CDE Medication Management 3 — Questions and Answers
Question 1: A patient is prescribed empagliflozin (Jardiance) and develops painful urination with white discharge. What is the most likely adverse effect?
- Urinary tract infection from glucosuria
- Hyperosmolar hyperglycemic state
- Genital mycotic infection due to glucosuria (Correct answer)
- Drug-induced nephritis
Correct answer: Genital mycotic infection due to glucosuria
SGLT2 inhibitors increase urinary glucose excretion, creating an environment that promotes genital mycotic (yeast) infections, especially in women.
Question 2: Which insulin analogue has the longest duration of action among the following options?
- Insulin lispro (Humalog)
- NPH insulin (Humulin N)
- Insulin glargine U-300 (Toujeo) (Correct answer)
- Insulin detemir (Levemir)
Correct answer: Insulin glargine U-300 (Toujeo)
Insulin glargine U-300 (Toujeo) has the longest duration of action at up to 36 hours, longer than standard glargine U-100, NPH, or detemir.
Question 3: A patient taking sitagliptin (Januvia) reports severe, persistent abdominal pain radiating to the back. What complication should be immediately suspected?
- Diabetic ketoacidosis
- Acute pancreatitis (Correct answer)
- Cholecystitis
- Intestinal obstruction
Correct answer: Acute pancreatitis
DPP-4 inhibitors including sitagliptin have been associated with acute pancreatitis; severe abdominal pain radiating to the back is a classic presentation.
Question 4: Which statement about pramlintide (Symlin) is correct?
- It is used as monotherapy in type 2 diabetes
- It is a synthetic amylin analogue that slows gastric emptying and suppresses glucagon (Correct answer)
- It stimulates insulin release from the pancreas
- It requires dose increase when combined with mealtime insulin
Correct answer: It is a synthetic amylin analogue that slows gastric emptying and suppresses glucagon
Pramlintide is a synthetic analogue of amylin that mimics its effects: slowing gastric emptying, suppressing postprandial glucagon, and promoting satiety.
Question 5: When educating a patient about taking acarbose (Precose), which instruction is most important?
- Take it on an empty stomach 30 minutes before meals
- Take it with the first bite of each main meal (Correct answer)
- Take it at bedtime to control fasting glucose
- Take it only when blood glucose exceeds 200 mg/dL
Correct answer: Take it with the first bite of each main meal
Acarbose must be taken with the first bite of each meal because it works by competitively inhibiting alpha-glucosidase enzymes in the small intestine during carbohydrate digestion.
Question 6: A patient on basal-bolus insulin therapy has consistently elevated fasting blood glucose values. Which adjustment is most appropriate?
- Increase the rapid-acting insulin dose at dinner
- Increase the basal insulin dose (Correct answer)
- Add an oral hypoglycemic agent
- Reduce carbohydrate intake at breakfast
Correct answer: Increase the basal insulin dose
Consistently elevated fasting glucose indicates insufficient basal insulin coverage overnight; the basal (long-acting) insulin dose should be increased.
Question 7: Which cardiovascular benefit is uniquely associated with SGLT2 inhibitors compared to other diabetes drug classes?
- Reduction in LDL cholesterol
- Significant reduction in hospitalization for heart failure (Correct answer)
- Prevention of myocardial infarction in all patients
- Lowering of blood pressure to normal range
Correct answer: Significant reduction in hospitalization for heart failure
SGLT2 inhibitors have demonstrated consistent, robust reduction in heart failure hospitalizations in multiple cardiovascular outcomes trials, a benefit not seen with other glucose-lowering drug classes.
CDE Medication Management 3
A patient is prescribed empagliflozin (Jardiance) and develops painful urination with white discharge.
What is the most likely adverse effect?