Medication Management Flashcards

A patient using an insulin pump (CSII) develops hyperglycemia with ketones. What is the most common mechanical cause?

Answer: Infusion set occlusion or site failure

Infusion set occlusion or catheter site failure is the most frequent mechanical cause of hyperglycemia with ketone production in pump users because subcutaneous rapid-acting insulin delivery is interrupted.

Which statement best describes the Somogyi effect in insulin-treated patients?

Answer: Morning hyperglycemia caused by rebound from nocturnal hypoglycemia triggering counter-regulatory hormones

The Somogyi effect (rebound hyperglycemia) occurs when nocturnal hypoglycemia triggers counter-regulatory hormones (glucagon, epinephrine, cortisol) that overshoot and cause morning hyperglycemia.

A type 2 diabetes patient with an HbA1c of 9.5% and established atherosclerotic cardiovascular disease is starting medication. According to ADA guidelines, which drug class should be prioritized after metformin?

Answer: GLP-1 receptor agonist with proven CV benefit

ADA guidelines recommend GLP-1 receptor agonists or SGLT2 inhibitors with proven cardiovascular benefit as preferred second-line agents in patients with established ASCVD.

What is the recommended storage instruction for an insulin pen that is currently in use?

Answer: Store at room temperature (below 77°F/25°C) for up to 28-30 days

An insulin pen in use should be stored at room temperature (below 77°F/25°C) for up to 28-30 days depending on the insulin type; refrigerating in-use pens can cause discomfort and is unnecessary.

A patient asks about combining exenatide (Byetta) with insulin. Which statement is accurate?

Answer: Exenatide should not be used with mealtime insulin due to additive hypoglycemia risk without clear benefit evidence

Exenatide should not be combined with prandial insulin as this increases hypoglycemia risk; basal insulin combinations with GLP-1 RAs (e.g., Xultophy, Soliqua) are approved but not mixing in the same syringe.

Which monitoring parameter is most important to assess regularly in patients taking thiazolidinediones (TZDs)?

Answer: Liver function tests and signs of fluid retention/edema

TZDs require monitoring of liver function (hepatotoxicity risk) and signs of fluid retention such as edema or weight gain, which can precipitate or worsen heart failure.

A patient with type 1 diabetes using multiple daily injections (MDI) wants to know the correct injection technique. Which guidance is most appropriate?

Answer: Rotate injection sites within the same body region for consistent absorption

Rotating injection sites within the same anatomical region (e.g., rotating within the abdomen) provides consistent absorption rates while preventing lipohypertrophy.