Ambulatory Diabetes Management Flashcards
7 cards from real BCACP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Ambulatory Diabetes Management flashcards as text
A patient with T2DM and an eGFR of 38 mL/min/1.73m² is currently on metformin 1000 mg twice daily. What is the most appropriate action?
Answer: Discontinue metformin
Metformin is contraindicated when eGFR falls below 30 and should be discontinued at eGFR <30; at eGFR 30-45 it should be used with caution at reduced doses, but eGFR 38 warrants discontinuation per many guidelines.
Which GLP-1 receptor agonist is FDA-approved for once-weekly subcutaneous injection and has demonstrated cardiovascular outcome benefits in the LEADER trial?
Answer: Liraglutide
Liraglutide (Victoza) was studied in the LEADER trial, demonstrating significant reduction in major adverse cardiovascular events in high-risk T2DM patients.
A patient with T2DM develops recurrent genital mycotic infections after starting empagliflozin. What is the mechanism behind this adverse effect?
Answer: Increased urinary glucose promotes fungal growth
SGLT2 inhibitors increase urinary glucose excretion (glucosuria), creating an environment that promotes Candida and other fungal infections of the genitourinary tract.
For a patient with T2DM and established ASCVD, which medication class has the strongest evidence for reducing cardiovascular mortality as a first add-on to metformin?
Answer: GLP-1 receptor agonists or SGLT2 inhibitors
ADA guidelines recommend GLP-1 receptor agonists or SGLT2 inhibitors with proven cardiovascular benefit as preferred add-ons to metformin in patients with established ASCVD.
A pharmacist is counseling a patient starting insulin glargine. Which statement about insulin glargine storage is correct?
Answer: Once opened, insulin glargine can be kept at room temperature for up to 28 days
Once opened (in-use), insulin glargine vials and pens can be stored at room temperature (below 86°F/30°C) for up to 28 days.
Which of the following best describes the mechanism of action of pioglitazone in T2DM?
Answer: Activates PPAR-gamma to improve insulin sensitivity in peripheral tissues
Pioglitazone is a thiazolidinedione that activates peroxisome proliferator-activated receptor gamma (PPAR-γ), improving insulin sensitivity in muscle, fat, and liver.
A patient with T2DM has an A1C of 9.2% and is asymptomatic. According to ADA standards, what is the most appropriate initial pharmacotherapy approach?
Answer: Start dual combination therapy
ADA recommends considering dual combination therapy from the start when A1C is ≥1.5% above the patient's goal, which 9.2% typically satisfies.