Medication Management Flashcards

A patient reports taking his metformin 500 mg twice daily but has persistent GI side effects (nausea, diarrhea) after 6 weeks. What is the best recommendation?

Answer: Switch to metformin extended-release (XR) formulation

Metformin extended-release formulation is associated with significantly fewer GI side effects than immediate-release metformin and is often better tolerated.

Which GLP-1 receptor agonist is available as an oral tablet (not injectable)?

Answer: Oral semaglutide (Rybelsus)

Oral semaglutide (Rybelsus) is the only GLP-1 receptor agonist currently available in tablet form, taken once daily on an empty stomach with a small amount of water.

A patient taking canagliflozin (Invokana) is scheduled for surgery. What is the recommended perioperative management?

Answer: Hold canagliflozin at least 3-4 days before surgery due to euglycemic DKA risk

SGLT2 inhibitors should be held 3-4 days before surgery due to risk of euglycemic diabetic ketoacidosis (eDKA), which can occur perioperatively even with normal glucose levels.

Which insulin formulation is considered 'ultra-rapid acting' and has the fastest onset of action?

Answer: Faster insulin aspart (Fiasp)

Faster insulin aspart (Fiasp) contains niacinamide and L-arginine that accelerate absorption, giving it an onset within 2-4 minutes, making it the fastest commercially available mealtime insulin.

A patient with type 2 diabetes, BMI 38, and HbA1c 8.8% wants to lose weight while improving glycemic control. Which medication would best address both goals?

Answer: Semaglutide (Ozempic)

GLP-1 receptor agonists like semaglutide provide significant weight loss (5-15% body weight) alongside meaningful HbA1c reduction, making them the preferred choice for obese patients needing dual benefit.

What is the appropriate treatment for mild-to-moderate hypoglycemia (glucose 54-70 mg/dL) in a conscious patient?

Answer: Consume 15-20 grams of fast-acting carbohydrates and recheck glucose in 15 minutes

The '15-15 rule' recommends 15g of fast-acting carbohydrates (e.g., glucose tablets, juice), recheck in 15 minutes, and repeat if still below 70 mg/dL.

A patient asks why their provider prescribed both basal insulin glargine and a GLP-1 receptor agonist. What is the best explanation?

Answer: Basal insulin addresses fasting glucose while GLP-1 agonist targets postprandial glucose, weight, and CV risk

The basal insulin/GLP-1 RA combination (e.g., Xultophy, Soliqua) is complementary: basal insulin targets fasting hyperglycemia while GLP-1 RA addresses postprandial glucose, promotes weight loss, and provides cardiovascular benefits.