acting than sulfonylureas.
C)Meglitinides are shorter acting than sulfonylureas.
D)Meglitinides decrease glucose production;sulfonylureas stimulate insulin secretion.

Question 26

One reason diabetic patients have difficulty losing weight is due to the effects of insulin.Which of the following effects most specifically relates to this inability to lose weight?

A)Insulin acts on glucose cell membrane transporters.
B)Insulin acts on glucose/glycogen storage in the liver.
C)Insulin acts on adipose tissue,circulating free fatty acids.
D)Insulin acts on muscle cell growth,promoting protein synthesis.

Question 27

The primary mechanism of action for alpha-glucosidase inhibitors includes:

A)Increased production of insulin.
B)Increased production of glucagon.
C)Decreased absorption of carbohydrates in the GI tract.
D)Decreased gastric emptying.

Question 28

A patient who was just recently started on repaglinide (Prandin)has called in to ask for your advice.She will not be able to take time to eat lunch today and because she is on the medication three times daily,she needs to know what to do about her usual lunch time dose.How should you advise her?

A)Continue to take the medication as prescribed.
B)Skip the lunch dose and double the dose for dinner.
C)Skip the lunch dose and continue with the normal dose for dinner.
D)Skip both the lunch and dinner doses.
E)Take the lunch and dinner doses at 10 minutes before the meal.

Question 29

From which location is the subcutaneous injection of insulin best absorbed?

A)Inner thigh
B)Upper arm
C)Buttock
D)Abdomen
E)Outer thigh

Question 30

What instructions would you give to a newly diagnosed diabetic patient you have just started on insulin?

A)Measure blood glucose every morning and report to you every 2 weeks.
B)Measure blood glucose twice daily and report to you weekly.
C)Measure blood glucose three times daily and report to you weekly.
D)Measure blood glucose every other day and report to you every 2 weeks.

Question 31

When treating a patient with T1DM for severe hypoglycemia,which condition is considered a contraindication for administering glucagon?

A)Pheochromocytoma
B)Acute pancreatitis
C)History of gastroparesis
D)Cirrhosis
E)Congestive heart failure

Question 32

You have just evaluated a patient that has been recently diagnosed with T2DM.You choose to start this patient on metformin (Glucophage).Which instruction is most appropriate to give this patient regarding dosing and instructions?

A)Take 500 mg once daily in the evening.
B)Take 850 mg once daily in the evening before eating.
C)Take 850 mg once daily in the evening after eating.
D)Take 500 mg twice daily with meals.
E)Take 500 mg twice daily before meals.

Question 33

An established patient in your practice is coming to see you for ongoing treatment of T2DM.She is a 59-year-old female who is currently on repaglinide (Prandin)0.5 mg daily.However,her recent HbA1c level was 9%.What changes,if any,would you make in her medication dose at this time?

A)No changes at this time;wait and check HbA1c in 2 weeks.
B)Decrease her dose to 0.25% daily.
C)Increase her dose to 3 mg daily in divided doses.
D)Increase her dose to 4 mg daily in divided doses.
E)Increase her dose to 6 mg in the morning.

Question 34

While working in the emergency department,you see a 24-year-old male with T1DM who appears lethargic,confused,and disoriented.A stat blood sugar reveals the patient is severely hypoglycemic.Which action is most appropriate for immediate treatment for this patient?

A)Instruct the nurse to give the patient a glass of orange juice.
B)Instruct the nurse to give the patient another dose of his regular insulin.
C)Instruct the nurse to administer 1 mg IV glucagon.
D)Instruct the nurse to administer 3 mg IM glucagon.
E)Instruct the nurse to administer 5mg SQ glucagon.

Question 35

As a surgical physician assistant student,you are taking care of a patient with T2DM who is undergoing an emergency appendectomy.She is currently maintained on the meglitinide repaglinide (Prandin).You speak to the anesthesiologist,who informs you the patient will be started on insulin before surgery.Based on this information,what will you expect to occur in regards to her Prandin dosage?

A)Discontinued Prandin
B)Increased dose of Prandin by double
C)Decreased dose of Prandin by one-half
D)No change in the Prandin dose because the insulin will self-regulate

Question 36

The most common adverse effects of the drug class thiazolidinediones (TZDs)are weight gain and:

A)Headaches.
B)GI upset.
C)Constipation.
D)Fluid retention.
E)Hypoglycemia.

Question 37

Which medication class produces GI discomfort,including gas production,to the point that many patients discontinue them secondary to their side effects?

A)Alpha-glucosidase inhibitors
B)TZDs
C)Amylin analogs
D)GLP-1 agonists

Question 38

You have been caring for a patient with T2DM and have decided to begin insulin therapy.What general rule is important to remember when prescribing insulin to a T2DM patient?

A)A T2DM patient should never be given insulin.
B)Insulin dose should be lower than dose given to a T1DM patient.
C)Insulin dose should be higher than dose given to a T1DM patient.
D)T2DM should only receive fast-acting insulin.
E)T2DM should only receive long-acting insulin.

Question 39

The GLP-1 agonist exenatide (Byetta)is administered in which manner?

A)5 mg po twice daily 30 minutes prior to morning and evening meals
B)5 mg po twice daily 60 minutes prior to morning and evening meals
C)5 mcg SQ twice daily 30 minutes prior to morning and evening meals
D)5 mcg SQ twice daily 60 minutes prior to morning and evening meals

Question 40

A 35-year-old male patient with diabetes presents to the emergency department with complaints of weakness and dizziness.He states that he thinks the symptoms are related to a recently played soccer game.He is on insulin and took his normal recommended dose before he ate lunch.As you are talking to him,he becomes diaphoretic,complains of being very hungry,and his heart rate increases to 100 beats/minute.What is the most likely problem at this time?

A)Patient took too little insulin
B)Patient took too much insulin

Question 41

The incidence of T2DM in the pediatric and adolescent population has been dramatically rising.Knowing this,what is the best practice for treating this population when diet,exercise,and metformin treatment have been unsuccessful?

A)Add chlorpropamide
B)Add insulin
C)Add a sulfonylurea
D)Refer to a pediatrician
E)Refer to a pediatric endocrinologist