Medication & Therapeutic Interventions Flashcards

Which rapid-acting insulin analog has the fastest onset of action and is approved for dosing up to 20 minutes after meal start?

Answer: Faster insulin aspart (Fiasp)

Faster insulin aspart (Fiasp) contains niacinamide and L-arginine that accelerate initial absorption, giving it an onset of 2.5 minutes and FDA approval for dosing at the start of or up to 20 minutes after meal initiation.

A patient on insulin pump therapy presents with persistent hyperglycemia despite multiple bolus corrections. The most likely cause and immediate intervention is:

Answer: Infusion site occlusion or catheter failure; change the infusion set and site

Persistent hyperglycemia unresponsive to bolus corrections in pump therapy most commonly indicates an infusion set or catheter problem, requiring immediate set and site change and often a corrective injection.

Colesevelam's glucose-lowering mechanism in T2DM is best described as:

Answer: Altering bile acid metabolism to improve FXR-mediated glucose homeostasis

Colesevelam binds bile acids in the intestine, altering the enterohepatic bile acid pool and activating farnesoid X receptor (FXR) pathways that improve hepatic and peripheral glucose metabolism.

When initiating a GLP-1 receptor agonist, the primary reason for starting at the lowest dose and titrating slowly is to:

Answer: Minimize gastrointestinal side effects including nausea and vomiting

GLP-1 receptor agonists commonly cause dose-dependent nausea and vomiting due to delayed gastric emptying; slow titration allows GI accommodation and improves adherence.

A 68-year-old patient with T1DM on multiple daily injections frequently experiences nocturnal hypoglycemia. Which intervention is most appropriate?

Answer: Transition to a hybrid closed-loop insulin delivery system

Hybrid closed-loop systems automatically suspend or reduce basal insulin delivery when glucose is predicted to drop, significantly reducing nocturnal hypoglycemia in T1DM patients.

Which drug interaction is most clinically significant for a patient with T2DM starting fluconazole therapy?

Answer: Fluconazole inhibits CYP2C9, increasing sulfonylurea levels and hypoglycemia risk

Fluconazole is a potent CYP2C9 inhibitor; sulfonylureas (especially glipizide, glimepiride) are CYP2C9 substrates, so co-administration can markedly increase sulfonylurea plasma levels and precipitate severe hypoglycemia.

Bromocriptine QR (Cycloset) lowers glucose in T2DM primarily by:

Answer: Resetting hypothalamic circadian dopaminergic tone to improve hepatic insulin sensitivity

Bromocriptine QR, a dopamine D2 agonist taken at waking, is thought to reset dysregulated hypothalamic dopaminergic activity that drives insulin resistance and hepatic glucose overproduction.