Diabetes Quiz Flashcards
You want to start pharmacologic treatment for a patient with type 2 diabetes, and continue with his current treatment of lifestyle modification. Which medication has been shown to reduce the risk of diabetic complications, and to improve mortality in patients having type 2 DM?
A) Regular/NPH insulin twice daily regimen
B) Metformin
C) Lantus/Novolog insulin regimen
D) Glyburide
B - metformin
What would you tell your patient about starting metformin?
A) Watch for signs and symptoms of hypoglycemia
B) You may experience some GI side effects such as nausea and GI upset
C) You do not need to get your renal function checked regularly
D) None of the above
B
Identify the correct statement about insulin:
A) The most convenient and practical classification is by time course of onset, and duration of effects
B) All types of insulin can be given IV
C) Glucagon and epinephrine enhance the effects of insulin
D) Insulin inhibits the entry of glucose into peripheral tissues, and prevents its conversion to storage forms such as glycogen
A
B - wrong because only some can be given I V
C - wrong because they INHIBIT the effects of insulin
D - wrong because it stimulates uptake of glucose into peripheral tissues and PROMOTES conversion to storage forms such as glycogen
Identify the correct statement:
A) Drugs classified as sulfonylurea agents act by preventing secretion of insulin into the urine
B) Hypoglycemic reactions are rarely seen in patients whose diabetes is managed by sulfonylurea agents
C) Acarbose (an alpha glucosidase inhibitor) increases the oral absorption of carbs, and promotes the utilization of non-insulin dependent metabolic pathways for glucose
D) Metformin and pioglitazone a thiazolidinedione) act to increase the activity of insulin receptors
D
A - wrong because this is the MOA of SGLT2i, sulfonylurea prevent calcium entry and potassium exit
B - wrong bc hypoglycemia is common in sulfonylurea agents d/t increased insulin secretion
C - wrong bc it DECREASES oral reabsorption of carbs
Match the correct statements:
Metformin
Glyburide and repaglinide
Incretin enhancers
Sodium glucose cotransporters
A) Stimulates insulin secretion via closure of potassium channels
B) Block renal glucose reabsorption
C) Inhibits an inhibitory pathway of insulin
D) This medication decreases hepatic gluconeogenesis, decreases intestinal absorption of glucose, and increases insulin sensitivity
Metformin - D
Glyburide and repaglinide - A
Incretin enhancers - C
Sodium glucose cotransporters - B
Which statement is correct about tight glucose control?
A) Twice daily injections of regular insulin combined with NPH is considered the best option for tight control of blood glucose in type 1 diabetes
B) Tight control of blood glucose has been shown to reduce microvascular complications of type 1 diabetes
C) Tight control of blood glucose is always the best option for management of type 2 diabetes
D) Tight control of blood glucose is always the best option for management of elevated blood glucose in critically ill non diabetic patients
B
Which of the following is NOT a contraindication to the use of metformin?
A) Metabolic acidosis
B) Renal failure
C) Parenteral radiographic contrast administration
D) Any condition associated with hypoxemia, dehydration, or sepsis
E) As adjunct treatment of patients with hyperinsulinemia secondary to PCOS, especially as a treatment of infertility in these patients
E - only condition where it would be ACCEPTABLE to give metformin
Select the recommended dose for initiation of metformin therapy in patients diagnosed with type 2 diabetes:
A) Initiate metformin therapy with 1000mg PO twice daily or 2000mg PO once daily given with meals
B) Initiate metformin therapy with 2.5-5mg PO of conventional tablets once daily, with the first main meal of the day or breakfast. Or with 1.5-3 mg PO once daily of micronized tablets
C) Initiate metformin therapy with 500 mg PO twice daily or 850 mg PO once daily, given with meals
D) Skip metformin and use a medication that has a unique mechanism of action
C
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes, recommends that the combination of metformin with lifestyle interventions should be initiated at the time of diagnosis. Metformin was chosen as the initial drug therapy because:
A) This recommendation was based on the efficacy, safety, and cost of metformin. Additionally, in a follow up to the UKPDS, researchers found that after 10 years, patients originally randomized to metformin therapy had a 33% relative reduction (RR 0.67, 95% CI 0.51-0.89, p = 0.005) in the risk of MI and a 27% relative reduction in the risk of death from any cause as compared to patients originally randomized to conventional therapy; it should be noted that these reductions in cardiovascular risks persisted even though HbA1c concentrations were similar in the 2 groups after 1 year of follow up
B) This unique recommendation was based upon the unique mechanism of action of metformin
C) This recommendation to initiate therapy with metformin was not an evidence based recommendation
D) You should initiate therapy with any of the FDA approved medications. All of the medications improve lab values to the same extent. And our goal is to improve lab values
A
Which of the following situations is most likely to be treated with IV glucagon?
A) Severe bradycardia and hypotension resulting from an overdose of atenolol
B) Lactic acidosis as a complication of severe infection and shock
C) Severe diarrhea caused by a flare in her inflammatory bowel disease
D) Cocaine overdose with blood pressure of 190/110 mm Hg
A - glucagon acts through cardiac glucagon receptors to stimulate the rate and force of contraction of the heart. Because glucagon’s effect is independent of cardiac beta adenoreceptors, glucagon is useful in the treatment of beta blocker induced cardiac depression
An adolescent with type 1 diabetes is brought to the ED complaining of dizziness. Lab findings include severe hyperglycemia, ketoacidosis, and a blood pH of 7.15
Which of the following agents should be administered to achieve rapid control of the severe ketoacidosis in this diabetic?
A) NPH insulin
B) Insulin glargine
C) Crystalline zinc insulin
D) Glyburide
C - regular insulin = crystalline zinc insulin
A 26 year old woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long term prognosis. Which of the following regimens would you prescribe?
A) Morning injections of mixed insulin lispro and insulin aspart
B) Evening injections of mixed regular insulin and insulin glargine
C) Morning and evening injections of regular insulin, supplemented by small amounts of NPH insulin at mealtimes
D) Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes
E) Morning injection of NPH insulin and evening injection of regular insulin
D - insulin regimens for tight control usually establish a basal level of insulin with a small amount of a long acting preparation (i.e. insulin glargine) and supplementing the insulin levels, when called for by food intake, with short acting insulin lispro. Less tight control may be achieved with 2 injections of intermediate acting insulin per day. Because intake of glucose is mainly during the day, long acting insulins are given in the morning and not at night
Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of type 2 diabetes?
A) Acarbose
B) Glyburide
C) Metformin
D) Canagliflozin
B - agents that stimulate the release of insulin, like the sulfonylurea medication glyburide, cause hypoglycemia as a result of their ability to increase serum insulin levels. The biguanides, alpha glucosidase inhibitors, and canagliflozin are unlikely to cause hypoglycemia when used alone
Which of the following drugs is taken during the first part of a meal for the purpose of delaying the absorption of dietary carbohydrates?
A) Exenatide
B) Pioglitazone
C) Acarbose
D) Repaglinide
C - to be absorbed, carbs are converted into monosaccharides by alpha glucosidase enzymes in the GI tract. Acarbose inhibits these enzymes, and delays the uptake of carbs when present during digestion
Which of the following is the drug of choice for pregnant women with type 2 diabetes?
A) Metformin
B) Insulin
C) Canagliflozin
D) Liraglutide
B - insulin does not cross the placenta. It is secreted into human breast milk, but women who use insulin can breastfeed safely. Metformin is relatively safe for use in pregnancy. There is not enough safety information about the use of the other medications in pregnancy to recommend any of the others.
