AGNP FInal Exam Questions and Answers Latest Version 2025 Graded A+
Metformin: Mechanisms - Answers Reduces hepatic gluconeogenesis
Increased insulin sensitivity
Enhances peripheral glucose uptake
Decreases absorption of glucose from GI tract
Metformin: Advantages - Answers No hypoglycemia
Limits weight gain
Improves lipid levels (Increase triglycerides)
Metformin: Disadvantages - Answers Contraindicated: Renal insufficiency: Male Cr> 1.5 female >1.4,
Liver disease, ETOH abuse.
Caution significant heart disease CVD or CHF
Iodinated contrast- Do not use medication 48 hours before and after, can lead to lactic acidosis.
Secretagogues: Mechanisms - Answers Stimulate release of insulin
Secretagogues: Advantages - Answers Lowest cost and few side effects or cautions
Secretagogues: Contraindications and precautions - Answers Pregnancy & lactation
Liver and renal disease
Allergies to sulfa
Secretagogues: Side effects - Answers May cause wt gain and hypoglycemia
Secretagogues: Sulfonylureas Action - Answers Increase insulin secreted from pancreas
Sulfonylureas - Answers ONLY use type II
Take 15-30 minutes before meals
Second generation: glyburide, glipizide
Long acting: Glucotrol XL
Increasing dose does not usually improve A1C
Side effect= hypoglycemia
Wt gain
,Contra: Allergy to sulfa
Sulfonylureas: Third Generation - Answers Stimulate glucose use in peripheral tissues, Stimulate insulin
secretion from pancreas
Glimepiride (Amaryl)
Meglitinides - Answers Repaglinide (Prandin) or Nateglinide (Starlix)
Modulate beta cell insulin release
Very rapid onset- peak effect in one hour
Short duration of action- half life 1 hr.
Give less than 15min before a meal
Omit if no meal eaten
Monotherapy or in combination with biguanide
DO NOT USE in hepatic failure
No sulfur content so okay in sulfa allergic patient
Thiazolidinediones: Mechanism Action - Answers Diminish insulin resistance by increasing glucose
uptake and metabolism in muscle and adipose tissue
Decrease hepatic gluconeogenesis
Pioglitazone (Actos): Contraindicated - Answers Stage III & Stage IV heart failure; potentially increases
bladder cancer risk
Rosiglitazine (Avandia): Contraindicated - Answers FDA restricted use beginning November 18, 2011
Thiazolidinediones: side effects - Answers Euglycemics- restore normal glucose levels without causing
hypoglycemia
Takes 3/4 weeks to take effect
Fluid retention & edema
Increase risk of bone fracture
Risk of hepatotoxicity
Associated with increase risk of MI and HF
Alpha Glucosidase Inhibitors: Mechanism - Answers Competitive inhibition of intestinal α - glucosidase
,Modulate postprandial digestion and absorption - "insulin-sparing"
I.e. Precose/Glyset
Alpha Glucosidase Inhibitors: Side effects - Answers Flatulence, diarrhea, abdominal pain
Contraindications: IBS, renal disease. Caution pt with hepatic disease
Incretin Hormones - Answers Incretin hormones (GLP-1 & GLP) are hormones released by the gut
throughout the day and rise in response to eating
GLP-1 ( Glucagon like peptide) - Answers Stimulates glucose-dependent insulin secretion
Delays gastric emptying
Improves satiety
GLP (Glucose-dependent insulinotropic peptide) - Answers Stimulates insulin secretion and regulates fat
metabolism
Incretin Mimetics: Mechanism - Answers Increases the secretion of insulin from the pancreas
Slows the absorption of glucose from the gut
Reduces the action of glucagon
Reduces appetite
I.E. Byetta
Exenatide (Byetta) - Answers Injectable-subq
Given 1 hour prior to meal twice daily
used in combo with Metformin/Sulfonylurea
Not recommended for ESRD.
Dipeptidyl Peptidase-4 Inhibitors: Mechanism - Answers Increase incretins GLP-1 and GLP
Stimulate insulin secretion
Block glucagon release
Sitagliptin (Januvia): Renally cleared - Answers Cr > 30-50=> 1/2 dose; <30=> 1/4 dose
Saxagliptin (Onglyza): Renally cleared - Answers lower dose
Amylin Analog: Mechanism - Answers Amylin is secreted from beta cells of pancreas along with insulin
, Slows gastric emptying
Suppresses glucagon secretion
Modulates appetite
Pramlintide acetate (Symalin) - injectable - Answers Type 1 or Type 2 diabetics as an adjunct to insulin
Give immediately prior to meal
Glucagon-Like Peptide-1
Receptor Agonist: Mechanism - Answers Increases glucose-dependent insulin secretion
Decreases glucagon secretion
Delays gastric emptying
Increases satiety
Glucagon-Like Peptide-1
Receptor Agonist: Side effects - Answers nausea and vomiting.
Sodium-Glucose Co-transporter 2 Inhibitors: Mechanism - Answers Promote urinary excretion of glucose
by preventing tubular reabsorption via the sodium-glucose co-transporter
Sodium-Glucose Co-transporter 2 Inhibitors: Types - Answers Inokana
Farxiga
Jardiance
**May lead to ketoacidosis
Benefits of Insulin-Oral Agent Combination: - Answers Improves glycemic control
Simplifies insulin regimen
Less insulin is needed to achieve good
glycemic control
May improve lipid profile
Managing DM Sick Days - Answers Blood glucose levels usually increase
Perform self-blood-glucose monitoring several times a day and check urine for ketones
Call health care provider
Vomiting with ketosis
Metformin: Mechanisms - Answers Reduces hepatic gluconeogenesis
Increased insulin sensitivity
Enhances peripheral glucose uptake
Decreases absorption of glucose from GI tract
Metformin: Advantages - Answers No hypoglycemia
Limits weight gain
Improves lipid levels (Increase triglycerides)
Metformin: Disadvantages - Answers Contraindicated: Renal insufficiency: Male Cr> 1.5 female >1.4,
Liver disease, ETOH abuse.
Caution significant heart disease CVD or CHF
Iodinated contrast- Do not use medication 48 hours before and after, can lead to lactic acidosis.
Secretagogues: Mechanisms - Answers Stimulate release of insulin
Secretagogues: Advantages - Answers Lowest cost and few side effects or cautions
Secretagogues: Contraindications and precautions - Answers Pregnancy & lactation
Liver and renal disease
Allergies to sulfa
Secretagogues: Side effects - Answers May cause wt gain and hypoglycemia
Secretagogues: Sulfonylureas Action - Answers Increase insulin secreted from pancreas
Sulfonylureas - Answers ONLY use type II
Take 15-30 minutes before meals
Second generation: glyburide, glipizide
Long acting: Glucotrol XL
Increasing dose does not usually improve A1C
Side effect= hypoglycemia
Wt gain
,Contra: Allergy to sulfa
Sulfonylureas: Third Generation - Answers Stimulate glucose use in peripheral tissues, Stimulate insulin
secretion from pancreas
Glimepiride (Amaryl)
Meglitinides - Answers Repaglinide (Prandin) or Nateglinide (Starlix)
Modulate beta cell insulin release
Very rapid onset- peak effect in one hour
Short duration of action- half life 1 hr.
Give less than 15min before a meal
Omit if no meal eaten
Monotherapy or in combination with biguanide
DO NOT USE in hepatic failure
No sulfur content so okay in sulfa allergic patient
Thiazolidinediones: Mechanism Action - Answers Diminish insulin resistance by increasing glucose
uptake and metabolism in muscle and adipose tissue
Decrease hepatic gluconeogenesis
Pioglitazone (Actos): Contraindicated - Answers Stage III & Stage IV heart failure; potentially increases
bladder cancer risk
Rosiglitazine (Avandia): Contraindicated - Answers FDA restricted use beginning November 18, 2011
Thiazolidinediones: side effects - Answers Euglycemics- restore normal glucose levels without causing
hypoglycemia
Takes 3/4 weeks to take effect
Fluid retention & edema
Increase risk of bone fracture
Risk of hepatotoxicity
Associated with increase risk of MI and HF
Alpha Glucosidase Inhibitors: Mechanism - Answers Competitive inhibition of intestinal α - glucosidase
,Modulate postprandial digestion and absorption - "insulin-sparing"
I.e. Precose/Glyset
Alpha Glucosidase Inhibitors: Side effects - Answers Flatulence, diarrhea, abdominal pain
Contraindications: IBS, renal disease. Caution pt with hepatic disease
Incretin Hormones - Answers Incretin hormones (GLP-1 & GLP) are hormones released by the gut
throughout the day and rise in response to eating
GLP-1 ( Glucagon like peptide) - Answers Stimulates glucose-dependent insulin secretion
Delays gastric emptying
Improves satiety
GLP (Glucose-dependent insulinotropic peptide) - Answers Stimulates insulin secretion and regulates fat
metabolism
Incretin Mimetics: Mechanism - Answers Increases the secretion of insulin from the pancreas
Slows the absorption of glucose from the gut
Reduces the action of glucagon
Reduces appetite
I.E. Byetta
Exenatide (Byetta) - Answers Injectable-subq
Given 1 hour prior to meal twice daily
used in combo with Metformin/Sulfonylurea
Not recommended for ESRD.
Dipeptidyl Peptidase-4 Inhibitors: Mechanism - Answers Increase incretins GLP-1 and GLP
Stimulate insulin secretion
Block glucagon release
Sitagliptin (Januvia): Renally cleared - Answers Cr > 30-50=> 1/2 dose; <30=> 1/4 dose
Saxagliptin (Onglyza): Renally cleared - Answers lower dose
Amylin Analog: Mechanism - Answers Amylin is secreted from beta cells of pancreas along with insulin
, Slows gastric emptying
Suppresses glucagon secretion
Modulates appetite
Pramlintide acetate (Symalin) - injectable - Answers Type 1 or Type 2 diabetics as an adjunct to insulin
Give immediately prior to meal
Glucagon-Like Peptide-1
Receptor Agonist: Mechanism - Answers Increases glucose-dependent insulin secretion
Decreases glucagon secretion
Delays gastric emptying
Increases satiety
Glucagon-Like Peptide-1
Receptor Agonist: Side effects - Answers nausea and vomiting.
Sodium-Glucose Co-transporter 2 Inhibitors: Mechanism - Answers Promote urinary excretion of glucose
by preventing tubular reabsorption via the sodium-glucose co-transporter
Sodium-Glucose Co-transporter 2 Inhibitors: Types - Answers Inokana
Farxiga
Jardiance
**May lead to ketoacidosis
Benefits of Insulin-Oral Agent Combination: - Answers Improves glycemic control
Simplifies insulin regimen
Less insulin is needed to achieve good
glycemic control
May improve lipid profile
Managing DM Sick Days - Answers Blood glucose levels usually increase
Perform self-blood-glucose monitoring several times a day and check urine for ketones
Call health care provider
Vomiting with ketosis
