Antidiabetics Que Bank

Question 1
Which of the following is a common symptom of both Diabetes Insipidus (DI) and Diabetes Mellitus (DM)?

A) Polyphagia
B) Hyperglycemia
C) Polyuria
D) Slow wound healing
E) Weight gain

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Question 2
What distinguishes Diabetes Insipidus (DI) from Diabetes Mellitus (DM)?

A) DI causes polyuria due to hyperglycemia
B) DI involves excessive glucose excretion
C) DM is caused by a deficiency or resistance to insulin, while DI is related to a deficiency or resistance to antidiuretic hormone (ADH)
D) DM always presents with dilute urine
E) Both conditions are treated with insulin

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Question 3
A patient diagnosed with Central Diabetes Insipidus (DI) is likely to be treated with which of the following medications?

A) Metformin
B) Desmopressin
C) Insulin
D) Thiazide diuretics
E) Sulfonylureas

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Question 4
Which of the following symptoms is more likely to be seen in Type 1 Diabetes Mellitus compared to Diabetes Insipidus?

A) Dilute urine
B) Polyuria
C) Polyphagia
D) Polydipsia
E) Low urine specific gravity

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Question 5
A patient presents with excessive urination, excessive thirst, and dilute urine, but no signs of hyperglycemia. What is the most likely diagnosis?

A) Type 1 Diabetes Mellitus
B) Type 2 Diabetes Mellitus
C) Diabetes Insipidus
D) Gestational Diabetes Mellitus
E) Diabetic Ketoacidosis

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Question 6
Which of the following treatments would be most appropriate for a patient with Nephrogenic Diabetes Insipidus?

A) Desmopressin
B) Insulin
C) Thiazide diuretics
D) Metformin
E) Sulfonylureas

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Question 7
Which of the following hormones is primarily responsible for lowering blood glucose levels after a meal?

A) Glucagon
B) Epinephrine
C) Cortisol
D) Growth Hormone
E) Insulin

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Question 8
A patient’s fasting blood glucose level is 6.5 mmol/L (117 mg/dL). According to blood glucose control guidelines, what category does this patient fall under?

A) Normal
B) Prediabetes
C) Diabetes
D) Hypoglycemia
E) Hyperglycemia

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Question 9
Which of the following hormones stimulates glycogenolysis and gluconeogenesis to increase blood glucose levels during periods of fasting or physical activity?

A) Insulin
B) Cortisol
C) Epinephrine
D) Glucagon
E) Growth Hormone

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Question 10
A patient has a postprandial blood glucose level of 9.5 mmol/L (171 mg/dL). Based on this result, which category does the patient fall under?

A) Normal
B) Prediabetes
C) Diabetes
D) Hypoglycemia
E) Hyperglycemia

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Question 11
A patient with diabetes has a glycated hemoglobin (HbA1c) level of 7.5%. What does this result indicate about the patient’s blood glucose control over the past 2-3 months?

A) Normal blood glucose control
B) Prediabetes
C) Uncontrolled diabetes
D) Hypoglycemia
E) Early diabetes

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Question 12
Which of the following types of insulin is considered “rapid-acting” and should be taken at mealtime?

A) Regular (R) Insulin
B) NPH (N) Insulin
C) Lispro (Humalog)
D) Glargine (Lantus)
E) Detemir (Levemir)

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Question 13
Which of the following types of insulin has no peak and provides steady, long-lasting basal insulin coverage over 24 hours?

A) Regular (R) Insulin
B) NPH (N) Insulin
C) Glargine (Lantus)
D) Lispro (Humalog)
E) Aspart (NovoRapid)

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Question 14
Which insulin has a duration of action exceeding 24 hours and offers flexibility in dosing time?

A) Lispro (Humalog)
B) Regular (R) Insulin
C) Degludec (Tresiba)
D) Detemir (Levemir)
E) NPH (N) Insulin

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Question 15
Which insulin is often injected at bedtime and has a peak effect at predawn hours, making it a suitable choice for basal insulin control overnight?

A) Regular (R) Insulin
B) NPH (N) Insulin
C) Glargine (Lantus)
D) Aspart (NovoRapid)
E) Degludec (Tresiba)

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Question 16
Which insulin should not be mixed with other insulins due to its formulation in an acidic solution, which could lead to reduced effectiveness?

A) Regular (R) Insulin
B) Glargine (Lantus)
C) NPH (N) Insulin
D) Lispro (Humalog)
E) Detemir (Levemir)

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Question 17
Which of the following is the most common side effect of insulin therapy?

A) Weight gain
B) Injection site reactions
C) Hypoglycemia
D) Edema
E) Hypokalemia

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Question 18
Which of the following actions can help prevent lipodystrophy in patients using insulin therapy?

A) Increasing the insulin dose
B) Rotating injection sites
C) Taking insulin with meals
D) Reducing carbohydrate intake
E) Avoiding exercise

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Question 19
Which of the following can occur as a result of insulin driving potassium into cells, potentially leading to muscle cramps and weakness?

A) Hyperkalemia
B) Hyperglycemia
C) Hypokalemia
D) Hyponatremia
E) Hypocalcemia

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Question 20
Which of the following is contraindicated in patients with a known allergy to insulin or its excipients?

A) Metformin
B) Sulfonylureas
C) Insulin
D) DPP-4 inhibitors
E) GLP-1 agonists

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Question 21
Which of the following medications can mask the symptoms of hypoglycemia in patients using insulin?

A) Metformin
B) Beta-blockers
C) ACE inhibitors
D) Statins
E) Corticosteroids

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Question 22
Which of the following conditions would require cautious use or avoidance of insulin therapy due to the increased risk of hypoglycemia?

A) Gestational diabetes
B) Severe renal impairment
C) Type 1 diabetes
D) Hypertension
E) Hyperlipidemia

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Question 23
A patient using insulin reports fluid retention and swelling in their ankles and feet. Which of the following side effects is most likely responsible for these symptoms?

A) Weight gain
B) Hypokalemia
C) Lipodystrophy
D) Edema
E) Hypoglycemia

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Question 24
Which of the following non-pharmacological interventions can help manage weight gain associated with insulin therapy?

A) Increasing insulin doses
B) Regular exercise and a balanced diet
C) Reducing protein intake
D) Taking insulin before bedtime
E) Avoiding all carbohydrates

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Question 25
Which of the following drug interactions may reduce the effectiveness of insulin therapy by increasing blood glucose levels?

A) Beta-blockers
B) ACE inhibitors
C) Corticosteroids
D) DPP-4 inhibitors
E) Antihistamines

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Question 26
Which of the following statements is true regarding insulin therapy in elderly patients?

A) Elderly patients have a lower risk of hypoglycemia with insulin therapy
B) Insulin doses should be increased in elderly patients
C) Elderly patients have an increased risk of hypoglycemia and should be monitored closely
D) Insulin therapy is contraindicated in elderly patients
E) Insulin has no effect on elderly patients

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Question 27
Which of the following statements is true regarding biosimilar insulins?

A) Biosimilars are identical to reference biologic insulins in structure
B) Biosimilars and reference biologics have the same clinical efficacy and safety but may have minor inactive ingredient differences
C) Biosimilars are approved in the same way as generic drugs
D) Biosimilars are made from non-living chemical compounds
E) Biosimilars are significantly cheaper due to easier manufacturing processes

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Question 28
What is a significant regulatory difference between biosimilars and generic drugs in Canada?

A) Biosimilars are regulated as identical to reference biologics, while generics are not
B) Biosimilars are approved as new drugs, while generics are approved based on bioequivalence
C) Biosimilars and generics are both subject to the same regulatory process
D) Biosimilars require less regulatory scrutiny compared to generics
E) Biosimilars are not regulated by Health Canada

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Question 29
Which of the following is a potential benefit of biosimilar insulins in Canada?

A) Higher efficacy compared to reference insulins
B) Lower cost, improving access to essential insulin therapies
C) Easier manufacturing process leading to faster production
D) Complete structural identity with reference insulins
E) Lower risk of side effects compared to reference insulins

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Question 30
What is one challenge associated with the use of biosimilars in clinical practice?

A) Less regulatory oversight than reference insulins
B) Poor clinical efficacy compared to reference insulins
C) Complex manufacturing process requiring stringent oversight
D) Difficulty in obtaining approval from Health Canada
E) Complete structural differences from reference insulins

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Question 31
What is the proper storage method for unopened insulin vials to maintain potency?

A) Store in the freezer
B) Keep at room temperature indefinitely
C) Refrigerate at 2°C to 8°C (36°F to 46°F)
D) Keep in direct sunlight
E) Store above 30°C (86°F)

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Question 32
Once opened, insulin vials should be stored:

A) In the refrigerator only
B) At room temperature for up to 28 days
C) At room temperature indefinitely
D) In the freezer for maximum effectiveness
E) In direct sunlight

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Question 33
Which of the following signs indicates that insulin has degraded and should not be used?

A) Clear appearance in rapid-acting insulin
B) Cloudy appearance in intermediate-acting insulin
C) Discolored, cloudy insulin with clumps
D) Unopened insulin stored in the refrigerator
E) Clear appearance in short-acting insulin

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Question 34
Which of the following is true regarding the formation of insulin in the pancreas?

A) Insulin is directly synthesized as its final active form
B) Proinsulin is cleaved to form insulin and C-peptide
C) Preproinsulin is directly secreted by the pancreas
D) Insulin synthesis occurs in the mitochondria
E) C-peptide and insulin are formed independently

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Question 35
Which injection site is most commonly used for insulin due to its consistent absorption?

A) Upper arms
B) Thighs
C) Abdomen
D) Buttocks
E) Lower back

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Question 36
Which of the following antidiabetic drugs is classified as a biguanide?

A) Glipizide
B) Metformin
C) Pioglitazone
D) Sitagliptin
E) Canagliflozin

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Question 37
Thiazolidinediones, such as pioglitazone, primarily exert their effects by:

A) Increasing insulin secretion from the pancreas
B) Decreasing hepatic glucose production
C) Increasing insulin sensitivity in peripheral tissues
D) Inhibiting glucose absorption in the intestines
E) Stimulating glucagon secretion

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Question 38
Which class of antidiabetic drugs works by inhibiting the enzyme DPP-4, which degrades incretins?

A) SGLT2 inhibitors
B) GLP-1 receptor agonists
C) DPP-4 inhibitors
D) Sulfonylureas
E) Meglitinides

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Question 39
Which of the following drugs belongs to the SGLT2 inhibitor class and reduces glucose reabsorption in the kidneys?

A) Glimepiride
B) Liraglutide
C) Empagliflozin
D) Acarbose
E) Repaglinide

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Question 40
Sulfonylureas, such as glipizide, work by:

A) Enhancing the sensitivity of insulin receptors
B) Stimulating insulin release from pancreatic beta cells
C) Reducing hepatic glucose production
D) Blocking glucose absorption in the intestines
E) Inhibiting glucose reabsorption in the kidneys

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Question 41
What is the primary mechanism of action of biguanides, such as metformin?

A) Increasing insulin secretion
B) Reducing hepatic glucose production
C) Stimulating glucose absorption in the intestines
D) Blocking insulin receptors
E) Promoting glucagon secretion

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Question 42
Which of the following is a significant side effect associated with metformin use?

A) Hyperglycemia
B) Vitamin B12 deficiency
C) Hypercalcemia
D) Pancreatitis
E) Increased appetite

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Question 43
In which of the following conditions is metformin contraindicated due to the increased risk of lactic acidosis?

A) Mild renal impairment (CrCl > 60 mL/min)
B) Pregnancy
C) Severe liver disease
D) Type 1 diabetes
E) Mild hypertension

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Question 44
Which of the following is an advantage of metformin over other antidiabetic drugs?

A) Weight gain
B) High risk of hypoglycemia
C) Weight neutral
D) Severe hyperglycemia risk
E) Appetite stimulation

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Question 45
Why is alcohol consumption discouraged in patients taking metformin?

A) It increases the risk of hypoglycemia
B) It increases the risk of lactic acidosis
C) It decreases the effectiveness of metformin
D) It increases gastrointestinal side effects
E) It reduces vitamin B12 absorption

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Question 46
Which of the following conditions should warrant cautious use or avoidance of metformin due to an increased risk of lactic acidosis?

A) Polycystic ovary syndrome
B) Gestational diabetes
C) Heart failure with hypoxia
D) Mild hypertension
E) Hyperthyroidism

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Question 47
What is the significance of insulin detemir’s 14-carbon fatty acid chain and its high binding to serum albumin?

A) It shortens the duration of action
B) It delays absorption and prolongs the duration of action
C) It reduces the need for insulin administration
D) It increases the rate of glucose uptake
E) It limits insulin’s interaction with glucose

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Question 48
What is the primary risk of administering a high dose of insulin at bedtime for someone with diabetes?

A) Morning hyperglycemia
B) Nocturnal hypoglycemia
C) Increased weight gain
D) Reduced insulin resistance
E) Polyuria

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Question 49
A patient is prescribed regular insulin and NPH insulin to be taken both in the morning and at bedtime. What is the purpose of this regimen?

A) To prevent hyperglycemia during the night
B) To achieve a bolus and basal insulin effect
C) To provide a consistent bolus effect throughout the day
D) To prevent hypoglycemia during meals
E) To eliminate the need for additional medication

Follow-up Question
If the patient experiences hypoglycemia in the morning as indicated by low fasting blood glucose levels, what is the most appropriate recommendation?

A) Increase the dose of regular insulin at bedtime
B) Reduce the dose of NPH insulin at bedtime
C) Switch to long-acting insulin instead of NPH insulin
D) Administer an additional dose of NPH insulin in the morning
E) Increase carbohydrate intake at dinner

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Question 50
Which of the following drugs does not cause hypoglycemia when taken without food?

A) Insulin
B) Glyburide
C) Metformin
D) Glipizide
E) Repaglinide

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Question 51
Which of the following is a common complication of uncontrolled diabetes mellitus?

A) Hyperthyroidism
B) Neuropathy
C) Asthma
D) Renal stones
E) Chronic Obstructive Pulmonary Disease (COPD)

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Question 52
Which type of insulin is prepared in an acidic solution and forms microprecipitates upon subcutaneous injection?

A) Lispro
B) Regular insulin
C) Glargine
D) NPH
E) Detemir

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Question 53
What is the drug of choice for diabetes in pregnancy?

A) Insulin
B) Metformin
C) Glyburide
D) Pioglitazone
E) Liraglutide

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Question 54
What is the most important recommendation for patients using insulin?

A) Take insulin only when experiencing hyperglycemia
B) Always inject insulin at the same site
C) Regularly monitor blood glucose and rotate injection sites
D) Avoid exercising after insulin injection
E) Keep insulin refrigerated at all times

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Question 55
Which type of insulin is most commonly used to treat diabetic ketoacidosis (DKA)?

A) NPH insulin
B) Long-acting insulin (e.g., Glargine)
C) Rapid-acting insulin (e.g., Lispro)
D) Regular insulin (IV)
E) Pre-mixed insulin

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Question 56
Which type of insulin is most commonly used in emergency situations for rapid blood sugar control?

A) Regular insulin (IV)
B) Long-acting insulin (e.g., Detemir)
C) Intermediate-acting insulin (e.g., NPH)
D) Insulin Glargine
E) Insulin Degludec

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Question 57
Which of the following is the drug of choice for managing gestational diabetes?

A) Metformin
B) Insulin
C) Glyburide
D) Pioglitazone
E) Empagliflozin

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Question 58
A patient is taking a combination of Metformin and Empagliflozin for type 2 diabetes management. What is the primary benefit of this combination?

A) Increased risk of hypoglycemia
B) Enhanced blood glucose control with weight loss
C) Increased renal impairment risk
D) Increased insulin resistance
E) Reduced absorption of carbohydrates

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Question 59
A patient with type 2 diabetes drinks two glasses of alcohol. The patient is taking Metformin and Empagliflozin for diabetes. What is the potential effect on their blood glucose levels?

A) Hyperglycemia
B) Hypoglycemia
C) Increased insulin resistance
D) No effect on blood glucose
E) Increased risk of diabetic ketoacidosis

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Question 60
Which of the following best describes the mechanism of action of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors?

A) They increase insulin sensitivity in peripheral tissues
B) They block glucose reabsorption in the kidneys, leading to glucose excretion in the urine
C) They stimulate insulin secretion from pancreatic beta cells
D) They inhibit the breakdown of carbohydrates in the gastrointestinal tract
E) They prevent the conversion of glucose to fat in adipose tissue

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Question 61
Which of the following is a recognized cardiovascular benefit of SGLT2 inhibitors?

A) Increased insulin production
B) Reduction in LDL cholesterol levels
C) Decreased risk of heart failure hospitalization
D) Increased blood pressure control
E) Improved HDL cholesterol levels

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Question 62
What is a potential risk associated with the use of Canagliflozin?

A) Bone fractures and lower limb amputations
B) Severe hypoglycemia
C) Increased HDL cholesterol
D) Reduced kidney function in all patients
E) Increased insulin production

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Question 63
Which of the following patients would most likely be at risk of developing euglycemic diabetic ketoacidosis (DKA) when using an SGLT2 inhibitor?

A) A patient with type 1 diabetes
B) A patient with well-controlled type 2 diabetes
C) A patient using insulin therapy with normal ketone levels
D) A patient with no history of kidney disease
E) A patient on metformin monotherapy

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Question 64
Which of the following is a contraindication for the use of SGLT2 inhibitors?

A) Heart failure
B) Chronic kidney disease with CrCl < 30 mL/min
C) Type 2 diabetes with cardiovascular risk
D) High blood pressure
E) Type 2 diabetes without insulin therapy

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Question 65
Which of the following describes the primary mechanism of action of GLP-1 analogues in managing type 2 diabetes?

A) Stimulating glucagon secretion to lower blood glucose levels
B) Enhancing insulin secretion only when blood glucose is elevated
C) Reducing insulin resistance by increasing muscle glucose uptake
D) Preventing the breakdown of incretin hormones
E) Inhibiting glucose absorption from the intestines

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Question 66
Which of the following side effects is primarily associated with the use of GLP-1 analogues like exenatide?

A) Thyroid C-cell tumor
B) Hypoglycemia
C) Pancreatitis
D) Weight gain
E) Renal failure

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Question 67
Which of the following drugs used for diabetes management requires dose adjustment or caution in patients with renal impairment and has been associated with a risk of pancreatitis?

A) Metformin
B) Sitagliptin
C) Exenatide
D) Empagliflozin
E) Pioglitazone

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Question 68
Which of the following drugs is most appropriate for a patient with CrCl < 15 mL/min and a history of heart failure?

A) Saxagliptin
B) Linagliptin
C) Sitagliptin
D) Alogliptin
E) Exenatide

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Question 69
Which of the following is a common side effect of DPP-4 inhibitors, such as sitagliptin or saxagliptin?

A) Hypoglycemia
B) Pancreatitis
C) Weight gain
D) Increased risk of heart failure hospitalization
E) All of the above

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Question 70
Which of the following medications used in diabetes treatment is associated with an increased risk of heart failure hospitalization?

A) Liraglutide
B) Semaglutide
C) Saxagliptin
D) Linagliptin
E) Metformin

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Question 71
Which of the following sulfonylureas is associated with the highest risk of hypoglycemia and is primarily metabolized in the liver?

A) Glipizide
B) Glimepiride
C) Glyburide
D) Repaglinide
E) Nateglinide

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Question 72
What is the primary mechanism of action for both sulfonylureas and meglitinides in managing Type 2 diabetes?

A) Increase insulin sensitivity in muscle and fat cells
B) Block glucagon release from the pancreas
C) Inhibit glucose reabsorption in the kidneys
D) Stimulate insulin release from pancreatic beta cells
E) Increase incretin levels

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Question 73
Which class of drugs used in diabetes management should have its dose skipped if a meal is skipped to prevent hypoglycemia?

A) Sulfonylureas
B) GLP-1 agonists
C) Meglitinides
D) SGLT2 inhibitors
E) DPP-4 inhibitors

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Question 74
In which situation should sulfonylureas be avoided?

A) Patients with Type 1 diabetes
B) Patients with sulfa allergy
C) Pregnant women
D) Patients with significant renal impairment
E) All of the above

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Question 75
Which of the following is the primary mechanism of action for thiazolidinediones (TZDs) in the management of Type 2 diabetes?

A) Stimulate insulin release from pancreatic beta cells
B) Inhibit glucose reabsorption in the kidneys
C) Improve insulin sensitivity by activating PPAR-γ receptors
D) Inhibit the breakdown of incretins
E) Delay carbohydrate absorption in the intestines

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Question 76
Which of the following adverse effects is most commonly associated with thiazolidinediones (TZDs)?

A) Increased risk of pancreatitis
B) Fluid retention and edema
C) Hypoglycemia
D) Diarrhea
E) Thyroid C-cell tumors

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Question 77
In which patient population should thiazolidinediones (TZDs) be avoided?

A) Patients with hepatic impairment
B) Patients with heart failure (NYHA class III/IV)
C) Patients with a history of bone fractures
D) All of the above

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Question 78
What is a key consideration when using alpha-glucosidase inhibitors in the management of Type 2 diabetes?

A) They significantly reduce fasting blood glucose levels
B) They should be taken with meals to reduce postprandial glucose spikes
C) They cause significant weight loss
D) They are first-line agents for Type 1 diabetes
E) They are primarily excreted by the kidneys

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Question 79
Which adverse effect is most commonly associated with the use of alpha-glucosidase inhibitors?

A) Hypoglycemia
B) Weight gain
C) Gastrointestinal issues such as flatulence and diarrhea
D) Renal impairment
E) Anemia

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Question 80
Alpha-glucosidase inhibitors are contraindicated in patients with which of the following conditions?

A) Hepatic impairment
B) Digestive conditions such as inflammatory bowel disease
C) Heart failure
D) Hyperlipidemia
E) Thyroid dysfunction

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Question 81
Which antidiabetic drug is known for having the highest HbA1C lowering effect?

A) Metformin
B) Glimepiride
C) Pioglitazone
D) Liraglutide
E) Sitagliptin

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Note: There could be questions like this – which drug causes the least hypoglycemia or which drug can be taken if meals are skipped – In all these questions, go by the mechanism of action. Evaluate each option and select the best possible option in the context of the given information.

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*** End of chapter ***