PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
PharmD Endocrine
Pharmacotherapy
2026–2027 | Diabetes Review | 110 Clinical Practice Questions
ORIGINAL PRACTICE EXAMINATION • QUESTIONS, ANSWERS & DETAILED RATIONALES
Designed for PharmD learners reviewing diabetes and related endocrine therapeutics. Includes realistic
hypothetical cases, safety decisions, calculations, the consolidated answer key, and a seven-day study plan.
Scope and safety: This is not an official licensure/university examination. Cases are simplified and not
instructions for treating an actual patient. Verify product labeling, current guidance, renal dosing, and pregnancy
indications before clinical use.
Exam blueprint
Assessment and individualized diabetes goals 10 questions
Metformin and noninsulin oral therapies 10 questions
GLP-1 and dual-incretin pharmacotherapy 10 questions
SGLT2 inhibitors and cardiorenal care 10 questions
Basal, prandial, and insulin product safety 10 questions
Hypoglycemia, CGM, and monitoring 10 questions
Hyperglycemic crises and inpatient decisions 10 questions
CKD, vascular prevention, and coexisting diseases 10 questions
Pregnancy, aging, and special populations 10 questions
Thyroid, adrenal, and bone pharmacotherapy 10 questions
Insulin calculations and clinical numeracy 10 questions
Instructions
Select the one best answer (A–D). Attempt each question before reading its explanation. For medication math,
assume all clinical numbers and instructions given in the stem are hypothetical teaching inputs; do not round
intermediate arithmetic unless asked. Allow 130–160 minutes if using this as a timed review.
The correct answers appear directly after each question for active review. A compact answer key follows all 110
questions.
Independent educational practice resource • Not an official exam | 1
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
01 | Assessment and individualized diabetes goals
Q001. A 48-year-old has thirst, polyuria, and a random plasma glucose of 248 mg/dL. What is the most
appropriate interpretation?
A. A1C testing must always precede diagnosis
B. The findings meet diagnostic criteria for diabetes in a symptomatic patient
C. The glucose level represents prediabetes only
D. Repeat random glucose on three separate days before any diagnosis
Correct answer: B. The findings meet diagnostic criteria for diabetes in a symptomatic patient
Rationale: Classic symptoms plus random plasma glucose at least 200 mg/dL establish diabetes.
Why the other options are incorrect: Symptoms plus a diagnostic random glucose are sufficient; an A1C or multiple
repetitions is not invariably required.
Q002. An asymptomatic adult has an A1C of 6.7% on a first laboratory test. What is the next best diagnostic
step?
A. Begin insulin before confirming the diagnosis
B. Confirm the result using a second abnormal diagnostic test
C. Diagnose diabetes from any single abnormal A1C regardless of symptoms
D. Order urine glucose instead of a diagnostic blood test
Correct answer: B. Confirm the result using a second abnormal diagnostic test
Rationale: In the absence of unequivocal hyperglycemia, diagnosis generally requires two abnormal test results.
Why the other options are incorrect: Urine glucose is not confirmatory, and starting insulin before diagnostic
confirmation is not the default response.
Q003. A 60-year-old with type 2 diabetes, no major comorbidities, and low treatment burden asks about an
A1C goal. Which is a common starting target?
A. Exactly 6% without considering hypoglycemia
B. Below 7%, individualized to risks and preferences
C. Below 5% for every adult
D. Below 9% regardless of health status
Correct answer: B. Below 7%, individualized to risks and preferences
Rationale: For many nonpregnant adults, an A1C goal below 7% is reasonable, but goals are individualized.
Why the other options are incorrect: Very tight universal goals increase treatment harms; overly permissive fixed targets
may leave avoidable hyperglycemia.
Q004. An 84-year-old with frailty, cognitive impairment, and repeated severe hypoglycemia is taking
intensive insulin. What principle should guide therapy?
A. Add a sulfonylurea without reviewing insulin
B. Ignore the hypoglycemia because the A1C is low
C. Intensify to an A1C below 6%
D. Relax individualized glycemic targets and reduce hypoglycemia-producing treatment
Independent educational practice resource • Not an official exam | 2
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
Correct answer: D. Relax individualized glycemic targets and reduce hypoglycemia-producing treatment
Rationale: Avoiding symptomatic and severe hypoglycemia takes priority in this high-risk older adult.
Why the other options are incorrect: Intensification and additional insulin secretagogues increase risk, while dismissing
hypoglycemia is unsafe.
Q005. A patient with microcytic anemia has A1C values inconsistent with fingerstick measurements. What is
the best assessment approach?
A. Use plasma glucose or CGM/SMBG data while evaluating conditions affecting A1C
B. Use urinary ketones as the only long-term glycemic metric
C. Assume A1C is always accurate despite altered red cell turnover
D. Stop all glucose monitoring
Correct answer: A. Use plasma glucose or CGM/SMBG data while evaluating conditions affecting A1C
Rationale: Red-cell disorders can distort A1C; direct glucose-based measures help clarify control.
Why the other options are incorrect: A1C can be unreliable in altered erythrocyte turnover; ketones do not measure
longitudinal glucose control.
Q006. A patient has fasting plasma glucose 114 mg/dL and no symptoms. Which category does this fasting
value support?
A. Normal fasting glucose by ADA criteria
B. Diabetes mellitus by fasting criteria
C. Hyperosmolar hyperglycemic state
D. Prediabetes (impaired fasting glucose)
Correct answer: D. Prediabetes (impaired fasting glucose)
Rationale: Fasting plasma glucose of 100–125 mg/dL is within the prediabetes range.
Why the other options are incorrect: Diabetes requires fasting glucose at least 126 mg/dL on diagnostic testing; HHS is a
clinical emergency with much higher glucose.
Q007. A pharmacist plans intensification for type 2 diabetes with CKD and prior myocardial infarction.
Which feature deserves the greatest influence on drug selection?
A. Choose only the least expensive medicine even if outcomes differ
B. Demonstrated cardiovascular and kidney benefit in addition to glucose lowering
C. Choose a drug solely by its color and tablet size
D. Use a sulfonylurea automatically regardless of hypoglycemia risk
Correct answer: B. Demonstrated cardiovascular and kidney benefit in addition to glucose lowering
Rationale: Comorbid ASCVD and CKD justify prioritizing agents with proven cardiorenal benefits.
Why the other options are incorrect: Cost and burden matter, but drug appearance and automatic sulfonylurea selection
do not address documented comorbidity risks.
Q008. An adult newly diagnosed with diabetes requests education beyond a medication handout. What
referral is most appropriate?
A. Diabetes self-management education and support (DSMES)
B. Only a one-time brochure without follow-up
C. No education until insulin is required
Independent educational practice resource • Not an official exam | 3
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
D. Routine antibiotic counseling
Correct answer: A. Diabetes self-management education and support (DSMES)
Rationale: DSMES supports skills, adherence, problem-solving, and individualized self-care.
Why the other options are incorrect: Education should not be delayed or limited to passive reading, and antibiotic
counseling does not address diabetes needs.
Q009. A patient on basal insulin has fasting glucose near target but A1C remains 8.8% with high after-meal
readings. What should be evaluated first?
A. Postprandial glucose patterns and need for targeted treatment
B. Assume the laboratory A1C must be erroneous
C. Continuously increase basal insulin despite fasting values at goal
D. Discontinue all glucose monitoring
Correct answer: A. Postprandial glucose patterns and need for targeted treatment
Rationale: When fasting values are near target, residual hyperglycemia may be predominantly postprandial.
Why the other options are incorrect: Further basal escalation can cause nocturnal hypoglycemia; ignoring meals or
assuming lab error misses the pattern.
Q010. A patient takes insulin and describes shakiness and sweating after skipping lunch. What is the
pharmacist’s first concern?
A. Metformin-induced lactic acidosis as the only plausible cause
B. Chronic hyperglycemia requiring insulin escalation
C. Diabetic retinopathy requiring emergent eye surgery
D. Possible hypoglycemia requiring immediate glucose assessment and treatment
Correct answer: D. Possible hypoglycemia requiring immediate glucose assessment and treatment
Rationale: Adrenergic symptoms after missed food in an insulin user warrant immediate hypoglycemia
evaluation.
Why the other options are incorrect: Giving more insulin or delaying evaluation for unrelated chronic complications may
worsen a low glucose event.
02 | Metformin and noninsulin oral therapies
Q011. A patient beginning metformin develops mild nausea and diarrhea. Which counseling strategy often
improves tolerability?
A. Take with food and consider gradual dose titration or extended-release formulation
B. Increase immediately to the highest dose while fasting
C. Stop all treatment permanently without reassessment
D. Add a sulfonylurea specifically to eliminate diarrhea
Correct answer: A. Take with food and consider gradual dose titration or extended-release formulation
Rationale: Metformin gastrointestinal symptoms often improve with food, slow titration, or extended-release
products.
Why the other options are incorrect: Abrupt escalation may worsen symptoms; adding secretagogues does not directly
treat intolerance.
Independent educational practice resource • Not an official exam | 4
PharmD Endocrine
Pharmacotherapy
2026–2027 | Diabetes Review | 110 Clinical Practice Questions
ORIGINAL PRACTICE EXAMINATION • QUESTIONS, ANSWERS & DETAILED RATIONALES
Designed for PharmD learners reviewing diabetes and related endocrine therapeutics. Includes realistic
hypothetical cases, safety decisions, calculations, the consolidated answer key, and a seven-day study plan.
Scope and safety: This is not an official licensure/university examination. Cases are simplified and not
instructions for treating an actual patient. Verify product labeling, current guidance, renal dosing, and pregnancy
indications before clinical use.
Exam blueprint
Assessment and individualized diabetes goals 10 questions
Metformin and noninsulin oral therapies 10 questions
GLP-1 and dual-incretin pharmacotherapy 10 questions
SGLT2 inhibitors and cardiorenal care 10 questions
Basal, prandial, and insulin product safety 10 questions
Hypoglycemia, CGM, and monitoring 10 questions
Hyperglycemic crises and inpatient decisions 10 questions
CKD, vascular prevention, and coexisting diseases 10 questions
Pregnancy, aging, and special populations 10 questions
Thyroid, adrenal, and bone pharmacotherapy 10 questions
Insulin calculations and clinical numeracy 10 questions
Instructions
Select the one best answer (A–D). Attempt each question before reading its explanation. For medication math,
assume all clinical numbers and instructions given in the stem are hypothetical teaching inputs; do not round
intermediate arithmetic unless asked. Allow 130–160 minutes if using this as a timed review.
The correct answers appear directly after each question for active review. A compact answer key follows all 110
questions.
Independent educational practice resource • Not an official exam | 1
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
01 | Assessment and individualized diabetes goals
Q001. A 48-year-old has thirst, polyuria, and a random plasma glucose of 248 mg/dL. What is the most
appropriate interpretation?
A. A1C testing must always precede diagnosis
B. The findings meet diagnostic criteria for diabetes in a symptomatic patient
C. The glucose level represents prediabetes only
D. Repeat random glucose on three separate days before any diagnosis
Correct answer: B. The findings meet diagnostic criteria for diabetes in a symptomatic patient
Rationale: Classic symptoms plus random plasma glucose at least 200 mg/dL establish diabetes.
Why the other options are incorrect: Symptoms plus a diagnostic random glucose are sufficient; an A1C or multiple
repetitions is not invariably required.
Q002. An asymptomatic adult has an A1C of 6.7% on a first laboratory test. What is the next best diagnostic
step?
A. Begin insulin before confirming the diagnosis
B. Confirm the result using a second abnormal diagnostic test
C. Diagnose diabetes from any single abnormal A1C regardless of symptoms
D. Order urine glucose instead of a diagnostic blood test
Correct answer: B. Confirm the result using a second abnormal diagnostic test
Rationale: In the absence of unequivocal hyperglycemia, diagnosis generally requires two abnormal test results.
Why the other options are incorrect: Urine glucose is not confirmatory, and starting insulin before diagnostic
confirmation is not the default response.
Q003. A 60-year-old with type 2 diabetes, no major comorbidities, and low treatment burden asks about an
A1C goal. Which is a common starting target?
A. Exactly 6% without considering hypoglycemia
B. Below 7%, individualized to risks and preferences
C. Below 5% for every adult
D. Below 9% regardless of health status
Correct answer: B. Below 7%, individualized to risks and preferences
Rationale: For many nonpregnant adults, an A1C goal below 7% is reasonable, but goals are individualized.
Why the other options are incorrect: Very tight universal goals increase treatment harms; overly permissive fixed targets
may leave avoidable hyperglycemia.
Q004. An 84-year-old with frailty, cognitive impairment, and repeated severe hypoglycemia is taking
intensive insulin. What principle should guide therapy?
A. Add a sulfonylurea without reviewing insulin
B. Ignore the hypoglycemia because the A1C is low
C. Intensify to an A1C below 6%
D. Relax individualized glycemic targets and reduce hypoglycemia-producing treatment
Independent educational practice resource • Not an official exam | 2
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
Correct answer: D. Relax individualized glycemic targets and reduce hypoglycemia-producing treatment
Rationale: Avoiding symptomatic and severe hypoglycemia takes priority in this high-risk older adult.
Why the other options are incorrect: Intensification and additional insulin secretagogues increase risk, while dismissing
hypoglycemia is unsafe.
Q005. A patient with microcytic anemia has A1C values inconsistent with fingerstick measurements. What is
the best assessment approach?
A. Use plasma glucose or CGM/SMBG data while evaluating conditions affecting A1C
B. Use urinary ketones as the only long-term glycemic metric
C. Assume A1C is always accurate despite altered red cell turnover
D. Stop all glucose monitoring
Correct answer: A. Use plasma glucose or CGM/SMBG data while evaluating conditions affecting A1C
Rationale: Red-cell disorders can distort A1C; direct glucose-based measures help clarify control.
Why the other options are incorrect: A1C can be unreliable in altered erythrocyte turnover; ketones do not measure
longitudinal glucose control.
Q006. A patient has fasting plasma glucose 114 mg/dL and no symptoms. Which category does this fasting
value support?
A. Normal fasting glucose by ADA criteria
B. Diabetes mellitus by fasting criteria
C. Hyperosmolar hyperglycemic state
D. Prediabetes (impaired fasting glucose)
Correct answer: D. Prediabetes (impaired fasting glucose)
Rationale: Fasting plasma glucose of 100–125 mg/dL is within the prediabetes range.
Why the other options are incorrect: Diabetes requires fasting glucose at least 126 mg/dL on diagnostic testing; HHS is a
clinical emergency with much higher glucose.
Q007. A pharmacist plans intensification for type 2 diabetes with CKD and prior myocardial infarction.
Which feature deserves the greatest influence on drug selection?
A. Choose only the least expensive medicine even if outcomes differ
B. Demonstrated cardiovascular and kidney benefit in addition to glucose lowering
C. Choose a drug solely by its color and tablet size
D. Use a sulfonylurea automatically regardless of hypoglycemia risk
Correct answer: B. Demonstrated cardiovascular and kidney benefit in addition to glucose lowering
Rationale: Comorbid ASCVD and CKD justify prioritizing agents with proven cardiorenal benefits.
Why the other options are incorrect: Cost and burden matter, but drug appearance and automatic sulfonylurea selection
do not address documented comorbidity risks.
Q008. An adult newly diagnosed with diabetes requests education beyond a medication handout. What
referral is most appropriate?
A. Diabetes self-management education and support (DSMES)
B. Only a one-time brochure without follow-up
C. No education until insulin is required
Independent educational practice resource • Not an official exam | 3
, PHARMD | ENDOCRINE PHARMACOTHERAPY | 2026–2027
D. Routine antibiotic counseling
Correct answer: A. Diabetes self-management education and support (DSMES)
Rationale: DSMES supports skills, adherence, problem-solving, and individualized self-care.
Why the other options are incorrect: Education should not be delayed or limited to passive reading, and antibiotic
counseling does not address diabetes needs.
Q009. A patient on basal insulin has fasting glucose near target but A1C remains 8.8% with high after-meal
readings. What should be evaluated first?
A. Postprandial glucose patterns and need for targeted treatment
B. Assume the laboratory A1C must be erroneous
C. Continuously increase basal insulin despite fasting values at goal
D. Discontinue all glucose monitoring
Correct answer: A. Postprandial glucose patterns and need for targeted treatment
Rationale: When fasting values are near target, residual hyperglycemia may be predominantly postprandial.
Why the other options are incorrect: Further basal escalation can cause nocturnal hypoglycemia; ignoring meals or
assuming lab error misses the pattern.
Q010. A patient takes insulin and describes shakiness and sweating after skipping lunch. What is the
pharmacist’s first concern?
A. Metformin-induced lactic acidosis as the only plausible cause
B. Chronic hyperglycemia requiring insulin escalation
C. Diabetic retinopathy requiring emergent eye surgery
D. Possible hypoglycemia requiring immediate glucose assessment and treatment
Correct answer: D. Possible hypoglycemia requiring immediate glucose assessment and treatment
Rationale: Adrenergic symptoms after missed food in an insulin user warrant immediate hypoglycemia
evaluation.
Why the other options are incorrect: Giving more insulin or delaying evaluation for unrelated chronic complications may
worsen a low glucose event.
02 | Metformin and noninsulin oral therapies
Q011. A patient beginning metformin develops mild nausea and diarrhea. Which counseling strategy often
improves tolerability?
A. Take with food and consider gradual dose titration or extended-release formulation
B. Increase immediately to the highest dose while fasting
C. Stop all treatment permanently without reassessment
D. Add a sulfonylurea specifically to eliminate diarrhea
Correct answer: A. Take with food and consider gradual dose titration or extended-release formulation
Rationale: Metformin gastrointestinal symptoms often improve with food, slow titration, or extended-release
products.
Why the other options are incorrect: Abrupt escalation may worsen symptoms; adding secretagogues does not directly
treat intolerance.
Independent educational practice resource • Not an official exam | 4
