Study Questions349

Study Questions

Choose the ONE best answer.

25.1 Which of the following statements is correct regarding

Correct answer = B. Insulin glargine has a relatively flat,
insulin glargine? prolonged hypoglycemic effect. Because of this it is used
A. It is primarily used to control postprandial for basal glucose control, not postprandial. The prolonged
hyperglycemia. duration is due to its low pH, which leads to precipitation
at the injection site and resultant extended action. Insulin
B. It is a “peakless” insulin.
glargine is often used for basal control in a regimen where
C. The prolonged duration of activity is due to slow insulin lispro, glulisine, or aspart are used for mealtime glu-
dissociation from albumin. cose control. [Note: Glargine should not be combined with
D. It should not be used in a regimen with insulin lispro other insulins in the same syringe, as it may alter the phar-
or glulisine. macodynamic properties of the medication.]
E. It may be administered intravenously in emergency
cases.

25.2 DW is a patient with type 2 diabetes who has a blood

Correct answer = A. Insulin aspart is a rapid-acting insulin
glucose of 400 mg/dL today at his office visit. The that has an onset of action within 15 to 20 minutes. Insulin
physician would like to give some insulin to bring the glargine is a long-acting insulin that is used for basal control.
glucose down before he leaves the office. Which of NPH insulin is an intermediate-acting insulin that is used for
the following would lower the glucose in the quickest basal control. Although regular insulin can be used to bring
manner in DW? the glucose down, its onset is not as quick as insulin aspart.
The onset of regular insulin is about 30 to 60 minutes.
A. Insulin aspart.
B. Insulin glargine.
C. NPH insulin.
D. Regular insulin.

25.3 Which of the following classes of oral diabetes drugs is

paired most appropriately with its primary mechanism
of action?
A. DPP-4 inhibitor—inhibits breakdown of complex
carbohydrates.
B. Glinide—increases insulin sensitivity.
C. Sulfonylurea—increases insulin secretion.
D. Thiazolidinedione—decreases hepatic
gluconeogenesis.
Correct answer = C. Sulfonylureas work primarily by increas-
ing insulin secretion through stimulation of the β cells of the
pancreas. DPP-4 inhibitors work by inhibiting breakdown of
incretins, thereby increasing postprandial insulin secretion,
decreasing postprandial glucagon, etc. Glinides work pri-
marily by increasing insulin secretion. TZDs work primarily
by increasing insulin sensitivity.

25.4 Which of the following statements is characteristic of

Correct answer = B. Metformin works by inhibiting hepatic
metformin? gluconeogenesis. It is the preferred initial agent for man-
A. Metformin is inappropriate for initial management of agement of type 2 diabetes. Metformin is not metabolized.
type 2 diabetes. It may be combined with sulfonylureas, insulin, or TZDs.
Unlike the sulfonylureas and insulin, weight gain is not an
B. Metformin decreases hepatic glucose production.
adverse effect, and some patients actually lose weight due
C. Metformin undergoes significant metabolism via the to GI side effects.
cytochrome P450 system.
D. Metformin should not be combined with
sulfonylureas or insulin.
E. Weight gain is a common adverse effect.

25.5 Which of the following is the most appropriate initial oral

Correct answer = C. Metformin is the preferred initial agent
agent for management of type 2 diabetes in patients for management of type 2 diabetes. See Figure 25.14.
with no other comorbid conditions?
A. Glipizide.
B. Insulin.
C. Metformin.
D. Pioglitazone.
 350 25. Drugs for Diabetes

25.6 A 64-year-old woman with a history of type 2 diabetes Correct answer = D. The TZDs (pioglitazone and rosigli-
is diagnosed with heart failure. Which of the following tazone) can cause fluid retention and lead to a worsening
medications would be a poor choice for controlling her of heart failure. They should be used with caution and dose
diabetes? reduction, if at all, in patients with heart failure. Exenatide,
A. Exenatide. glyburide, nateglinide, and sitagliptin do not have precau-
tions for use in heart failure patients.
B. Glyburide.
C. Nateglinide.
D. Pioglitazone.
E. Sitagliptin.

25.7 KD is a 69-year-old male with type 2 diabetes and

Correct answer = C. Metformin should not be used in
advanced chronic kidney disease. Which of the patients with kidney disease due to the possibility of lactic
following diabetes medications is contraindicated in acidosis. Glipizide can be used safely in patients with CrCl
this patient? as low as 10 mL/min. Insulin is not contraindicated in renal
A. Glipizide. dysfunction, although the dosage may need to be adjusted.
While the dose of the DPP-4 inhibitor saxagliptin may need
B. Insulin lispro.
to be reduced in renal dysfunction, it is not contraindicated.
C. Metformin.
D. Saxagliptin.

25.8 Which of the following drugs for diabetes would be

Correct answer = B. Incretin mimetics are usually associ-
LEAST likely to cause weight gain? ated with weight loss due to their ability to enhance satiety.
A. Glimepiride. All of the other agents are associated with weight gain.
B. Liraglutide.
C. Pioglitazone.
D. Repaglinide.
E. Insulin glulisine.

25.9 A patient with type 2 diabetes is taking metformin. The

The correct answer = D. Although all of these drugs target
fasting glucose levels are in range, but the postprandial postprandial glucose, pramlintide should only be used in
glucose is uncontrolled. All of the following drugs conjunction with mealtime insulin. Since this patient is not
would be appropriate to add to metformin to target on insulin, pramlintide is not indicated.
postprandial glucose except:
A. Acarbose.
B. Exenatide.
C. Insulin aspart.
D. Pramlintide.

25.10 Which of the following diabetes medications is most

Correct answer = D. The incretin mimetics are associated
appropriately paired with an adverse effect associated with a risk of pancreatitis. Lactic acidosis is a rare but seri-
with its use? ous side effect of metformin (not canagliflozin). Adverse
A. Canagliflozin—lactic acidosis. effects of canagliflozin are genital mycotic infections, uri-
nary tract infections, and urinary frequency. Nateglinide may
B. Metformin—urinary tract infections.
cause hypoglycemia but has not been associated with heart
C. Nateglinide—heart failure. failure. The TZDs have been associated with heart failure.
D. Liraglutide—pancreatitis.

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