CDCES Pharmacology Fundamentals 2 — Questions and Answers
Question 1: A patient with type 2 diabetes is started on a SGLT-2 inhibitor. Which serious adverse effect requires patient education?
- Hypoglycemia when used as monotherapy
- Euglycemic diabetic ketoacidosis (Correct answer)
- Severe constipation
- Peripheral neuropathy
Correct answer: Euglycemic diabetic ketoacidosis
SGLT-2 inhibitors can cause euglycemic DKA, where ketoacidosis occurs even with near-normal blood glucose levels.
Question 2: Which insulin has the longest duration of action and is used for basal coverage?
- Regular insulin
- NPH insulin
- Insulin glargine U-300 (Correct answer)
- Insulin lispro
Correct answer: Insulin glargine U-300
Insulin glargine U-300 has a duration of action exceeding 36 hours, making it one of the longest-acting basal insulins available.
Question 3: A GLP-1 receptor agonist is prescribed for a patient with type 2 diabetes. What is an important contraindication to consider?
- Renal impairment with eGFR <30
- Personal or family history of medullary thyroid carcinoma (Correct answer)
- Hepatic impairment
- Allergy to sulfonamides
Correct answer: Personal or family history of medullary thyroid carcinoma
GLP-1 receptor agonists are contraindicated in patients with personal or family history of medullary thyroid carcinoma due to potential thyroid C-cell stimulation.
Question 4: Which oral antidiabetic agent works by inhibiting the enzyme DPP-4, thereby increasing incretin levels?
- Metformin
- Acarbose
- Sitagliptin (Correct answer)
- Pioglitazone
Correct answer: Sitagliptin
Sitagliptin is a DPP-4 inhibitor that prevents the breakdown of incretins (GLP-1 and GIP), enhancing glucose-dependent insulin secretion.
Question 5: A patient on metformin develops lactic acidosis risk when scheduled for a procedure requiring which type of contrast?
- MRI gadolinium contrast
- Iodinated intravenous contrast (Correct answer)
- Barium sulfate oral contrast
- Ultrasound contrast agents
Correct answer: Iodinated intravenous contrast
Iodinated IV contrast can cause acute kidney injury, reducing metformin clearance and increasing lactic acidosis risk; metformin should be held before and after the procedure.
Question 6: Which thiazolidinedione (TZD) was withdrawn from the US market due to cardiovascular safety concerns?
- Pioglitazone
- Rosiglitazone (Correct answer)
- Troglitazone
- Ciglitazone
Correct answer: Rosiglitazone
Rosiglitazone's market access was significantly restricted due to concerns about increased myocardial infarction risk, though it remains technically available with restrictions.
Question 7: When educating a patient about alpha-glucosidase inhibitors like acarbose, what should be used to treat hypoglycemia if it occurs with concurrent sulfonylurea use?
- Orange juice
- Glucose tablets or gel (Correct answer)
- Candy bars
- Milk
Correct answer: Glucose tablets or gel
Acarbose inhibits carbohydrate digestion, so only pure glucose (not sucrose or complex carbs) will effectively treat hypoglycemia in patients taking alpha-glucosidase inhibitors.
CDCES Pharmacology Fundamentals 2
A patient with type 2 diabetes is started on a SGLT-2 inhibitor.
Which serious adverse effect requires patient education?