MTM Diabetes & Cardiovascular Pharmacotherapy 2

Question 1

A patient with T2DM and CKD stage 3b (eGFR 32 mL/min) is on metformin 1000 mg BID. What is the most appropriate action?

Accepted Answer

Discontinue metformin due to increased lactic acidosis risk

Answer

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and should be discontinued at eGFR <30 due to lactic acidosis risk.

Question 2

Which SGLT2 inhibitor is FDA-approved specifically to reduce the risk of hospitalization for heart failure in patients with T2DM and established cardiovascular disease?

Accepted Answer

Empagliflozin

Answer

Empagliflozin (EMPA-REG OUTCOME trial) was first to demonstrate CV death and HF hospitalization reduction, earning that specific FDA indication.

Question 3

A patient with newly diagnosed T2DM has an A1C of 8.4% and no cardiovascular or renal disease. Which agent is most appropriate as add-on to metformin according to ADA guidelines?

Accepted Answer

Sulfonylurea or other glucose-lowering agent based on patient factors

Answer

Without compelling CV or renal indications, ADA guidelines recommend selecting add-on therapy based on patient-specific factors like weight, cost, and hypoglycemia risk.

Question 4

A pharmacist reviewing a patient's regimen notices they are on glipizide and clarithromycin. What interaction is most concerning?

Accepted Answer

Enhanced hypoglycemic effect due to CYP2C9 inhibition

Answer

Clarithromycin inhibits CYP3A4 and may also potentiate sulfonylurea effects, increasing hypoglycemia risk.

Question 5

Which antihypertensive class is considered first-line for patients with T2DM and microalbuminuria?

Accepted Answer

ACE inhibitors or ARBs

Answer

ACE inhibitors and ARBs provide renoprotective benefits by reducing intraglomerular pressure and are first-line for diabetic patients with albuminuria.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Diabetes & Cardiovascular Pharmacotherapy 2