Medication & Therapeutic Interventions Flashcards

A patient with T2DM, obesity (BMI 38), and an A1C of 9.1% is seeking the most effective dual therapy for both glycemic control and weight loss. The best combination is:

Answer: Metformin + semaglutide

Semaglutide (GLP-1 RA) combined with metformin provides superior A1C reduction and significant weight loss (6–14%) compared to other add-on agents, making it the preferred choice for this patient profile.

The 'correction factor' (insulin sensitivity factor) is used in intensive insulin therapy to:

Answer: Estimate how much 1 unit of rapid-acting insulin will lower blood glucose

The correction factor (e.g., 1 unit lowers glucose by 50 mg/dL) is calculated from the total daily insulin dose and guides supplemental bolus dosing to bring elevated glucose back to target.

A patient with long-standing T1DM develops recurrent unexplained hypoglycemia and loss of hypoglycemia awareness. The most appropriate therapeutic adjustment is:

Answer: Raising glycemic targets temporarily and using CGM with alerts

Hypoglycemia unawareness requires relaxing glycemic targets to allow glucose levels to run higher temporarily, combined with real-time CGM alarms to alert the patient, which can restore awareness over weeks.

Which statement about U-500 regular insulin is correct?

Answer: It is 5 times more concentrated and has a longer duration of action than U-100 regular

U-500 regular insulin is 500 units/mL (5× U-100) and due to depot formation has a duration of action of 17–24 hours, behaving more like an intermediate-acting insulin despite being 'regular' type.

When educating a patient about DPP-4 inhibitors, which adverse effect requires specific counseling?

Answer: Possible joint pain (arthralgia) which should prompt reporting

The FDA has issued a warning about severe, disabling, and potentially persistent arthralgia associated with DPP-4 inhibitors; patients should be counseled to report new or unusual joint pain.

A patient on metformin 2000 mg/day with A1C 7.9% requires contrast-enhanced CT imaging. According to current guidelines, metformin should be:

Answer: Held at the time of or before the procedure only if eGFR <30 or acute kidney injury risk

Updated guidelines recommend withholding metformin only in patients with eGFR <30 or risk factors for AKI (dehydration, hemodynamic instability) at the time of IV contrast administration, not universally.

Tirzepatide's superior glucose-lowering and weight-loss effects compared to semaglutide are primarily due to its:

Answer: Dual agonism at both GLP-1 and GIP receptors

Tirzepatide is a dual GIP and GLP-1 receptor co-agonist; the additive or synergistic incretin effects from both receptor pathways produce greater A1C reduction and weight loss than selective GLP-1 agonism alone.