Pharmacotherapy - Diabetes Cont...

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| By Caitlinb
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Caitlinb
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Quizzes Created: 12 | Total Attempts: 8,980
Questions: 20 | Attempts: 121

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Diabetes Quizzes & Trivia

Questions and Answers
  • 1. 

    To decrease the probability of the somogyi effect....

    • A.

      Inject NPH at dinner and not HS

    • B.

      Inject NPH HS and not at dinner

    Correct Answer
    B. Inject NPH HS and not at dinner
    Explanation
    Injecting NPH (Neutral Protamine Hagedorn) insulin at bedtime (HS) rather than at dinner helps decrease the probability of the somogyi effect. The somogyi effect is a rebound phenomenon where low blood sugar levels during the night trigger the release of counter-regulatory hormones, leading to high blood sugar levels in the morning. By injecting NPH at bedtime, the insulin is at its peak action during the early morning hours, preventing the drop in blood sugar levels and subsequent rebound hyperglycemia. Injecting NPH at dinner would not provide adequate coverage during the critical overnight period.

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  • 2. 

    Rotating sites prevents...

    • A.

      Lipoatrophy

    • B.

      Lipohypertrophy

    • C.

      Somogyi effect

    • D.

      Dawn phenomenon

    Correct Answer
    B. Lipohypertrophy
    Explanation
    Rotating sites prevents lipohypertrophy, which is the abnormal accumulation of fat in certain areas of the body. By regularly changing injection sites, the risk of developing lipohypertrophy is reduced. Lipohypertrophy can interfere with insulin absorption and lead to inconsistent blood sugar levels. Therefore, rotating sites is an important practice for individuals who require regular insulin injections to manage their diabetes.

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  • 3. 

    Type 2 diabetics usually need more exogenous insulin.

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    Type 2 diabetics usually need more exogenous insulin because their bodies either do not produce enough insulin or do not use it effectively. Exogenous insulin is insulin that is taken externally, either through injections or an insulin pump, to help regulate blood sugar levels. Since type 2 diabetics have insulin resistance or insufficient insulin production, they often require additional insulin to effectively manage their blood sugar levels.

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  • 4. 

    Basal insulin should equal __________ of your total daily dose

    • A.

      1/3 - 2/3

    • B.

      1/2 - 2/3

    • C.

      1/3 - 3/4

    • D.

      1/4 - 1/2

    Correct Answer
    B. 1/2 - 2/3
    Explanation
    Basal insulin should equal 1/2 - 2/3 of your total daily dose. This means that approximately half to two-thirds of the total daily dose of insulin should be the basal insulin. Basal insulin is a long-acting insulin that provides a steady level of insulin throughout the day and night, mimicking the body's natural insulin production. The remaining portion of the total daily dose is typically made up of bolus or mealtime insulin, which is taken before meals to cover the rise in blood sugar after eating.

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  • 5. 

    Generally patients will be 1 unit of rapid acting insulin per ___ grams of carbohydrates.

    • A.

      5

    • B.

      15

    • C.

      25

    • D.

      35

    Correct Answer
    B. 15
    Explanation
    Patients generally require 1 unit of rapid acting insulin for every 15 grams of carbohydrates. This ratio helps to regulate blood sugar levels after consuming meals or snacks. By calculating the amount of carbohydrates in a meal or snack, patients can determine the appropriate dose of insulin needed to properly metabolize the carbohydrates and prevent blood sugar spikes.

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  • 6. 

    If your blood glucose levels are out of target at midafternoon, you should check...

    • A.

      Pre-supper and rapid acting insulin

    • B.

      Evening NPH and long-acting insulin

    • C.

      Morning NPH and long-acting insulin

    • D.

      Pre-lunch rapid/short-acting insulin and morning NPH

    • E.

      Pre-breakfast rapid-acting insulin

    Correct Answer
    C. Morning NPH and long-acting insulin
    Explanation
    If your blood glucose levels are out of target at midafternoon, you should check your morning NPH and long-acting insulin. This is because morning NPH and long-acting insulin are typically taken in the morning and can have an effect on blood glucose levels throughout the day. By checking these insulin doses, you can assess if they were taken correctly or if any adjustments need to be made to better manage your blood glucose levels in the afternoon.

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  • 7. 

    If your blood glucose levels are out of target postlunch/presupper, you should check...

    • A.

      Pre-lunch rapid/short insulin and/or morning NPH

    • B.

      Pre-breakfast rapid/short acting

    • C.

      Pre-supper rapid/short insulin

    • D.

      Morning NPH, or long-acting insulin

    Correct Answer
    A. Pre-lunch rapid/short insulin and/or morning NPH
    Explanation
    If your blood glucose levels are out of target post-lunch/presupper, it is recommended to check the pre-lunch rapid/short insulin and/or morning NPH. These are the types of insulin that are typically taken before meals to control blood sugar levels. Checking these insulin doses can help identify if there was an issue with the dosage or timing, which may have caused the high blood glucose levels after lunch or before supper.

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  • 8. 

    If your blood glucose levels are out of target in the early morning, you should check...

    • A.

      Pre-supper rapid/short insulin

    • B.

      Evening NPH, or long-acting insulin

    • C.

      Evening NPH, or long-acting insulin

    • D.

      Pre-breakfast rapid/short acting

    Correct Answer
    B. Evening NPH, or long-acting insulin
    Explanation
    If your blood glucose levels are out of target in the early morning, you should check your Evening NPH or long-acting insulin. This is because NPH or long-acting insulin is typically taken in the evening to provide a basal level of insulin throughout the night. If the blood glucose levels are not in target in the morning, it could mean that the evening dose of NPH or long-acting insulin needs adjustment. Checking and potentially adjusting the evening insulin dose can help to regulate blood glucose levels in the early morning.

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  • 9. 

    Can you shake insulin?

    • A.

      Yes

    • B.

      No

    Correct Answer
    B. No
    Explanation
    Insulin is a medication that is usually available in the form of a liquid solution. It is typically stored in a vial or an insulin pen. However, shaking the insulin vigorously can cause air bubbles to form in the solution, which can affect the accuracy of the dosage. Therefore, it is generally recommended not to shake insulin before use.

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  • 10. 

    Injecting in the ____________ is the preferred site for insulin injection because of less variability and faster absorption.

    • A.

      Butt

    • B.

      Thigh

    • C.

      Arm

    • D.

      Abdomen

    Correct Answer
    D. Abdomen
    Explanation
    Injecting in the abdomen is the preferred site for insulin injection because it offers less variability and faster absorption compared to other sites such as the butt, thigh, or arm. The abdomen has a larger surface area and a higher number of blood vessels, allowing for quicker absorption of insulin into the bloodstream. Additionally, injecting insulin in the abdomen provides more consistent results as the absorption rate is less affected by factors such as exercise or body temperature.

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  • 11. 

    Which of the following statements regarding metformin are true?  Select all that apply.

    • A.

      It decreases hepatic glucose production

    • B.

      It increases peripheral glucose uptake and utilization

    • C.

      It can cause hypoglycemia as monotherapy

    • D.

      It generally causes patients to gain a few pounds

    • E.

      SCr should less than than 1.5 for a male and 1.4 for a female in order to use

    • F.

      It should be avoided in patients with heart failure

    • G.

      It can decrease vitamin B12 levels

    • H.

      The optimal dose is 2550mg/day

    • I.

      One third of patients have GI complaints

    • J.

      Metformin XR can be a ghost tablet

    Correct Answer(s)
    A. It decreases hepatic glucose production
    B. It increases peripheral glucose uptake and utilization
    E. SCr should less than than 1.5 for a male and 1.4 for a female in order to use
    F. It should be avoided in patients with heart failure
    I. One third of patients have GI complaints
    J. Metformin XR can be a ghost tablet
    Explanation
    Metformin is an oral medication commonly used to treat type 2 diabetes. It works by decreasing the production of glucose in the liver and increasing the uptake and utilization of glucose in peripheral tissues. Therefore, the statements "It decreases hepatic glucose production" and "It increases peripheral glucose uptake and utilization" are true. Metformin should be used with caution in patients with heart failure, so the statement "It should be avoided in patients with heart failure" is also true. Additionally, metformin can cause gastrointestinal (GI) side effects in some patients, with approximately one third of patients experiencing GI complaints. The statement "One third of patients have GI complaints" is true. Metformin XR (extended-release) tablets can sometimes appear as a "ghost tablet" in the stool, which means the outer shell of the tablet may be visible but the medication has been released. Therefore, the statement "Metformin XR can be a ghost tablet" is also true.

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  • 12. 

    Which of the following are associated with less GI upset with metformin?  Select all that apply.

    • A.

      Dividing dosing with meals and gradually increasing the dose

    • B.

      Not exceeding 2000mg/day

    • C.

      Switching to Metformin XR

    Correct Answer(s)
    A. Dividing dosing with meals and gradually increasing the dose
    B. Not exceeding 2000mg/day
    C. Switching to Metformin XR
    Explanation
    Dividing dosing with meals and gradually increasing the dose can help reduce gastrointestinal (GI) upset with metformin by allowing the body to adjust to the medication slowly. Not exceeding 2000mg/day is also important as higher doses may increase the likelihood of GI side effects. Switching to Metformin XR (extended-release) can be beneficial as it releases the medication slowly over time, reducing the concentration of the drug in the stomach and potentially minimizing GI upset.

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  • 13. 

    Which of the following are true regarding sulfonylureas?  Select all that apply.

    • A.

      They increase beta cell insulin secretion

    • B.

      They cause hypoglycemia

    • C.

      They cause weight loss

    • D.

      Chlorpropramide can cause SIADH and disulfiramin like reaction

    • E.

      They can be toxic to beta cells if BG is over 300 mg/dL

    • F.

      They probably work better in patients that have had diabetes less than 5 years

    • G.

      They can accumulate in renal impairment

    • H.

      50% of patients continue to respond adequately to a sulfonyulrea after 10 years

    Correct Answer(s)
    A. They increase beta cell insulin secretion
    B. They cause hypoglycemia
    D. Chlorpropramide can cause SIADH and disulfiramin like reaction
    E. They can be toxic to beta cells if BG is over 300 mg/dL
    F. They probably work better in patients that have had diabetes less than 5 years
    G. They can accumulate in renal impairment
    H. 50% of patients continue to respond adequately to a sulfonyulrea after 10 years
    Explanation
    Sulfonylureas are a class of medications used to treat diabetes. They increase beta cell insulin secretion, which helps to lower blood sugar levels. However, this can also lead to hypoglycemia, a condition characterized by low blood sugar levels. Chlorpropramide, a specific sulfonylurea, can cause syndrome of inappropriate antidiuretic hormone secretion (SIADH) and a disulfiram-like reaction. Sulfonylureas can be toxic to beta cells if blood glucose levels are over 300 mg/dL. They are believed to work better in patients who have had diabetes for less than 5 years. Sulfonylureas can accumulate in patients with renal impairment. Additionally, approximately 50% of patients continue to respond adequately to a sulfonylurea after 10 years of use.

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  • 14. 

    Which sulfonylurea is better to use if a patient has renal impairment?

    • A.

      Chlorpropramide

    • B.

      Glipizide

    • C.

      Glyburide

    • D.

      Glimepiride

    Correct Answer
    B. Glipizide
    Explanation
    Glipizide is the better sulfonylurea to use if a patient has renal impairment. This is because glipizide has a shorter half-life and is predominantly metabolized by the liver, rather than the kidneys. Therefore, it is less likely to accumulate in the body and cause hypoglycemia in patients with impaired renal function.

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  • 15. 

    Which of the following statements are true regarding meglitinides?  Select all that apply.

    • A.

      They have a very rapid onset and should be taken immediately before a meal

    • B.

      They are glucose dependent

    • C.

      If you skip a meal it is okay to still take the medication

    • D.

      They possibly have less hypoglycemia than sulfonylureas

    Correct Answer(s)
    A. They have a very rapid onset and should be taken immediately before a meal
    B. They are glucose dependent
    D. They possibly have less hypoglycemia than sulfonylureas
    Explanation
    Meglitinides have a very rapid onset and should be taken immediately before a meal because they stimulate insulin release from the pancreas in response to glucose levels. They are glucose dependent, meaning they only work when there is glucose present in the blood. If a meal is skipped, it is not recommended to take the medication as it may cause hypoglycemia. Meglitinides possibly have less hypoglycemia than sulfonylureas, which are another class of medications that stimulate insulin release.

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  • 16. 

    Which of the following are true regarding alpha glucosidase inhibitors?

    • A.

      They blunt the effects of carbohydrates in the gut

    • B.

      They cause flatulence and bloating

    • C.

      They do not cause hypoglycemia as monotherapy

    • D.

      Glucose and lactose should be used to treat hypoglycemia

    Correct Answer(s)
    A. They blunt the effects of carbohydrates in the gut
    B. They cause flatulence and bloating
    C. They do not cause hypoglycemia as monotherapy
    D. Glucose and lactose should be used to treat hypoglycemia
    Explanation
    Alpha glucosidase inhibitors work by inhibiting the enzymes that break down carbohydrates in the gut, thereby reducing the absorption of glucose from the intestines. This blunting effect on carbohydrates in the gut helps to control blood sugar levels in individuals with diabetes. However, this mechanism can also lead to side effects such as flatulence and bloating. Unlike some other diabetes medications, alpha glucosidase inhibitors do not typically cause hypoglycemia (low blood sugar) when used as monotherapy. In the event of hypoglycemia, glucose or lactose should be used to treat it.

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  • 17. 

    Which of the following statements regarding TZDs are correct?  Select all that apply.

    • A.

      Their initial response occurs within the first week and the peak response occurs in a 2 to 4 weeks after initiation

    • B.

      They do not cause hypoglycemia as monotherapy

    • C.

      They are agonists of PPAR gamma

    • D.

      They can increase ovulation in women with PCOS

    • E.

      They may increase one's risk of fractures

    • F.

      They are contraindicated in patients with Class III and Class IV heart failure

    • G.

      Actos can help improve cholesterol

    • H.

      They usually cause GI upset

    • I.

      They may cause an increase in LFTs

    Correct Answer(s)
    B. They do not cause hypoglycemia as monotherapy
    C. They are agonists of PPAR gamma
    D. They can increase ovulation in women with PCOS
    E. They may increase one's risk of fractures
    F. They are contraindicated in patients with Class III and Class IV heart failure
    G. Actos can help improve cholesterol
    I. They may cause an increase in LFTs
  • 18. 

    Which drugs would be the safest to use in renal dysfunction?

    • A.

      Metformin and a glinide

    • B.

      A glinide and Actos

    • C.

      Sulfonyulreas and Metformin

    • D.

      Actos and Januvia

    • E.

      Januvia and a sulfonylurea

    Correct Answer
    B. A glinide and Actos
    Explanation
    A glinide and Actos would be the safest drugs to use in renal dysfunction because they have a lower risk of causing further damage to the kidneys compared to other options.

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  • 19. 

    What is the main contraindication for the DPP-IV inhibitors?

    • A.

      Renal impairment

    • B.

      Hepatic impairment

    • C.

      Lactic acidosis

    • D.

      Radiographic contrast administration

    • E.

      There are no CIs with DPP-IV inhibitors

    Correct Answer
    E. There are no CIs with DPP-IV inhibitors
    Explanation
    DPP-IV inhibitors are a class of medications used to treat type 2 diabetes by increasing insulin production and reducing glucose levels. Unlike other diabetes medications, DPP-IV inhibitors do not have any specific contraindications (CIs) listed. This means that they can generally be used in patients with various medical conditions, including renal or hepatic impairment. However, it is important to note that individual patient factors and medical history should still be taken into consideration before prescribing DPP-IV inhibitors.

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  • 20. 

    A patient comes in that is on metformin.  She just underwent a procedure that used radiographic contrast dye and her doctor told her to stop taking her metformin.  She is wondering if she can restart her metformin.  You tell her...

    • A.

      Do not take metformin ever again

    • B.

      It is safe to take metformin after the procedure, just not before the procedure

    • C.

      Wait 48 hours after the completion of the procedure to start taking metformin again

    Correct Answer
    C. Wait 48 hours after the completion of the procedure to start taking metformin again
    Explanation
    The correct answer is to wait 48 hours after the completion of the procedure to start taking metformin again. This is because radiographic contrast dye can cause kidney damage in patients taking metformin. Stopping metformin before the procedure helps to prevent this potential harm. However, after the procedure, the dye is cleared from the body and it is safe to resume taking metformin after a waiting period of 48 hours.

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