NR 565 PHARMACOLOGY FINAL
CURRENTLY TESTING VERSIONS ACTUAL
EXAMINATION 2026 QUESTIONS WITH
DETAILED ANSWERS GRADED A+
⫸ Preventing Diabetic Nephropathy Answer: ACE inhibitors, such as
lisinopril. Or ARBs such as losartan if patient cannot tolerate ACEs
⫸ ADAs Stepped Care Approach to DM Treatment Answer: 1.
Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
⫸ Biguanides Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle receptors to
insulin (increased uptake of insulin). Safe in pregnancy. GI side effects
so take with meals. Excreted by kidneys so increased toxicity (lactic
acidosis) if renal impairment. Low risk of hypoglycemia.
⫸ 1st vs. 2nd Generation Sulfonylurea Answer: All 1st generation have
been discontinued. 2nd generation (Glipizide) have shorter duration of
action and increased potency.
,⫸ Sulfonylureas Answer: glipizide, glyburide, glimepiride. Promote
insulin release by beta cells. Block potassium channels of pancreatic
islets to let calcium in, which stimulates insulin release. Do not take with
ETOH (disulfiram reaction includes flushing, palpitations, nausea).
Hypoglycemia and weight gain are also common side effects. Do not
take if pregnant or breastfeeding. Increased risk of toxicity if liver or
kidneys are impaired.
⫸ Meglitinides MOA Answer: Stimulate a rapid/ short-lived release of
insulin from the pancreas.
⫸ Meglitinides (Glinides) Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
⫸ Meglitinides patient teaching Answer: Tell patient to eat within 30
minutes.
⫸ Meglitinides (Glinides) precautions Answer: Hypoglycemia increased
in patients with liver dysfunction 2/2 slower metabolism of the drug.
⫸ Meglitinides vs. Sulfonylureas Answer: -meglitinides are rapid acting
and will have its effect on a single meal-decreasing post prandial
hyperglycemia. Taken with each meal.
, -sulfonylureas continuously stimulate insulin release- having most of its
effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
⫸ Thiazolidinediones (TZDs) Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
⫸ Thiazolidinediones (TZDs) MOA Answer: Peroxisome proliferator-
activated receptor gamma agonists (PPAR𝜸 agonists) that increase
peripheral insulin sensitivity. Promotes increased glucose uptake by
skeletal and adipose cells.
⫸ Thiazolidinediones (TZDs) adverse effects Answer: Renal retention
of fluid- so not for patients with stage 3 or 4 heart failure. May also
cause upper respiratory infections, headache, and myalgia. Hepatotoxic.
Monitor liver function.
⫸ Dipeptidyl Peptidase-4 Inhibitors Answer: Sitagliptin (Januvia),
gliptins
⫸ Dipeptidyl Peptidase-4 Inhibitors MOA Answer: DDP-4 is an
enzyme that inactivate incretin hormones. So, by inhibiting this enzyme,
sitagliptin enhances the activity of incretins, stimulate release of insulin
from pancreatic B cells, decrease hepatic glucose production
CURRENTLY TESTING VERSIONS ACTUAL
EXAMINATION 2026 QUESTIONS WITH
DETAILED ANSWERS GRADED A+
⫸ Preventing Diabetic Nephropathy Answer: ACE inhibitors, such as
lisinopril. Or ARBs such as losartan if patient cannot tolerate ACEs
⫸ ADAs Stepped Care Approach to DM Treatment Answer: 1.
Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
⫸ Biguanides Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle receptors to
insulin (increased uptake of insulin). Safe in pregnancy. GI side effects
so take with meals. Excreted by kidneys so increased toxicity (lactic
acidosis) if renal impairment. Low risk of hypoglycemia.
⫸ 1st vs. 2nd Generation Sulfonylurea Answer: All 1st generation have
been discontinued. 2nd generation (Glipizide) have shorter duration of
action and increased potency.
,⫸ Sulfonylureas Answer: glipizide, glyburide, glimepiride. Promote
insulin release by beta cells. Block potassium channels of pancreatic
islets to let calcium in, which stimulates insulin release. Do not take with
ETOH (disulfiram reaction includes flushing, palpitations, nausea).
Hypoglycemia and weight gain are also common side effects. Do not
take if pregnant or breastfeeding. Increased risk of toxicity if liver or
kidneys are impaired.
⫸ Meglitinides MOA Answer: Stimulate a rapid/ short-lived release of
insulin from the pancreas.
⫸ Meglitinides (Glinides) Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
⫸ Meglitinides patient teaching Answer: Tell patient to eat within 30
minutes.
⫸ Meglitinides (Glinides) precautions Answer: Hypoglycemia increased
in patients with liver dysfunction 2/2 slower metabolism of the drug.
⫸ Meglitinides vs. Sulfonylureas Answer: -meglitinides are rapid acting
and will have its effect on a single meal-decreasing post prandial
hyperglycemia. Taken with each meal.
, -sulfonylureas continuously stimulate insulin release- having most of its
effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
⫸ Thiazolidinediones (TZDs) Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
⫸ Thiazolidinediones (TZDs) MOA Answer: Peroxisome proliferator-
activated receptor gamma agonists (PPAR𝜸 agonists) that increase
peripheral insulin sensitivity. Promotes increased glucose uptake by
skeletal and adipose cells.
⫸ Thiazolidinediones (TZDs) adverse effects Answer: Renal retention
of fluid- so not for patients with stage 3 or 4 heart failure. May also
cause upper respiratory infections, headache, and myalgia. Hepatotoxic.
Monitor liver function.
⫸ Dipeptidyl Peptidase-4 Inhibitors Answer: Sitagliptin (Januvia),
gliptins
⫸ Dipeptidyl Peptidase-4 Inhibitors MOA Answer: DDP-4 is an
enzyme that inactivate incretin hormones. So, by inhibiting this enzyme,
sitagliptin enhances the activity of incretins, stimulate release of insulin
from pancreatic B cells, decrease hepatic glucose production
