NUR2474 PHARMACOLOGY EXAM 2 STUDY
GUIDE 2026 COMPLETE QUESTIONS AND
ANSWERS
◉ MOA of Metformin. Answer: Decreases hepatic gluconeogenesis,
improves peripheral insulin sensitivity (AMPK-mediated effects).
◉ Common SEs of Metformin. Answer: GI upset (nausea/diarrhea),
metallic taste, B12 deficiency with long-term use.
◉ Serious risk/contraindications of Metformin. Answer: Lactic
acidosis risk in severe renal impairment, unstable heart failure,
severe hepatic disease, acute alcohol intoxication, or conditions
causing hypoperfusion/hypoxia.
◉ eGFR <45 mL/min/1.73 m². Answer: Dose adjust Metformin.
◉ eGFR <30. Answer: Metformin is contraindicated.
◉ Pearl of Metformin. Answer: First-line for most T2DM unless
contraindicated; modest weight neutrality/weight loss; check B12
periodically.
,◉ DPP-4 inhibitors. Answer: Sitagliptin, saxagliptin, linagliptin,
alogliptin.
◉ MOA of DPP-4 inhibitors. Answer: Inhibit DPP-4 → increased
endogenous GLP-1 and GIP → glucose-dependent insulin release and
reduced glucagon.
◉ Common SEs of DPP-4 inhibitors. Answer: Generally well
tolerated; possible mild nasopharyngitis, joint pain (rare severe
arthralgia), and possible HF signal with saxagliptin in some studies.
◉ Contraindications/precautions of DPP-4 inhibitors. Answer:
Adjust for renal function except linagliptin (no renal dose
adjustment). Use caution with history of pancreatitis.
◉ GIP-GLP-1 agonists. Answer: Dual agonists: tirzepatide class.
◉ MOA of GIP-GLP-1 agonists. Answer: Agonize GIP and GLP-1
receptors → insulin secretion (glucose-dependent), reduced
glucagon, slowed gastric emptying, appetite suppression (potent
weight loss).
◉ Common SEs of GIP-GLP-1 agonists. Answer: GI (nausea, vomiting,
diarrhea), injection-site reactions, potential pancreatitis.
, ◉ Long-term safety signals of GIP-GLP-1 agonists. Answer: Thyroid
C-cell tumors in rodents — contraindicated if personal/family
history of medullary thyroid carcinoma or MEN2.
◉ When to use GIP-GLP-1 agonists. Answer: T2DM with need for
weight loss and/or A1c reduction; used increasingly per guidelines
for CV/weight/renal benefits.
◉ GLP-1 receptor agonists. Answer: Exenatide, liraglutide,
semaglutide, dulaglutide.
◉ MOA of GLP-1 receptor agonists. Answer: GLP-1 receptor agonists
→ glucose-dependent insulin secretion, decreased glucagon, slowed
gastric emptying, increased satiety.
◉ Common SEs of GLP-1 receptor agonists. Answer: GI symptoms
(nausea, vomiting, early satiety), weight loss, small increased risk of
pancreatitis.
◉ Contraindications/precautions of GLP-1 receptor agonists.
Answer: Severe GI disease (gastroparesis), history of pancreatitis
(use cautiously), adjust for injection vs oral forms.
◉ Insulins. Answer: Basal, prandial, mixed.
GUIDE 2026 COMPLETE QUESTIONS AND
ANSWERS
◉ MOA of Metformin. Answer: Decreases hepatic gluconeogenesis,
improves peripheral insulin sensitivity (AMPK-mediated effects).
◉ Common SEs of Metformin. Answer: GI upset (nausea/diarrhea),
metallic taste, B12 deficiency with long-term use.
◉ Serious risk/contraindications of Metformin. Answer: Lactic
acidosis risk in severe renal impairment, unstable heart failure,
severe hepatic disease, acute alcohol intoxication, or conditions
causing hypoperfusion/hypoxia.
◉ eGFR <45 mL/min/1.73 m². Answer: Dose adjust Metformin.
◉ eGFR <30. Answer: Metformin is contraindicated.
◉ Pearl of Metformin. Answer: First-line for most T2DM unless
contraindicated; modest weight neutrality/weight loss; check B12
periodically.
,◉ DPP-4 inhibitors. Answer: Sitagliptin, saxagliptin, linagliptin,
alogliptin.
◉ MOA of DPP-4 inhibitors. Answer: Inhibit DPP-4 → increased
endogenous GLP-1 and GIP → glucose-dependent insulin release and
reduced glucagon.
◉ Common SEs of DPP-4 inhibitors. Answer: Generally well
tolerated; possible mild nasopharyngitis, joint pain (rare severe
arthralgia), and possible HF signal with saxagliptin in some studies.
◉ Contraindications/precautions of DPP-4 inhibitors. Answer:
Adjust for renal function except linagliptin (no renal dose
adjustment). Use caution with history of pancreatitis.
◉ GIP-GLP-1 agonists. Answer: Dual agonists: tirzepatide class.
◉ MOA of GIP-GLP-1 agonists. Answer: Agonize GIP and GLP-1
receptors → insulin secretion (glucose-dependent), reduced
glucagon, slowed gastric emptying, appetite suppression (potent
weight loss).
◉ Common SEs of GIP-GLP-1 agonists. Answer: GI (nausea, vomiting,
diarrhea), injection-site reactions, potential pancreatitis.
, ◉ Long-term safety signals of GIP-GLP-1 agonists. Answer: Thyroid
C-cell tumors in rodents — contraindicated if personal/family
history of medullary thyroid carcinoma or MEN2.
◉ When to use GIP-GLP-1 agonists. Answer: T2DM with need for
weight loss and/or A1c reduction; used increasingly per guidelines
for CV/weight/renal benefits.
◉ GLP-1 receptor agonists. Answer: Exenatide, liraglutide,
semaglutide, dulaglutide.
◉ MOA of GLP-1 receptor agonists. Answer: GLP-1 receptor agonists
→ glucose-dependent insulin secretion, decreased glucagon, slowed
gastric emptying, increased satiety.
◉ Common SEs of GLP-1 receptor agonists. Answer: GI symptoms
(nausea, vomiting, early satiety), weight loss, small increased risk of
pancreatitis.
◉ Contraindications/precautions of GLP-1 receptor agonists.
Answer: Severe GI disease (gastroparesis), history of pancreatitis
(use cautiously), adjust for injection vs oral forms.
◉ Insulins. Answer: Basal, prandial, mixed.
