Oral hypoglycemic agents MCQs With Answer

Oral hypoglycemic agents MCQs With Answer

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Oral hypoglycemic agents MCQs With Answer

This concise introduction reviews oral hypoglycemic agents for B.Pharm students, focusing on antidiabetic drugs, mechanisms of action, pharmacokinetics, adverse effects, dosing and clinical monitoring. Key drug classes covered include biguanides (metformin), sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors and alpha-glucosidase inhibitors. Emphasis is placed on drug selection in renal or hepatic impairment, drug interactions, risks of hypoglycemia and lactic acidosis, and patient counseling points. These MCQs reinforce core concepts such as receptor targets, onset/duration profiles, contraindications and common side effects to prepare you for exams and clinical practice. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which oral hypoglycemic drug primarily reduces hepatic gluconeogenesis and increases peripheral glucose uptake?

  • Glibenclamide
  • Metformin
  • Pioglitazone
  • Sitagliptin

Correct Answer: Metformin

Q2. Which class of oral antidiabetic agents acts by stimulating insulin release via closure of pancreatic beta-cell KATP channels?

  • Biguanides
  • Thiazolidinediones
  • Sulfonylureas
  • SGLT2 inhibitors

Correct Answer: Sulfonylureas

Q3. Which adverse effect is most characteristically associated with thiazolidinediones like pioglitazone?

  • Genital mycotic infections
  • Weight loss
  • Fluid retention and risk of heart failure
  • Lactic acidosis

Correct Answer: Fluid retention and risk of heart failure

Q4. Which oral hypoglycemic is contraindicated in severe renal impairment due to risk of lactic acidosis?

  • Repaglinide
  • Metformin
  • Acarbose
  • Sitagliptin

Correct Answer: Metformin

Q5. Which drug class lowers blood glucose by preventing renal glucose reabsorption in the proximal tubule?

  • DPP-4 inhibitors
  • SGLT2 inhibitors
  • Alpha-glucosidase inhibitors
  • Meglitinides

Correct Answer: SGLT2 inhibitors

Q6. Acarbose lowers postprandial glucose by inhibiting which enzyme?

  • HMG-CoA reductase
  • Pancreatic lipase
  • Alpha-glucosidase
  • DPP-4

Correct Answer: Alpha-glucosidase

Q7. Which oral agent is a DPP-4 inhibitor that increases incretin levels and thereby enhances glucose-dependent insulin secretion?

  • Gliclazide
  • Pioglitazone
  • Sitagliptin
  • Canagliflozin

Correct Answer: Sitagliptin

Q8. Which sulfonylurea is known for a relatively long duration of action and higher hypoglycemia risk in elderly patients?

  • Glipizide
  • Gliclazide
  • Glibenclamide (glyburide)
  • Repaglinide

Correct Answer: Glibenclamide (glyburide)

Q9. Which oral hypoglycemic is primarily excreted unchanged by the kidney and therefore requires dose adjustment in renal impairment?

  • Metformin
  • Linagliptin
  • Pioglitazone
  • Gliclazide

Correct Answer: Metformin

Q10. Which agent is a rapid-acting insulin secretagogue useful to control postprandial hyperglycemia and taken just before meals?

  • Repaglinide
  • Pioglitazone
  • Canagliflozin
  • Metformin

Correct Answer: Repaglinide

Q11. Which mechanism explains how pioglitazone improves insulin sensitivity?

  • Inhibition of hepatic gluconeogenesis
  • Activation of PPAR-gamma nuclear receptors
  • Blocking renal glucose transporters
  • Enhancing incretin degradation

Correct Answer: Activation of PPAR-gamma nuclear receptors

Q12. Which side effect is most commonly seen with SGLT2 inhibitors?

  • Severe lactic acidosis
  • Genital mycotic (fungal) infections
  • Pancreatitis
  • Marked hypoglycemia when used alone

Correct Answer: Genital mycotic (fungal) infections

Q13. Which oral hypoglycemic is weight neutral and has low risk of hypoglycemia when used as monotherapy?

  • Sulfonylureas
  • Metformin
  • Meglitinides
  • Pioglitazone

Correct Answer: Metformin

Q14. DPP-4 inhibitors primarily increase levels of which hormones to improve glycemic control?

  • Glucagon and cortisol
  • GLP-1 and GIP (incretins)
  • Insulin-like growth factor
  • Adrenaline and noradrenaline

Correct Answer: GLP-1 and GIP (incretins)

Q15. Which oral agent’s efficacy is reduced when combined with an alpha-glucosidase inhibitor due to overlapping mechanism?

  • Sulfonylurea
  • Metformin
  • Acarbose
  • Sitagliptin

Correct Answer: Acarbose

Q16. Which drug interaction increases the risk of severe hypoglycemia with sulfonylureas?

  • Rifampicin (CYP inducer)
  • Beta-blockers masking hypoglycemia symptoms
  • Metformin coadministration
  • Concurrent use of pioglitazone

Correct Answer: Beta-blockers masking hypoglycemia symptoms

Q17. Which oral hypoglycemic is preferred when there is concern about cardiovascular mortality benefit based on large outcome trials?

  • Canagliflozin
  • Metformin
  • Glibenclamide
  • Acarbose

Correct Answer: Metformin

Q18. Which adverse effect is most associated with alpha-glucosidase inhibitors like acarbose?

  • Flatulence and abdominal discomfort
  • Severe hypoglycemia when used alone
  • Edema and weight gain
  • Lactic acidosis

Correct Answer: Flatulence and abdominal discomfort

Q19. Which oral hypoglycemic class requires caution in patients with a history of pancreatitis?

  • SGLT2 inhibitors
  • DPP-4 inhibitors and GLP-1 analogs
  • Thiazolidinediones
  • Alpha-glucosidase inhibitors

Correct Answer: DPP-4 inhibitors and GLP-1 analogs

Q20. Which sulfonylurea is often preferred for short duration of action to reduce prolonged hypoglycemia risk?

  • Glibenclamide (glyburide)
  • Gliclazide
  • Glipizide
  • Chlorpropamide

Correct Answer: Glipizide

Q21. Metformin’s primary effect on lipid profile is to:

  • Increase LDL cholesterol
  • Reduce triglycerides and improve HDL modestly
  • Cause severe hypertriglyceridemia
  • Have no effect on lipids

Correct Answer: Reduce triglycerides and improve HDL modestly

Q22. Which oral hypoglycemic can cause euglycemic diabetic ketoacidosis as a rare but serious adverse event?

  • Sitagliptin
  • Canagliflozin (SGLT2 inhibitor)
  • Metformin
  • Gliclazide

Correct Answer: Canagliflozin (SGLT2 inhibitor)

Q23. Which laboratory parameter should be routinely monitored in patients on metformin therapy?

  • Serum creatinine / eGFR
  • Serum amylase
  • Fasting insulin only
  • Thyroid function tests

Correct Answer: Serum creatinine / eGFR

Q24. Which oral agent is metabolized mainly by CYP2C8 and may interact with CYP modulators?

  • Repaglinide
  • Pioglitazone
  • Canagliflozin
  • Metformin

Correct Answer: Pioglitazone

Q25. In a patient with a history of frequent hypoglycemia, which class is least likely to cause hypoglycemia when used alone?

  • Sulfonylureas
  • Meglitinides
  • Metformin
  • Insulin secretagogues

Correct Answer: Metformin

Q26. What is the main therapeutic advantage of meglitinides compared to sulfonylureas?

  • Longer duration of action
  • Less postprandial glucose control
  • Shorter acting with dosing around meals to reduce prolonged hypoglycemia
  • Stronger PPAR-gamma activation

Correct Answer: Shorter acting with dosing around meals to reduce prolonged hypoglycemia

Q27. Which oral hypoglycemic should be avoided in pregnancy and breastfeeding, with insulin preferred instead?

  • Metformin (always contraindicated)
  • Sulfonylureas (many are avoided; insulin preferred)
  • Acarbose (safe in pregnancy)
  • Canagliflozin (established safe)

Correct Answer: Sulfonylureas (many are avoided; insulin preferred)

Q28. Which monitoring parameter is most important when initiating a thiazolidinedione?

  • Liver function tests for hepatotoxicity
  • Serum potassium
  • Complete blood count weekly
  • Serum amylase

Correct Answer: Liver function tests for hepatotoxicity

Q29. Which oral hypoglycemic agent is not significantly eliminated by the kidney and may be used without dose adjustment in moderate renal impairment?

  • Metformin
  • Linagliptin
  • Glibenclamide
  • Canagliflozin

Correct Answer: Linagliptin

Q30. Which adverse effect is a major concern when combining sulfonylureas with alcohol?

  • Increased risk of lactic acidosis
  • Disulfiram-like reaction or unpredictable hypoglycemia
  • Severe hypertension
  • Increased risk of pancreatitis

Correct Answer: Disulfiram-like reaction or unpredictable hypoglycemia

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