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
