BCACP Ambulatory Diabetes Management 2

Question 1

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?

Accepted Answer

Discontinue metformin

Answer

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.

Question 2

Which GLP-1 receptor agonist is FDA-approved for once-weekly subcutaneous injection and has demonstrated cardiovascular outcome benefits in the LEADER trial?

Accepted Answer

Liraglutide

Answer

Liraglutide (Victoza) was studied in the LEADER trial, demonstrating significant reduction in major adverse cardiovascular events in high-risk T2DM patients.

Question 3

A patient with T2DM develops recurrent genital mycotic infections after starting empagliflozin. What is the mechanism behind this adverse effect?

Accepted Answer

Increased urinary glucose promotes fungal growth

Answer

SGLT2 inhibitors increase urinary glucose excretion (glucosuria), creating an environment that promotes Candida and other fungal infections of the genitourinary tract.

Question 4

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?

Accepted Answer

GLP-1 receptor agonists or SGLT2 inhibitors

Answer

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.

Question 5

A pharmacist is counseling a patient starting insulin glargine. Which statement about insulin glargine storage is correct?

Accepted Answer

Once opened, insulin glargine can be kept at room temperature for up to 28 days

Answer

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.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Ambulatory Diabetes Management 2