Medication Management Flashcards

A patient with type 2 diabetes and stage 3 CKD (eGFR 35 mL/min) is currently on metformin 1000 mg twice daily. What is the most appropriate action?

Answer: Discontinue metformin immediately

Metformin is contraindicated when eGFR falls below 30 mL/min and should be discontinued at eGFR <30; at eGFR 30-45 it requires dose reduction and close monitoring, but at eGFR 35 most guidelines recommend stopping.

Which GLP-1 receptor agonist is administered once weekly and has demonstrated significant cardiovascular risk reduction in the SUSTAIN-6 trial?

Answer: Semaglutide (Ozempic)

Semaglutide (Ozempic) is a once-weekly GLP-1 RA that showed significant reduction in major adverse cardiovascular events in the SUSTAIN-6 cardiovascular outcomes trial.

A patient taking glipizide reports episodes of dizziness, sweating, and shakiness before lunch. Which intervention is most appropriate?

Answer: Reduce the glipizide dose or switch to a shorter-acting sulfonylurea

Sulfonylurea-induced hypoglycemia before meals indicates the dose may be too high or the medication duration is mismatched with meal timing; dose reduction is the primary intervention.

What is the primary mechanism by which SGLT2 inhibitors lower blood glucose?

Answer: Inhibit renal glucose reabsorption, increasing urinary glucose excretion

SGLT2 inhibitors block sodium-glucose cotransporter 2 in the proximal renal tubule, preventing reabsorption of filtered glucose and causing glucosuria.

A patient with type 1 diabetes uses an insulin-to-carbohydrate ratio of 1:15 and a correction factor of 1:50. If pre-meal glucose is 220 mg/dL, target is 120 mg/dL, and the meal has 60g carbs, how many total units should be given?

Answer: 6 units

Meal dose = 60÷15 = 4 units; correction dose = (220-120)÷50 = 2 units; total = 6 units.

Which class of diabetes medication is associated with the highest risk of causing lactic acidosis?

Answer: Biguanides (metformin)

Metformin, a biguanide, carries a risk of lactic acidosis, particularly in patients with renal impairment, liver disease, or conditions causing tissue hypoxia.

Pioglitazone (Actos) is contraindicated in patients with which condition?

Answer: New York Heart Association Class III or IV heart failure

Thiazolidinediones like pioglitazone cause fluid retention and are contraindicated in NYHA Class III-IV heart failure due to risk of worsening cardiac function.