CDCES Pharmacology Fundamentals 3 — Questions and Answers
Question 1: A patient with type 1 diabetes asks about the 'honeymoon phase.' Which pharmacological adjustment is typically needed during this period?
- Increasing insulin doses due to increased needs
- Reducing insulin doses as residual beta-cell function temporarily returns (Correct answer)
- Switching from basal-bolus to premixed insulin
- Adding metformin to reduce insulin requirements
Correct answer: Reducing insulin doses as residual beta-cell function temporarily returns
During the honeymoon phase, remaining beta cells temporarily resume function, often requiring significantly reduced insulin doses to avoid hypoglycemia.
Question 2: Which cardiovascular benefit is specifically associated with empagliflozin and liraglutide based on landmark clinical trials?
- Reduced stroke risk only
- Reduced major adverse cardiovascular events (MACE) and heart failure hospitalization (Correct answer)
- Reduced atrial fibrillation
- Improved lipid profiles without CV event reduction
Correct answer: Reduced major adverse cardiovascular events (MACE) and heart failure hospitalization
The EMPA-REG OUTCOME and LEADER trials demonstrated that empagliflozin and liraglutide significantly reduce MACE and cardiovascular death in high-risk patients.
Question 3: A patient taking insulin experiences the Somogyi effect. What is the best description of this phenomenon?
- Morning hyperglycemia due to growth hormone release at dawn
- Rebound hyperglycemia following nocturnal hypoglycemia (Correct answer)
- Insulin resistance due to antibody formation
- Hyperglycemia caused by missed evening insulin dose
Correct answer: Rebound hyperglycemia following nocturnal hypoglycemia
The Somogyi effect is rebound hyperglycemia that occurs in response to counterregulatory hormone release triggered by nocturnal hypoglycemia.
Question 4: Which characteristic distinguishes rapid-acting insulin analogs from regular human insulin?
- Longer duration of action
- Faster onset allowing injection at mealtime rather than 30 minutes before (Correct answer)
- Lower risk of hypoglycemia between meals
- No need for refrigeration
Correct answer: Faster onset allowing injection at mealtime rather than 30 minutes before
Rapid-acting analogs (lispro, aspart, glulisine) have onset within 10-15 minutes, allowing administration at mealtime rather than 30 minutes before eating.
Question 5: A CDCES is educating a patient about pramlintide. This amylin analog is approved for use in which patients?
- Type 2 diabetes on oral agents only
- Type 1 and insulin-treated type 2 diabetes patients (Correct answer)
- Type 2 diabetes with renal impairment
- Prediabetes to prevent progression
Correct answer: Type 1 and insulin-treated type 2 diabetes patients
Pramlintide is approved as adjunct therapy for type 1 diabetes and insulin-treated type 2 diabetes patients who have not achieved adequate glycemic control.
Question 6: Which medication class requires monitoring for urinary tract infections and genital mycotic infections as common adverse effects?
- Sulfonylureas
- GLP-1 receptor agonists
- SGLT-2 inhibitors (Correct answer)
- DPP-4 inhibitors
Correct answer: SGLT-2 inhibitors
SGLT-2 inhibitors increase urinary glucose excretion, creating an environment that promotes bacterial and fungal growth in the urinary tract and genital area.
Question 7: What is the mechanism of action of bromocriptine (Cycloset) in treating type 2 diabetes?
- Stimulates insulin secretion from beta cells
- Resets circadian rhythm-related hypothalamic dopamine activity to improve insulin sensitivity (Correct answer)
- Inhibits hepatic glucose production
- Blocks glucagon release from alpha cells
Correct answer: Resets circadian rhythm-related hypothalamic dopamine activity to improve insulin sensitivity
Bromocriptine is a dopamine agonist that modulates hypothalamic circadian rhythms, reducing post-meal glucose excursions through improved insulin sensitivity.
CDCES Pharmacology Fundamentals 3
A patient with type 1 diabetes asks about the 'honeymoon phase.' Which pharmacological adjustment is typically needed during this period?