FNP 2 EXAM 3 2026 CERTIFICATION
EVALUATION TEST PAPER QUESTIONS
SOLUTIONS GRADED A PLUS
◉ Glinides.
Answer: • Repaglinide (Prandin®) and • Nateglinide (Starlix®);
Stimulates insulin secretion and amounts is dependent on existing
glucose levesl; reduces post-prandial hyperglycemia
◉ Biguanides - Metformin (Glucophage).
Answer: Reduces hepatic glucose output and reduces insulin
resistance
Advatages: No hypoglycemia, limits weight gain, may imrpve
triglycerides
Disadvatnages: Contraindicated in Cr >1.4, diarrhea, risk of lactic
acidosis with procedures or iodinated contrast
◉ Combinations with Metformin.
Answer: • Glyburide, glipizide, repaglinide, sitagliptin, pioglitazone
◉ Glcophage XR.
,Answer: • 500-2000 mg with evening meal
• Use current daily dose to initiate XR therapy
• Less GI side effects
◉ TZDs.
Answer: • Rosiglitazone (Avandia®): 4 mg to 8 mg/d
• Pioglitazone (Actos®): 15 mg to 45 mg/d
Decrease insulin resistance and decreases hepatic glucose output
Risks: Wt gain and edema
◉ TZDs contraindications.
Answer: • Acute liver disease
• Concurrent metformin in renal impairment
• CHF class I and II caution; III-IV avoid drug
• Pregnancy category C
• Monitor LFTs baseline, prn
• If ALT >2.5 ULN, don't start therapy; discontinue if ALT >3 ULN or
jaundice occurs
◉ Alpha-Glucosidase Inhibitors "Starch Blockers".
Answer: Locally in GI tract- decrease glucosse absorption
,Acarbose (Precose®), miglitol (Glyset®)
SE: • Flatulence, abdominal pain, and diarrhea
CI: • Severe liver or renal disease (Cr >2.0); Inflammatory bowel
disease
◉ Incretin Mimetics.
Answer: • Exenatide (Byetta®), liraglutide (Victoza®), exenatide
extended release (Bydureon®), albiglutide (Tanzeum®)
• Mimics incretins like GLP-1
• Increases the secretion of insulin from the pancreas
Adjunct to Metformin and SU
Pancreatitis risk
◉ Dipeptidyl-Peptidase IV Inhibitor.
Answer: •
(Januvia®), saxagliptin (Onglyza®), linagliptin (Tradjenta®),
alogliptin (Nesina®)
, • Increases insulin, decreases glucagon
• Adjunct to diet/exercise
◉ SGLT2 Inhibitor.
Answer: • Canagliflozin (Invokana®)
◉ Rapid Acting Insulin.
Answer: Rapid Analogs
Aspart (NovoLog), Lispro (Humalog) Glulisine (Apidra)
Onset: 15 min
Peak: 1-2 hours
Duration: 3-5 hours
15 min before meals, can be combined with NPH
◉ Short - Regualr.
Answer: Onset: 30-60 min
Peak: 2-4 hour
Duration: 6-10 hour
◉ Intermediate - NPH.
EVALUATION TEST PAPER QUESTIONS
SOLUTIONS GRADED A PLUS
◉ Glinides.
Answer: • Repaglinide (Prandin®) and • Nateglinide (Starlix®);
Stimulates insulin secretion and amounts is dependent on existing
glucose levesl; reduces post-prandial hyperglycemia
◉ Biguanides - Metformin (Glucophage).
Answer: Reduces hepatic glucose output and reduces insulin
resistance
Advatages: No hypoglycemia, limits weight gain, may imrpve
triglycerides
Disadvatnages: Contraindicated in Cr >1.4, diarrhea, risk of lactic
acidosis with procedures or iodinated contrast
◉ Combinations with Metformin.
Answer: • Glyburide, glipizide, repaglinide, sitagliptin, pioglitazone
◉ Glcophage XR.
,Answer: • 500-2000 mg with evening meal
• Use current daily dose to initiate XR therapy
• Less GI side effects
◉ TZDs.
Answer: • Rosiglitazone (Avandia®): 4 mg to 8 mg/d
• Pioglitazone (Actos®): 15 mg to 45 mg/d
Decrease insulin resistance and decreases hepatic glucose output
Risks: Wt gain and edema
◉ TZDs contraindications.
Answer: • Acute liver disease
• Concurrent metformin in renal impairment
• CHF class I and II caution; III-IV avoid drug
• Pregnancy category C
• Monitor LFTs baseline, prn
• If ALT >2.5 ULN, don't start therapy; discontinue if ALT >3 ULN or
jaundice occurs
◉ Alpha-Glucosidase Inhibitors "Starch Blockers".
Answer: Locally in GI tract- decrease glucosse absorption
,Acarbose (Precose®), miglitol (Glyset®)
SE: • Flatulence, abdominal pain, and diarrhea
CI: • Severe liver or renal disease (Cr >2.0); Inflammatory bowel
disease
◉ Incretin Mimetics.
Answer: • Exenatide (Byetta®), liraglutide (Victoza®), exenatide
extended release (Bydureon®), albiglutide (Tanzeum®)
• Mimics incretins like GLP-1
• Increases the secretion of insulin from the pancreas
Adjunct to Metformin and SU
Pancreatitis risk
◉ Dipeptidyl-Peptidase IV Inhibitor.
Answer: •
(Januvia®), saxagliptin (Onglyza®), linagliptin (Tradjenta®),
alogliptin (Nesina®)
, • Increases insulin, decreases glucagon
• Adjunct to diet/exercise
◉ SGLT2 Inhibitor.
Answer: • Canagliflozin (Invokana®)
◉ Rapid Acting Insulin.
Answer: Rapid Analogs
Aspart (NovoLog), Lispro (Humalog) Glulisine (Apidra)
Onset: 15 min
Peak: 1-2 hours
Duration: 3-5 hours
15 min before meals, can be combined with NPH
◉ Short - Regualr.
Answer: Onset: 30-60 min
Peak: 2-4 hour
Duration: 6-10 hour
◉ Intermediate - NPH.
