NR565 FINAL TEST PAPER QUESTIONS
AND SOLUTIONS COMPLETE REVIEW
MATERIAL
●● 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
AND SOLUTIONS COMPLETE REVIEW
MATERIAL
●● 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
