BC ADM Medication & Therapeutic Interventions 2

Question 1

A patient with T2DM and stage 3b CKD (eGFR 35 mL/min) requires glucose-lowering therapy. Which agent is most appropriate?

Accepted Answer

Dulaglutide 0.75 mg weekly

Answer

GLP-1 receptor agonists like dulaglutide are safe in stage 3b CKD; metformin is contraindicated below eGFR 30 and cautioned below 45, SGLT2i lose efficacy and carry risks at this eGFR, and sulfonylureas increase hypoglycemia risk with renal impairment.

Question 2

Which insulin pharmacokinetic property best distinguishes insulin glargine U-300 from insulin glargine U-100?

Accepted Answer

More stable, flatter 24-hour profile with less peak effect

Answer

Glargine U-300 forms a smaller subcutaneous depot that dissolves more slowly, producing a flatter, more peakless profile over ≥24 hours and a lower hypoglycemia risk compared to U-100.

Question 3

A patient on basal insulin therapy has consistently elevated fasting glucose but well-controlled postprandial values. The most appropriate next step is:

Accepted Answer

Titrate the basal insulin dose upward

Answer

Persistently high fasting glucose with controlled postprandial values indicates the basal insulin dose is insufficient to suppress overnight hepatic glucose production, so upward titration is the first step.

Question 4

Pramlintide is approved as adjunct therapy with mealtime insulin primarily because it:

Accepted Answer

Delays gastric emptying and suppresses postprandial glucagon

Answer

Pramlintide is a synthetic amylin analog that delays gastric emptying, suppresses postprandial glucagon secretion, and promotes satiety, complementing mealtime insulin's action.

Question 5

Which statement about thiazolidinediones (TZDs) and cardiovascular risk is most accurate?

Accepted Answer

Pioglitazone has demonstrated reduction in MACE in patients with prior stroke or MI

Answer

The PROactive trial showed pioglitazone significantly reduced secondary MACE endpoints in patients with established cardiovascular disease, while both TZDs increase heart failure hospitalization risk.

(BC ADM) Advanced Diabetes Management Certification Practice Test

(BC ADM) Advanced Diabetes Management Certification Practice Test

BC ADM Medication & Therapeutic Interventions 2