Oral & Injectable Medications Flashcards

What is the primary risk associated with SGLT-2 inhibitors in patients who are fasting or on very low carbohydrate diets?

Answer: Euglycemic diabetic ketoacidosis

SGLT-2 inhibitors can cause euglycemic DKA — ketoacidosis with near-normal glucose levels — especially during fasting or carbohydrate restriction.

Insulin storage: an opened vial of insulin should generally be discarded after how many days at room temperature?

Answer: 28 days

Most opened insulin vials and pens should be discarded after 28 days at room temperature regardless of remaining insulin.

Which combination of medications poses the HIGHEST risk of hypoglycemia?

Answer: Sulfonylurea + basal insulin

Combining a sulfonylurea (which stimulates insulin secretion) with basal insulin creates additive hypoglycemia risk.

A patient on liraglutide reports persistent nausea. What is the recommended counseling strategy?

Answer: Start at the lowest dose and titrate slowly; nausea often improves over time

GLP-1 agonist-related nausea is dose-dependent and typically subsides with gradual dose titration; patients should be reassured.

NPH insulin is classified as which type of insulin?

Answer: Intermediate-acting

NPH (Neutral Protamine Hagedorn) is an intermediate-acting insulin with onset in 1–2 hours and peak at 4–12 hours.

Which medication requires monitoring for bladder cancer risk and should be avoided in patients with active bladder cancer?

Answer: Pioglitazone

Pioglitazone (Actos) carries an FDA warning for increased bladder cancer risk with prolonged use.

When a patient using insulin develops hypoglycemia with a glucose of 62 mg/dL and is conscious, what is the first-line treatment?

Answer: Give 15–20 grams of fast-acting carbohydrate and recheck in 15 minutes

The '15-15 rule' recommends 15–20 g of fast-acting carbohydrate followed by a 15-minute recheck for mild-to-moderate hypoglycemia in a conscious patient.