NR 565 Advanced Pharmacology Final Exam
Study Guide Question and Answer (2026/2027)
| Real Tested Questions | A+ Verified
• 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
Study Guide Question and Answer (2026/2027)
| Real Tested Questions | A+ Verified
• 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
