MCQ Quiz: Pharmacologic Management of Diabetes

The pharmacologic management of diabetes mellitus has become increasingly complex and personalized, moving beyond a simple glucose-lowering strategy to a comprehensive approach focused on cardiovascular and renal risk reduction. Pharmacists, guided by the principles taught in the Patient Care 5 curriculum, are essential for navigating the numerous classes of oral and injectable medications. This quiz will test the clinical knowledge required to select appropriate therapies based on patient-specific factors and comorbidities, manage side effects, and achieve therapeutic goals.

1. According to most guidelines, what is the first-line pharmacologic agent for a newly diagnosed patient with Type 2 Diabetes, assuming no contraindications?

• a. Insulin
• b. A sulfonylurea
• c. Metformin
• d. An SGLT2 inhibitor

Answer: c. Metformin

2. Which class of oral diabetes medications works primarily by stimulating insulin secretion from pancreatic beta cells, regardless of glucose levels?

• a. Biguanides
• b. Thiazolidinediones (TZDs)
• c. Sulfonylureas
• d. DPP-4 inhibitors

Answer: c. Sulfonylureas

3. A patient with Type 2 Diabetes and established atherosclerotic cardiovascular disease (ASCVD) would benefit most from adding which of the following agents to their metformin?

• a. A sulfonylurea like glipizide.
• b. A GLP-1 receptor agonist with proven cardiovascular benefit, like liraglutide.
• c. A DPP-4 inhibitor like sitagliptin.
• d. Basal insulin.

Answer: b. A GLP-1 receptor agonist with proven cardiovascular benefit, like liraglutide.

4. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as empagliflozin, lower blood glucose by:

• a. Increasing insulin sensitivity.
• b. Decreasing hepatic glucose production.
• c. Increasing the urinary excretion of glucose.
• d. Slowing gastric emptying.

Answer: c. Increasing the urinary excretion of glucose.

5. Pioglitazone is a thiazolidinedione (TZD) that is contraindicated in patients with what comorbid condition?

• a. Hypertension
• b. Asthma
• c. Symptomatic Heart Failure
• d. Gout

Answer: c. Symptomatic Heart Failure

6. The “Pharmacology of Oral Diabetes Medications” is a specific lecture in which course?

• a. PHA5787C Patient Care 5
• b. PHA5104 Sterile Compounding
• c. PHA5703 Pharmacy Law and Ethics
• d. PHA5878C Patient Care 3

Answer: a. PHA5787C Patient Care 5

7. A common and often dose-limiting side effect of metformin is:

• a. Weight gain
• b. Hypoglycemia
• c. Gastrointestinal upset (diarrhea, nausea)
• d. Edema

Answer: c. Gastrointestinal upset (diarrhea, nausea)

8. Which of the following is a long-acting (basal) insulin?

• a. Insulin lispro
• b. Insulin aspart
• c. Insulin detemir
• d. Regular insulin

Answer: c. Insulin detemir

9. GLP-1 receptor agonists are administered via which route?

• a. Oral
• b. Transdermal
• c. Subcutaneous injection
• d. Inhalation

Answer: c. Subcutaneous injection

10. A patient taking glipizide should be counseled extensively on the risk, signs, and management of:

• a. Lactic acidosis
• b. Hypoglycemia
• c. Genitourinary infections
• d. Pancreatitis

Answer: b. Hypoglycemia

11. The management of Type 1 and Type 2 Diabetes are topics within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

12. Which of the following is considered a weight-neutral oral diabetes medication class?

• a. Sulfonylureas
• b. TZDs
• c. DPP-4 inhibitors
• d. Insulin

Answer: c. DPP-4 inhibitors

13. In addition to glycemic control, SGLT2 inhibitors have demonstrated benefit in patients with:

• a. Heart failure and chronic kidney disease.
• b. Severe peripheral neuropathy.
• c. Gastroparesis.
• d. Allergic rhinitis.

Answer: a. Heart failure and chronic kidney disease.

14. A basal-bolus insulin regimen is designed to mimic the natural physiologic secretion of insulin. It consists of:

• a. A long-acting insulin and a rapid-acting insulin.
• b. Only a rapid-acting insulin.
• c. Only an intermediate-acting insulin.
• d. Two different long-acting insulins.

Answer: a. A long-acting insulin and a rapid-acting insulin.

15. A patient should be counseled to take their rapid-acting insulin (e.g., lispro):

• a. Once daily at bedtime.
• b. 30 minutes before meals.
• c. With meals, or within 15 minutes before eating.
• d. In the morning only.

Answer: c. With meals, or within 15 minutes before eating.

16. A common side effect of SGLT2 inhibitors is an increased risk of:

• a. Weight gain
• b. Pancreatitis
• c. Genital mycotic infections
• d. Lactic acidosis

Answer: c. Genital mycotic infections

17. The “Pharmacology of Injectable Diabetes Medications” is a lecture covered in the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

18. What is the mechanism of action of DPP-4 inhibitors like sitagliptin?

• a. They increase urinary glucose excretion.
• b. They increase insulin sensitivity.
• c. They prevent the breakdown of endogenous incretin hormones like GLP-1.
• d. They stimulate insulin secretion directly.

Answer: c. They prevent the breakdown of endogenous incretin hormones like GLP-1.

19. Which oral diabetes medication should be held before receiving IV iodinated contrast dye?

• a. Glipizide
• b. Pioglitazone
• c. Sitagliptin
• d. Metformin

Answer: d. Metformin

20. An active learning session on diabetes is part of the Patient Care 5 course.

• a. True
• b. False

Answer: a. True

21. A patient with a history of pancreatitis should use which class of medications with caution?

• a. Metformin
• b. Sulfonylureas
• c. GLP-1 receptor agonists and DPP-4 inhibitors
• d. TZDs

Answer: c. GLP-1 receptor agonists and DPP-4 inhibitors

22. Which of the following is NOT a benefit of GLP-1 receptor agonists?

• a. A1c reduction
• b. Weight loss
• c. Low risk of hypoglycemia
• d. Reduction in blood pressure

Answer: c. Low risk of hypoglycemia

23. Insulin glargine should not be mixed in the same syringe with which other type of insulin?

• a. Insulin lispro
• b. Insulin aspart
• c. Regular insulin
• d. All of the above

Answer: d. All of the above

24. An active learning session on diabetes is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

25. A patient with Type 1 Diabetes requires:

• a. At least one oral medication.
• b. Lifelong insulin therapy.
• c. A GLP-1 receptor agonist as monotherapy.
• d. Diet and exercise alone.

Answer: b. Lifelong insulin therapy.

26. The “Rule of 15” for treating hypoglycemia involves:

• a. Consuming 15 grams of protein.
• b. Consuming 15 grams of a simple carbohydrate.
• c. Injecting 15 units of insulin.
• d. Waiting 15 minutes before taking any action.

Answer: b. Consuming 15 grams of a simple carbohydrate.

27. A key counseling point for a patient starting an SGLT2 inhibitor is to:

• a. Restrict fluid intake.
• b. Maintain adequate hydration and be aware of the signs of a UTI.
• c. Take the medication at bedtime.
• d. Expect weight gain.

Answer: b. Maintain adequate hydration and be aware of the signs of a UTI.

28. Which sulfonylurea has a long-acting, active metabolite that can accumulate in renal impairment, and should be avoided in the elderly?

• a. Glipizide
• b. Glimepiride
• c. Glyburide
• d. Gliclazide

Answer: c. Glyburide

29. The main goal of pharmacologic therapy in diabetes is to:

• a. Lower A1c to prevent long-term microvascular and macrovascular complications.
• b. Use the highest number of medications possible.
• c. Eliminate the need for blood glucose monitoring.
• d. Cause weight loss.

Answer: a. Lower A1c to prevent long-term microvascular and macrovascular complications.

30. The management of diabetes complications is a lecture within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

31. When is it appropriate to initiate dual therapy at the time of diagnosis of Type 2 Diabetes?

• a. When the patient’s A1c is ≥ 1.5% above their glycemic target.
• b. For every patient.
• c. When the patient refuses metformin.
• d. When the fasting blood glucose is > 150 mg/dL.

Answer: a. When the patient’s A1c is ≥ 1.5% above their glycemic target.

32. The primary mechanism of action of thiazolidinediones (TZDs) is:

• a. Increasing insulin secretion.
• b. Increasing peripheral insulin sensitivity by acting as a PPARγ agonist.
• c. Blocking glucose reabsorption.
• d. Inhibiting DPP-4.

Answer: b. Increasing peripheral insulin sensitivity by acting as a PPARγ agonist.

33. The pharmacist’s role in diabetes management includes:

• a. Educating patients on how to use their glucometer and injectable medications.
• b. Screening for drug interactions and contraindications.
• c. Counseling on lifestyle modifications.
• d. All of the above.

Answer: d. All of the above.

34. Long-term use of metformin is associated with a risk of deficiency in which vitamin?

• a. Vitamin C
• b. Vitamin D
• c. Vitamin B12
• d. Vitamin K

Answer: c. Vitamin B12

35. A patient on a basal-bolus regimen should be taught to adjust their bolus (mealtime) insulin based on:

• a. Their fasting blood glucose.
• b. The amount of carbohydrates in their meal.
• c. The time of day.
• d. Their blood pressure.

Answer: b. The amount of carbohydrates in their meal.

36. Which class of medication is generally considered weight neutral or may cause slight weight loss?

• a. Sulfonylureas
• b. TZDs
• c. Insulin
• d. Metformin

Answer: d. Metformin

37. When choosing a second-line agent to add to metformin for a patient with T2DM and heart failure, which class should be prioritized?

• a. A sulfonylurea
• b. A TZD
• c. An SGLT2 inhibitor with proven HF benefit.
• d. Basal insulin.

Answer: c. An SGLT2 inhibitor with proven HF benefit.

38. The medicinal chemistry of diabetes medications is a topic within the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

39. Which of the following is NOT a rapid-acting insulin?

• a. Lispro
• b. Aspart
• c. Glulisine
• d. NPH

Answer: d. NPH

40. An active learning session covering diabetes is part of which course module?

• a. Module 1: Diabetes Mellitus
• b. Module 3: Women’s Health
• c. Module 4: Medication Safety
• d. Module 8: Men’s Health

Answer: a. Module 1: Diabetes Mellitus

41. The primary side effect that limits the titration of GLP-1 receptor agonists is:

• a. Hypoglycemia
• b. Gastrointestinal intolerance (nausea)
• c. Headache
• d. Injection site reactions

Answer: b. Gastrointestinal intolerance (nausea)

42. Which oral diabetes medication works by slowing the intestinal absorption of carbohydrates?

• a. Acarbose (an alpha-glucosidase inhibitor)
• b. Metformin
• c. Glipizide
• d. Sitagliptin

Answer: a. Acarbose (an alpha-glucosidase inhibitor)

43. A patient with T2DM and CKD with albuminuria should be on what medication for renal protection, regardless of their blood pressure?

• a. A beta-blocker
• b. An ACE inhibitor or ARB
• c. Amlodipine
• d. Hydrochlorothiazide

Answer: b. An ACE inhibitor or ARB

44. What is the role of a pharmacist in a “sick day” plan for a patient with diabetes?

• a. To advise the patient to stop all their diabetes medications.
• b. To counsel on more frequent blood glucose monitoring and when to seek medical attention.
• c. To recommend increasing their insulin dose.
• d. To tell the patient not to eat or drink anything.

Answer: b. To counsel on more frequent blood glucose monitoring and when to seek medical attention.

45. Which of the following medications primarily targets postprandial (after-meal) hyperglycemia?

• a. Insulin glargine
• b. Metformin
• c. A rapid-acting insulin like lispro
• d. Pioglitazone

Answer: c. A rapid-acting insulin like lispro

46. Counseling on medication use and devices is a key objective for pharmacy students.

• a. True
• b. False

Answer: a. True

47. A patient starting insulin therapy should also be provided with a prescription for what?

• a. Metformin
• b. Glucagon emergency kit
• c. A statin
• d. An ACE inhibitor

Answer: b. Glucagon emergency kit

48. An active learning session on diabetes is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

49. The overall management of diabetes pharmacotherapy is guided by:

• a. A stepwise approach based on patient characteristics, comorbidities, and glycemic needs.
• b. Using the newest medication available for every patient.
• c. The patient’s preference only.
• d. A goal of using as few medications as possible.

Answer: a. A stepwise approach based on patient characteristics, comorbidities, and glycemic needs.

50. The ultimate goal of diabetes pharmacotherapy is to:

• a. Lower the A1c value at all costs.
• b. Prevent acute and chronic complications, improve quality of life, and ensure patient safety.
• c. Eliminate the need for lifestyle modifications.
• d. Use only injectable medications.

Answer: b. Prevent acute and chronic complications, improve quality of life, and ensure patient safety.