Meglitinides – Repaglinide MCQs With Answer

Meglitinides – Repaglinide MCQs With Answer

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Meglitinides – Repaglinide MCQs With Answer

This concise introduction reviews meglitinides, focusing on repaglinide for B.Pharm students. Covering mechanism of action, pharmacokinetics, clinical uses in type 2 diabetes, dosing strategies, adverse effects such as hypoglycemia and weight gain, and important drug interactions, this resource emphasizes key pharmacology concepts, therapeutic monitoring, and differences from sulfonylureas. Keywords included: Meglitinides, Repaglinide, insulin secretagogue, onset, duration, hepatic metabolism, CYP3A4 interactions, hypoglycemia, dosing, and pharmacodynamics. Clear, exam-focused explanations prepare students for clinical decision-making and rational drug use. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which best describes the primary mechanism of action of repaglinide?

  • Increasing insulin sensitivity in peripheral tissues
  • Inhibiting hepatic gluconeogenesis
  • Stimulating pancreatic beta-cell insulin release by closing ATP-dependent K+ channels
  • Delaying intestinal carbohydrate absorption by inhibiting alpha-glucosidase

Correct Answer: Stimulating pancreatic beta-cell insulin release by closing ATP-dependent K+ channels

Q2. Compared to sulfonylureas, repaglinide is best characterized by which pharmacokinetic property?

  • Longer duration of action and once-daily dosing
  • Shorter onset and shorter duration, taken before meals
  • Primarily renal excretion and requires dose reduction in renal failure
  • Poor oral bioavailability and is administered parenterally

Correct Answer: Shorter onset and shorter duration, taken before meals

Q3. What is the main clinical advantage of repaglinide’s short-acting profile?

  • Lower risk of fasting hypoglycemia and flexible dosing around meals
  • Enhanced weight loss compared to other antidiabetics
  • Superior HbA1c lowering compared to metformin
  • No need for dose adjustment in hepatic impairment

Correct Answer: Lower risk of fasting hypoglycemia and flexible dosing around meals

Q4. Repaglinide is primarily metabolized by which hepatic enzyme system?

  • CYP2D6
  • CYP3A4 and CYP2C8
  • CYP1A2
  • UGT glucuronidation only

Correct Answer: CYP3A4 and CYP2C8

Q5. Which adverse effect is most characteristic of repaglinide therapy?

  • Severe lactic acidosis
  • Hyperkalemia
  • Hypoglycemia and possible weight gain
  • Thyroid dysfunction

Correct Answer: Hypoglycemia and possible weight gain

Q6. A patient taking repaglinide should be counseled to take the dose when?

  • At bedtime
  • Immediately before or up to 30 minutes before each meal
  • Only on days of high carbohydrate intake
  • Once weekly to maintain glycemic control

Correct Answer: Immediately before or up to 30 minutes before each meal

Q7. Which drug interaction significantly increases the plasma concentration of repaglinide?

  • Rifampin
  • Carbamazepine
  • Ketoconazole
  • Phenytoin

Correct Answer: Ketoconazole

Q8. In which patient population must repaglinide dose be used with particular caution and often reduced?

  • Young adults with type 1 diabetes
  • Patients with severe hepatic impairment
  • Patients with hyperthyroidism
  • Patients following a ketogenic diet

Correct Answer: Patients with severe hepatic impairment

Q9. Repaglinide should not be used as monotherapy in which type of diabetes?

  • Type 2 diabetes mellitus
  • Gestational diabetes managed with diet
  • Type 1 diabetes mellitus
  • Maturity-onset diabetes of the young (MODY)

Correct Answer: Type 1 diabetes mellitus

Q10. Which laboratory parameter is most important to monitor during repaglinide therapy?

  • Serum creatinine only
  • HbA1c and blood glucose for hypoglycemia risk
  • Liver enzymes weekly
  • Serum potassium

Correct Answer: HbA1c and blood glucose for hypoglycemia risk

Q11. Which statement best differentiates repaglinide from nateglinide (another meglitinide)?

  • Repaglinide has a much longer half-life than nateglinide
  • Nateglinide is more selective for late postprandial insulin release
  • Repaglinide primarily works via incretin enhancement
  • Nateglinide is injected subcutaneously

Correct Answer: Nateglinide is more selective for late postprandial insulin release

Q12. The binding site of repaglinide on the beta-cell is best described as:

  • The sulfonylurea receptor (SUR1) on the ATP-dependent K+ channel
  • GLP-1 receptor on beta-cell membrane
  • Insulin receptor tyrosine kinase
  • Sodium-glucose cotransporter 2 (SGLT2)

Correct Answer: The sulfonylurea receptor (SUR1) on the ATP-dependent K+ channel

Q13. Which clinical scenario increases the risk of severe hypoglycemia with repaglinide?

  • Missed meal after taking repaglinide
  • Taking repaglinide immediately after a carbohydrate-rich meal
  • Concurrent use of metformin without renal impairment
  • Using repaglinide at the lowest effective dose

Correct Answer: Missed meal after taking repaglinide

Q14. Which statement about repaglinide and renal impairment is correct?

  • No dose adjustment is needed in moderate renal impairment but monitor for hypoglycemia
  • Repaglinide is contraindicated in any renal impairment
  • Dose must be doubled in renal failure
  • It is cleared entirely by the kidneys so dialysis removes it completely

Correct Answer: No dose adjustment is needed in moderate renal impairment but monitor for hypoglycemia

Q15. Which adverse effect is less commonly associated with repaglinide compared to sulfonylureas?

  • Weight gain
  • Prolonged hypoglycemia due to active metabolites
  • Transient dizziness
  • Gastrointestinal upset

Correct Answer: Prolonged hypoglycemia due to active metabolites

Q16. Which pharmacodynamic property explains repaglinide’s rapid onset of action?

  • High renal clearance
  • Rapid absorption from the gastrointestinal tract and quick binding to SUR1
  • Slow hepatic metabolism leading to accumulation
  • Strong protein binding preventing tissue distribution

Correct Answer: Rapid absorption from the gastrointestinal tract and quick binding to SUR1

Q17. In designing a regimen for postprandial hyperglycemia, repaglinide is chosen because it primarily targets:

  • Basal hepatic glucose output
  • Early and rapid postprandial insulin secretion
  • Long-term insulin sensitization of muscle
  • Renal glucose excretion

Correct Answer: Early and rapid postprandial insulin secretion

Q18. Which dietary advice is most appropriate for a patient prescribed repaglinide?

  • Skip meals when feeling hypoglycemic to avoid side effects
  • Take repaglinide only with high-fat meals
  • Ensure a meal is consumed shortly after each dose to reduce hypoglycemia risk
  • Take repaglinide on an empty stomach at bedtime

Correct Answer: Ensure a meal is consumed shortly after each dose to reduce hypoglycemia risk

Q19. Which statement about repaglinide use in pregnancy is correct?

  • It is the first-line oral agent in gestational diabetes
  • Use in pregnancy is limited; insulin is preferred due to safety data
  • Repaglinide is proven safe in all trimesters
  • It prevents congenital malformations better than insulin

Correct Answer: Use in pregnancy is limited; insulin is preferred due to safety data

Q20. Which of the following best describes repaglinide’s elimination half-life?

  • Very long (over 24 hours)
  • Short (around 1 hour), supporting preprandial dosing
  • Irrelevant because repaglinide is not systemically absorbed
  • Extremely variable and up to several days in healthy adults

Correct Answer: Short (around 1 hour), supporting preprandial dosing

Q21. Combining repaglinide with which of the following increases hypoglycemia risk due to additive insulin secretion?

  • Metformin
  • SGLT2 inhibitors
  • Thiazolidinediones
  • Sulfonylureas

Correct Answer: Sulfonylureas

Q22. Which structural property distinguishes meglitinides from sulfonylureas?

  • They are peptides derived from insulin
  • They are chemically different, non-sulfonylurea small molecules that bind SUR1
  • They are carbohydrates that block alpha-glucosidase
  • They are metal complexes that chelate glucose

Correct Answer: They are chemically different, non-sulfonylurea small molecules that bind SUR1

Q23. A patient on repaglinide reports frequent lightheadedness and sweating. The most appropriate immediate action is:

  • Advise to skip the next dose and continue routine
  • Measure blood glucose and treat hypoglycemia if confirmed
  • Increase repaglinide dose to overcome symptoms
  • Switch to once-weekly dosing

Correct Answer: Measure blood glucose and treat hypoglycemia if confirmed

Q24. Which monitoring parameter helps assess long-term efficacy of repaglinide therapy?

  • Fasting plasma insulin levels
  • HbA1c every 3 months
  • Daily urine ketones only
  • Serum C-peptide monthly

Correct Answer: HbA1c every 3 months

Q25. Which condition is a relative contraindication to repaglinide therapy?

  • History of severe hypoglycemic episodes while on sulfonylureas
  • Mild hyperlipidemia
  • Controlled hypertension on ACE inhibitors
  • Seasonal allergic rhinitis

Correct Answer: History of severe hypoglycemic episodes while on sulfonylureas

Q26. Which of the following best describes the effect of grapefruit juice on repaglinide?

  • Grapefruit juice induces CYP3A4 and reduces repaglinide levels
  • Grapefruit juice inhibits CYP3A4 and can increase repaglinide exposure leading to hypoglycemia
  • No interaction; grapefruit only affects statins
  • Grapefruit increases renal clearance of repaglinide

Correct Answer: Grapefruit juice inhibits CYP3A4 and can increase repaglinide exposure leading to hypoglycemia

Q27. Which formulation is repaglinide available as for oral administration?

  • Immediate-release oral tablets
  • Transdermal patch only
  • Subcutaneous injection pens
  • Intravenous solution for acute care

Correct Answer: Immediate-release oral tablets

Q28. When switching a patient from a sulfonylurea to repaglinide, the pharmacist should advise:

  • Start repaglinide at the same time without stopping sulfonylurea
  • Taper and discontinue sulfonylurea before initiating repaglinide to reduce hypoglycemia risk
  • Double the dose of repaglinide for the first week
  • Stop all oral agents and start insulin immediately

Correct Answer: Taper and discontinue sulfonylurea before initiating repaglinide to reduce hypoglycemia risk

Q29. Which clinical trial endpoint is most appropriate to demonstrate repaglinide’s efficacy?

  • Reduction in LDL cholesterol over 6 months
  • Decrease in postprandial glucose excursions and reduction in HbA1c
  • Increase in urinary glucose excretion
  • Improvement in pulmonary function tests

Correct Answer: Decrease in postprandial glucose excursions and reduction in HbA1c

Q30. Which counseling point helps reduce risk when a patient is on repaglinide and starts a CYP3A4 inhibitor?

  • No change needed; continue same dose
  • Monitor for hypoglycemia and consider repaglinide dose reduction
  • Stop repaglinide permanently
  • Double the repaglinide dose to maintain glycemic control

Correct Answer: Monitor for hypoglycemia and consider repaglinide dose reduction

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