P&T Exam 3 Study Test 2

1.

1 point

What is one benefit of insulin glargine?

It is only dosed once daily

There is a low risk of hypoglycemia due to no pronounced peak

The pharmacokinetic formulation causes it to be released slowly over 24 hours

All of these are benefits of insulin glargine

2.

1 point

When switching from TWICE daily NPH to glargine, the conversion should be...

90% of the [previous] total daily dose of NPH as glargine

80% of the [previous] total daily dose of NPH as glargine

120% of the [previous] total daily dose of NPH as glargine

100% of the [previous] total daily dose of NPH as glargine

3.

1 point

What is the MOA of TZDs?

They act in the absence of insulin to increase glucose uptake through cAMP-mediated GCPR signaling in the hepatocyte

They block receptor-mediated internalization of glucose moieties in the liver

They increase insulin sensitivity in the muscle

They bind to PPARy and activate insulin-responsive genes

4.

1 point

Which of these is incorrectly matched with its action regarding the PPAR enzyme?

PPAR-Alpha: primary action on lipids

PPAR-Delta: primary action on carbohydrates

PPAR-Gamma: primary action on carbohydrates

PPAR-Delta: primary action on smooth muscle wall energy

PPAR-Alpha: primary action on gastric motility

B and E only

5.

1 point

Which part of this sig for U-500 is wrong?

Inj 100U TID 30 minutes AC UTD

[see slide 26/73 for understanding]

TID

AC

Inj

100U

6.

1 point

Which of these insulins CANNOT be mixed with Lantus?

Regular

Glulisine

Lispro

Levemir

7.

1 point

Stephano Stodgvalley is starting insulin therapy for his Type 2 DM. He was previously controlled on glipizide, Januvia and metformin, but after becoming an overnight celebrity for an ATV commercial he did, he's been living the high life, and eating too many sweets.

As a pharmacist, you are going to make some recommendations to Mr. Stodgvalley's endocrinologist about the best insulin to initiate and some changes to his current therapy you would make.

Start with a basal insulin such as insulin glargine, and give 10 units or 0.2 units/kg daily to target FBG values

Start with bolus insulin before meals, such as lispro or glulisine, to target postprandial glucose

If the endocrinologist chooses to move to a basal/bolus regimen, you should D/C Mr. Stodgvalley's TZD and sulfonylurea, these can increase cardiac ADRs and cause hypoglycemia, respectively, when given with insulin therapy

A and C only are the 'preferred' choices

8.

1 point

When switching from NPH to detemir, the adjustment should be

120% of the [previous] total daily dose of NPH as detemir

90% of the [previous] total daily dose of NPH as detemir

80% of the [previous] total daily dose of NPH as detemir

100% of the [previous] total daily dose of NPH as detemir

9.

1 point

Where is the most consistent absorption of insulin obtained (on the body)?

Abdomen

Buttocks

Thigh (quadricep)

Forearm

10.

1 point

Which is INCORRECT regarding GLP-1 agents?

They enhance glucose-dependent insulin secretion

They increase post meal hepatic glucose output

They promote satiety and reduce appetite

They gastric emptying from the stomach to the small intestine

11.

1 point

Which is the only DPP-IV inhibitor that DOES NOT require adjustment for renal dysfunction?

Linagliptin (Tradjenta)

Saxagliptin (Onglyza)

Alogliptin (Nesina)

Sitagliptin (Januvia)

12.

1 point

Which one of these is INCORRECT regarding Exenatide (Byetta/Bydureon) and Liraglutide (Victoza)?

Liraglutide has a closer homology to GLP1 than exenatide

Dosing is BID for Byetta, while it is only qD for Victoza

Exenatide is renally elimated, and liraglutide is not

Byetta has less persistent nausea than Victoza

13.

1 point

Which is NOT a potential ADR of insulin?

Hypoglycemia

Hypercalcemia

Weight gain

Hypokalemia

14.

1 point

Which of these is INCORRECT about the actions of amylin?

Suppresses postprandial glucagon secretion

Modulates nutrient delivery from the stomach to the small intestine

Causes decreased insulin secretion

Helps to regulate food intake

15.

1 point

As a part of a survey on pharmacy student's knowledge of diabetic agents you are given 4 patient's medication list and you have to guess what other conditions they have (besides diabetes). Which of the following patients probably DOESN'T HAVE ANY CONTRAINDICATIONS to thiazolidinedione (TZD) based on your best guess of what condition they have from their med list? (I.e. they CAN take a TZD)

[Medication lists do not include diabetic agents for simplicity.]

Lasix 40mg BID (adjust as necessary), Digoxin, Nitroglycerin, Milrinone, Lisinopril, Metoprolol

ASA 81mg, rosuvastatin, orlistat

Acetylcysteine, nutrition support

Peg-interferon, boceprevir

16.

1 point

When switching to NPH from Glargine or Detemir, the conversion ratio is...

1:4

3:1

1:1

1:2

2:1

17.

1 point

Which gauge might be inappropriate for administration of insulin?

29

26

30

32

18.

1 point

Which one of these drugs is likely to interact with acarbose (Precose) or miglitol (Glyset)?

Ibuprofen

Simvastatin

Ranitidine

Warfarin

19.

1 point

What does DPP-IV do?

Activates mu dopamine channels, increasing glucagon secretion

Breaks down complex carbohydrates into simple sugars

Breaks down GLP-1 and GIP

Causes HDAC-mediated upregulation of synthesis of pancreatic alpha cells leading to increased glucagon

20.

1 point

True or false: It is okay to reuse insulin needles up to 3 times.

True

False

21.

1 point

Which is the most common and recommended strategy for initiating insulin therapy in Type 2 DM?

Fixing overnight glucose excursions

Fixing fasting and postprandial first, with mixed insulin

Fixing fasting BG first

Fixing postprandial glucose

22.

1 point

Which of these is incorrect?

Glulisine - Short-acting

Glargine - Long-acting

NPH - Short-acting

Detemir - Long-acting