The pharmacologic management of Type 2 Diabetes has evolved significantly, with a diverse and expanding arsenal of oral medications available. A deep understanding of the distinct pharmacology of each drug class—from their mechanisms of action to their side effect profiles—is essential for pharmacists to provide personalized, evidence-based care. As detailed in the Patient Care 5 curriculum, the “Pharmacology of Oral Diabetes Medications” is a foundational topic for modern pharmacy practice. This quiz will test your knowledge of the mechanisms, benefits, risks, and clinical pearls for these crucial therapies.
1. What is the primary mechanism of action of metformin?
- a. It stimulates insulin secretion from the pancreas.
- b. It decreases hepatic glucose production.
- c. It inhibits the DPP-4 enzyme.
- d. It blocks the reabsorption of glucose in the kidneys.
Answer: b. It decreases hepatic glucose production.
2. Sulfonylureas, such as glipizide, lower blood glucose by:
- a. Increasing insulin sensitivity in muscle tissue.
- b. Blocking the SGLT2 transporter in the kidney.
- c. Stimulating insulin secretion from pancreatic beta-cells by closing K-ATP channels.
- d. Slowing gastric emptying.
Answer: c. Stimulating insulin secretion from pancreatic beta-cells by closing K-ATP channels.
3. Which class of oral diabetes medications has a black box warning for causing or exacerbating congestive heart failure?
- a. Biguanides
- b. DPP-4 inhibitors
- c. Sulfonylureas
- d. Thiazolidinediones (TZDs)
Answer: d. Thiazolidinediones (TZDs)
4. The “-gliptin” suffix is characteristic of which drug class?
- a. SGLT2 inhibitors
- b. DPP-4 inhibitors
- c. Sulfonylureas
- d. TZDs
Answer: b. DPP-4 inhibitors
5. SGLT2 inhibitors, such as empagliflozin, exert their glucose-lowering effect by which mechanism?
- a. Increasing insulin secretion.
- b. Increasing urinary excretion of glucose.
- c. Decreasing hepatic glucose output.
- d. Enhancing the incretin effect.
Answer: b. Increasing urinary excretion of glucose.
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, often dose-limiting side effect of metformin is:
- a. Hypoglycemia
- b. Weight gain
- c. Gastrointestinal distress (diarrhea, nausea)
- d. Edema
Answer: c. Gastrointestinal distress (diarrhea, nausea)
8. Which of the following is the most significant adverse effect associated with sulfonylureas?
- a. Lactic acidosis
- b. Pancreatitis
- c. Hypoglycemia
- d. Urinary tract infections
Answer: c. Hypoglycemia
9. Pioglitazone is a TZD that works by:
- a. Inhibiting DPP-4.
- b. Acting as a PPAR-gamma agonist to increase insulin sensitivity.
- c. Stimulating insulin release.
- d. Blocking SGLT2.
Answer: b. Acting as a PPAR-gamma agonist to increase insulin sensitivity.
10. What is a key counseling point for a patient starting an SGLT2 inhibitor?
- a. To restrict fluid intake.
- b. To expect significant weight gain.
- c. The increased risk of genital mycotic infections and the importance of hydration.
- d. To take the medication at bedtime.
Answer: c. The increased risk of genital mycotic infections and the importance of hydration.
11. The management of diabetes is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. Which oral antidiabetic agent is considered weight neutral?
- a. Pioglitazone
- b. Glipizide
- c. Sitagliptin
- d. Insulin
Answer: c. Sitagliptin
13. The mechanism of action of DPP-4 inhibitors leads to:
- a. Increased levels of active incretin hormones like GLP-1.
- b. Decreased levels of active incretin hormones.
- c. Inhibition of glucose absorption.
- d. Increased glucagon secretion.
Answer: a. Increased levels of active incretin hormones like GLP-1.
14. Acarbose is an alpha-glucosidase inhibitor that works in the:
- a. Kidneys
- b. Liver
- c. Pancreas
- d. Small intestine
Answer: d. Small intestine
15. A patient taking an alpha-glucosidase inhibitor who experiences hypoglycemia from a concurrent drug must treat it with:
- a. Sucrose (table sugar)
- b. A candy bar
- c. Glucose tablets or gel
- d. A complex carbohydrate
Answer: c. Glucose tablets or gel
16. Long-term use of metformin can lead to a deficiency of which vitamin?
- a. Vitamin C
- b. Vitamin D
- c. Vitamin K
- d. Vitamin B12
Answer: d. Vitamin B12
17. The management of diabetes complications is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. Which sulfonylurea should be avoided in patients with significant renal impairment due to its long-acting, active metabolite?
- a. Glipizide
- b. Glyburide
- c. Glimepiride
- d. All are safe.
Answer: b. Glyburide
19. Which oral antidiabetic class has shown significant benefits in reducing adverse cardiovascular events and hospitalization for heart failure?
- a. Sulfonylureas
- b. SGLT2 inhibitors
- c. DPP-4 inhibitors
- d. Meglitinides
Answer: b. SGLT2 inhibitors
20. An active learning session on diabetes is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A common side effect of TZDs like pioglitazone is:
- a. Weight loss
- b. Peripheral edema and weight gain
- c. Nausea and vomiting
- d. Dehydration
Answer: b. Peripheral edema and weight gain
22. Which DPP-4 inhibitor does NOT require dose adjustment for renal impairment?
- a. Sitagliptin
- b. Saxagliptin
- c. Alogliptin
- d. Linagliptin
Answer: d. Linagliptin
23. The “-gliflozin” suffix is characteristic of which drug class?
- a. DPP-4 inhibitors
- b. SGLT2 inhibitors
- c. TZDs
- d. Sulfonylureas
Answer: b. SGLT2 inhibitors
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. Metformin is contraindicated at what eGFR threshold?
- a. < 90 mL/min/1.73m²
- b. < 60 mL/min/1.73m²
- c. < 45 mL/min/1.73m²
- d. < 30 mL/min/1.73m²
Answer: d. < 30 mL/min/1.73m²
26. The primary role of the pharmacist in managing oral diabetes pharmacotherapy is to:
- a. Ensure safe and effective use through education, monitoring, and adherence promotion.
- b. Only dispense the medications as written.
- c. Recommend the newest medication for every patient.
- d. Perform A1c tests in the pharmacy.
Answer: a. Ensure safe and effective use through education, monitoring, and adherence promotion.
27. Meglitinides like repaglinide should be taken:
- a. Once daily in the morning.
- b. Before meals to reduce postprandial glucose excursions.
- c. At bedtime.
- d. On an empty stomach an hour before food.
Answer: b. Before meals to reduce postprandial glucose excursions.
28. An active learning session on 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
29. A patient taking an SGLT2 inhibitor should be advised to hold their medication during times of illness (“sick days”) to reduce the risk of:
- a. Hyperglycemia
- b. Dehydration and euglycemic DKA
- c. Weight gain
- d. Hypertension
Answer: b. Dehydration and euglycemic DKA
30. The “Medicinal Chemistry of Diabetes Medications” is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. Which of the following is an insulin-independent mechanism of action?
- a. The action of sulfonylureas.
- b. The action of DPP-4 inhibitors.
- c. The action of SGLT2 inhibitors.
- d. The action of meglitinides.
Answer: c. The action of SGLT2 inhibitors.
32. The primary advantage of DPP-4 inhibitors over sulfonylureas is:
- a. They are more potent at lowering A1c.
- b. They cause significant weight loss.
- c. They have a much lower risk of causing hypoglycemia.
- d. They are less expensive.
Answer: c. They have a much lower risk of causing hypoglycemia.
33. What is a key counseling point for a patient starting metformin to minimize GI side effects?
- a. Take it on an empty stomach.
- b. Start at a high dose.
- c. Titrate the dose up slowly and take it with food.
- d. Crush the extended-release tablets.
Answer: c. Titrate the dose up slowly and take it with food.
34. The effect of TZDs on improving insulin sensitivity has a(n):
- a. Immediate onset of action.
- b. Delayed onset of action, taking several weeks to months for full effect.
- c. Onset of action within 24 hours.
- d. Unpredictable onset.
Answer: b. Delayed onset of action, taking several weeks to months for full effect.
35. A pharmacist counseling a patient on a sulfonylurea should always emphasize:
- a. The need for a low-carbohydrate diet.
- b. The importance of not skipping meals to avoid hypoglycemia.
- c. To take the medication only when blood sugar is high.
- d. That this medication helps with weight loss.
Answer: b. The importance of not skipping meals to avoid hypoglycemia.
36. A patient has T2DM and heart failure. Which of the following oral agents would be most beneficial?
- a. Pioglitazone
- b. Saxagliptin
- c. Empagliflozin
- d. Glyburide
Answer: c. Empagliflozin
37. The “pharmacology of oral diabetes medications” is a lecture within the diabetes module.
- a. True
- b. False
Answer: a. True
38. The main side effect that limits the use of alpha-glucosidase inhibitors like acarbose is:
- a. Hypoglycemia
- b. Weight gain
- c. Significant flatulence and GI discomfort
- d. Edema
Answer: c. Significant flatulence and GI discomfort
39. A patient is prescribed metformin XR. A key counseling point is:
- a. It can be crushed or chewed.
- b. A “ghost tablet” or shell may appear in the stool.
- c. It must be taken on an empty stomach.
- d. It has a higher risk of GI side effects than immediate-release metformin.
Answer: b. A “ghost tablet” or shell may appear in the stool.
40. An active learning session covering diabetes pharmacotherapy 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
41. Which class of oral diabetes agents works on an incretin-based mechanism?
- a. Sulfonylureas
- b. TZDs
- c. SGLT2 inhibitors
- d. DPP-4 inhibitors
Answer: d. DPP-4 inhibitors
42. Which oral agent is considered first-line therapy for prediabetes?
- a. A sulfonylurea
- b. A TZD
- c. Metformin (though lifestyle modification is paramount)
- d. No agents are used.
Answer: c. Metformin (though lifestyle modification is paramount)
43. A pharmacist reviewing a new prescription for pioglitazone should screen the patient’s profile for a history of:
- a. Asthma
- b. Heart Failure
- c. GERD
- d. Gout
Answer: b. Heart Failure
44. What is the role of a pharmacist when a patient experiences a side effect from an oral diabetes medication?
- a. To tell the patient to stop all their medications immediately.
- b. To assess the severity of the side effect and counsel on management strategies or recommend a change in therapy to the provider.
- c. To ignore the complaint as all drugs have side effects.
- d. To switch the medication to another one without consulting the provider.
Answer: b. To assess the severity of the side effect and counsel on management strategies or recommend a change in therapy to the provider.
45. Which of the following is a primary benefit of metformin?
- a. It causes weight loss.
- b. It does not cause hypoglycemia when used as monotherapy.
- c. It is available as a once-weekly formulation.
- d. It has no side effects.
Answer: b. It does not cause hypoglycemia when used as monotherpay.
46. SGLT2 inhibitors are recommended in patients with diabetic kidney disease because they:
- a. Lower A1c.
- b. Lower blood pressure.
- c. Have been shown to slow the progression of nephropathy.
- d. All of the above.
Answer: d. All of the above.
47. A key part of the pharmacologic management of diabetes is:
- a. Individualizing therapy based on patient-specific factors and comorbidities.
- b. Using the same regimen for every patient.
- c. Starting with insulin for all Type 2 patients.
- d. Focusing only on fasting blood glucose.
Answer: a. Individualizing therapy based on patient-specific factors and comorbidities.
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 goal of oral diabetes pharmacotherapy is to:
- a. Achieve the lowest possible A1c, regardless of hypoglycemia risk.
- b. Help patients achieve their glycemic goals safely to prevent long-term complications.
- c. Use as many oral agents as possible.
- d. Avoid the use of insulin.
Answer: b. Help patients achieve their glycemic goals safely to prevent long-term complications.
50. The ultimate reason to understand the pharmacology of oral diabetes drugs is to:
- a. Be able to recommend safe, effective, and evidence-based therapy tailored to each individual patient.
- b. Pass the endocrinology module.
- c. Memorize a list of drug interactions.
- d. Be able to counsel on every brand name.
Answer: a. Be able to recommend safe, effective, and evidence-based therapy tailored to each individual patient.