Lippincott Chapter 25: Drugs for Diabetes Flashcards
25.1 Which of the following statements is correct regarding
insulin glargine?
A. It is primarily used to control postprandial
hyperglycemia.
B. It is a “peakless” insulin.
C. The prolonged duration of activity is due to slow
dissociation from albumin.
D. It should not be used in a regimen with insulin lispro
or glulisine.
E. It may be administered intravenously in emergency
cases.
Correct answer = B. Insulin glargine has a relatively flat,
prolonged hypoglycemic effect. Because of this it is used
for basal glucose control, not postprandial. The prolonged
duration is due to its low pH, which leads to precipitation
at the injection site and resultant extended action. Insulin
glargine is often used for basal control in a regimen where
insulin lispro, glulisine, or aspart are used for mealtime glu-
cose control. [Note: Glargine should not be combined with
other insulins in the same syringe, as it may alter the phar-
macodynamic properties of the medication.]
25.2 DW is a patient with type 2 diabetes who has a blood
glucose of 400 mg/dL today at his office visit. The
physician would like to give some insulin to bring the
glucose down before he leaves the office. Which of
the following would lower the glucose in the quickest
manner in DW?
A. Insulin aspart.
B. Insulin glargine.
C. NPH insulin.
D. Regular insulin.
Correct answer = A. Insulin aspart is a rapid-acting insulin
that has an onset of action within 15 to 20 minutes. Insulin
glargine is a long-acting insulin that is used for basal control.
NPH insulin is an intermediate-acting insulin that is used for
basal control. Although regular insulin can be used to bring
the glucose down, its onset is not as quick as insulin aspart.
The onset of regular insulin is about 30 to 60 minutes.
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
metformin?
A. Metformin is inappropriate for initial management of
type 2 diabetes.
B. Metformin decreases hepatic glucose production.
C. Metformin undergoes significant metabolism via the
cytochrome P450 system.
D. Metformin should not be combined with
sulfonylureas or insulin.
E. Weight gain is a common adverse effect.
Correct answer = B. Metformin works by inhibiting hepatic
gluconeogenesis. It is the preferred initial agent for man-
agement of type 2 diabetes. Metformin is not metabolized.
It may be combined with sulfonylureas, insulin, or TZDs.
Unlike the sulfonylureas and insulin, weight gain is not an
adverse effect, and some patients actually lose weight due
to GI side effects
25.5 Which of the following is the most appropriate initial oral
agent for management of type 2 diabetes in patients
with no other comorbid conditions?
A. Glipizide.
B. Insulin.
C. Metformin.
D. Pioglitazone.
Correct answer = C. Metformin is the preferred initial agent
for management of type 2 diabetes. See Figure 25.14.
25.6 A 64-year-old woman with a history of type 2 diabetes
is diagnosed with heart failure. Which of the following
medications would be a poor choice for controlling her
diabetes?
A. Exenatide.
B. Glyburide.
C. Nateglinide.
D. Pioglitazone.
E. Sitagliptin.
Correct answer = D. The TZDs (pioglitazone and rosigli-
tazone) can cause fluid retention and lead to a worsening
of heart failure. They should be used with caution and dose
reduction, if at all, in patients with heart failure. Exenatide,
glyburide, nateglinide, and sitagliptin do not have precau-
tions for use in heart failure patients.
25.7 KD is a 69-year-old male with type 2 diabetes and
advanced chronic kidney disease. Which of the
following diabetes medications is contraindicated in
this patient?
A. Glipizide.
B. Insulin lispro.
C. Metformin.
D. Saxagliptin
Correct answer = C. Metformin should not be used in
patients with kidney disease due to the possibility of lactic
acidosis. Glipizide can be used safely in patients with CrCl
as low as 10 mL/min. Insulin is not contraindicated in renal
dysfunction, although the dosage may need to be adjusted.
While the dose of the DPP-4 inhibitor saxagliptin may need
to be reduced in renal dysfunction, it is not contraindicated
25.8 Which of the following drugs for diabetes would be
LEAST likely to cause weight gain?
A. Glimepiride.
B. Liraglutide.
C. Pioglitazone.
D. Repaglinide.
E. Insulin glulisine.
Correct answer = B. Incretin mimetics are usually associ-
ated with weight loss due to their ability to enhance satiety.
All of the other agents are associated with weight gain.
25.9 A patient with type 2 diabetes is taking metformin. The
fasting glucose levels are in range, but the postprandial
glucose is uncontrolled. All of the following drugs
would be appropriate to add to metformin to target
postprandial glucose except:
A. Acarbose.
B. Exenatide.
C. Insulin aspart.
D. Pramlintide.
The correct answer = D. Although all of these drugs target
postprandial glucose, pramlintide should only be used in
conjunction with mealtime insulin. Since this patient is not
on insulin, pramlintide is not indicated.
25.10 Which of the following diabetes medications is most
appropriately paired with an adverse effect associated
with its use?
A. Canagliflozin—lactic acidosis.
B. Metformin—urinary tract infections.
C. Nateglinide—heart failure.
D. Liraglutide—pancreatitis.
Correct answer = D. The incretin mimetics are associated
with a risk of pancreatitis. Lactic acidosis is a rare but seri-
ous side effect of metformin (not canagliflozin). Adverse
effects of canagliflozin are genital mycotic infections, uri-
nary tract infections, and urinary frequency. Nateglinide may
cause hypoglycemia but has not been associated with heart
failure. The TZDs have been associated with heart failure.
