NR 565 ADVANCED PHARMACOLOGY FINAL EXAM STUDY GUIDE |
COMPLETE PHARMACOLOGY FINAL REVIEW QUESTIONS AND
ANSWERS 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.
Glucagon-like peptide 1 (GLP-1) -CORRECT ANSWER ✔✔semaglutide, dulaglutide
Glucagon-like peptide 1 (GLP-1) MOA -CORRECT ANSWER ✔✔Mimic and augment the effects of the
incretin hormones GLP-1. Slow gastric emptying, stimulate glucose dependent release of insulin,
suppress appetite, inhibit post meal release of glucagon from liver, induce weight loss.
COMPLETE PHARMACOLOGY FINAL REVIEW QUESTIONS AND
ANSWERS 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.
Glucagon-like peptide 1 (GLP-1) -CORRECT ANSWER ✔✔semaglutide, dulaglutide
Glucagon-like peptide 1 (GLP-1) MOA -CORRECT ANSWER ✔✔Mimic and augment the effects of the
incretin hormones GLP-1. Slow gastric emptying, stimulate glucose dependent release of insulin,
suppress appetite, inhibit post meal release of glucagon from liver, induce weight loss.
