NR 565 Advanced Pharmacology Final Exam Study Guide questions and
answers A+ Grade 2026\2027
Glycemic Goals in DM2
- correct answer Blood glucose of 80-130 before meals, 180 or less 1-2 hrs post meals, A1C under 7.
Long term goals are to manage BG and preveny long term complications.
Preventing Diabetic Nephropathy
- correct answer ACE inhibitors, such as lisinopril. Or ARBs such as losartan if patient cannot tolerate
ACEs
ADAs Stepped Care Approach to DM Treatment
- correct 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
- correct 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
- correct answer All 1st generation have been discontinued. 2nd generation (Glipizide) have shorter
duration of action and increased potency.
Sulfonylureas
- correct 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
- correct answer Stimulate a rapid/ short-lived release of insulin from the pancreas.
Meglitinides (Glinides)
- correct answer Repaglinide (Prandin)
Nateglinide (Starlix)
Meglitinides patient teaching
- correct answer Tell patient to eat within 30 minutes.
Meglitinides (Glinides) precautions
- correct answer Hypoglycemia increased in patients with liver dysfunction 2/2 slower metabolism of the
drug.
Meglitinides vs. Sulfonylureas
- correct 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)
- correct answer Pioglitazone (Actos)
Rosiglitazone (Avandia)
Thiazolidinediones (TZDs) MOA
- correct 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
- correct 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
- correct answer Sitagliptin (Januvia), gliptins
Dipeptidyl Peptidase-4 Inhibitors MOA
- correct 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
Dipeptidyl Peptidase-4 Inhibitors Adverse effects
- correct answer -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors
- correct answer Canagliflozin
Dapagliflozin
Empagliflozin
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors
- correct answer - SGLT2 is expressed in the proximal renal tubules which is responsible for the majority
of the reabsorption of filtered glucose from the tubular lumen. By inhibiting SGLT2, these agents reduce
reabsorption of filtered glucose, which increase urinary glucose excretion.
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors adverse effects
- correct answer UTI, genitalia fungal infections, increased urination, weight loss. Hypotension and
dizziness when used concurrently with diuretics.
Which diabetic medication(s) is beneficial for patients with heart failure?
- correct answer SGLT-2 inhibitors 2/2 diuretic effect.
answers A+ Grade 2026\2027
Glycemic Goals in DM2
- correct answer Blood glucose of 80-130 before meals, 180 or less 1-2 hrs post meals, A1C under 7.
Long term goals are to manage BG and preveny long term complications.
Preventing Diabetic Nephropathy
- correct answer ACE inhibitors, such as lisinopril. Or ARBs such as losartan if patient cannot tolerate
ACEs
ADAs Stepped Care Approach to DM Treatment
- correct 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
- correct 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
- correct answer All 1st generation have been discontinued. 2nd generation (Glipizide) have shorter
duration of action and increased potency.
Sulfonylureas
- correct 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
- correct answer Stimulate a rapid/ short-lived release of insulin from the pancreas.
Meglitinides (Glinides)
- correct answer Repaglinide (Prandin)
Nateglinide (Starlix)
Meglitinides patient teaching
- correct answer Tell patient to eat within 30 minutes.
Meglitinides (Glinides) precautions
- correct answer Hypoglycemia increased in patients with liver dysfunction 2/2 slower metabolism of the
drug.
Meglitinides vs. Sulfonylureas
- correct 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)
- correct answer Pioglitazone (Actos)
Rosiglitazone (Avandia)
Thiazolidinediones (TZDs) MOA
- correct 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
- correct 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
- correct answer Sitagliptin (Januvia), gliptins
Dipeptidyl Peptidase-4 Inhibitors MOA
- correct 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
Dipeptidyl Peptidase-4 Inhibitors Adverse effects
- correct answer -Upper respiratory infection
-Headache and inflammation of nasal passages and throat
-Pancreatitis
-hypersensitivity reactions
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors
- correct answer Canagliflozin
Dapagliflozin
Empagliflozin
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors
- correct answer - SGLT2 is expressed in the proximal renal tubules which is responsible for the majority
of the reabsorption of filtered glucose from the tubular lumen. By inhibiting SGLT2, these agents reduce
reabsorption of filtered glucose, which increase urinary glucose excretion.
Sodium Glucose Co-Transporter-2 (SGLT2) Inhibitors adverse effects
- correct answer UTI, genitalia fungal infections, increased urination, weight loss. Hypotension and
dizziness when used concurrently with diuretics.
Which diabetic medication(s) is beneficial for patients with heart failure?
- correct answer SGLT-2 inhibitors 2/2 diuretic effect.
