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Worksheets529 ME Pharmacotherapy 25-26
Total questions: 10
Worksheet time: 5mins
A 55-year-old man with newly diagnosed Type 2 Diabetes Mellitus (T2DM) is started on metformin. He returns to the clinic after one week, complaining of significant nausea, anorexia, and diarrhoea. He is otherwise well and is keen to continue treatment. What is the most appropriate initial action to manage these side effects?
Switch to a sulphonylurea.
Advise him to take metformin on an empty stomach.
Advise him to take metformin together with or immediately after meals and consider a slower titration schedule.
Stop metformin immediately and initiate a DPP-4 inhibitor.
Add an antiemetic and antidiarrhoeal medication to his regimen.
A 70-year-old woman with type 2 diabetes mellitus (T2DM) and chronic heart failure (left ventricular ejection fraction 40%) has inadequate glycaemic control on metformin 1g twice daily. Her HbA1c is 8.5% (69 mmol/mol). Which of the following is the most appropriate next-line agent to add to her regimen?
Pioglitazone
Gliclazide
Repaglinide
Empagliflozin
Sitagliptin
A 48-year-old man with T2DM is started on Empagliflozin. His current medications include Gliclazide 80 mg BD and Metformin 1 g BD. His HbA1c is 7.8% (62 mmol/mol). According to the proposed algorithm for initiating an SGLT2 inhibitor, what is the most appropriate action regarding his other antidiabetic medications?
Stop Metformin.
Increase the dose of Gliclazide.
Continue the same daily dose of Gliclazide.
Reduce the dose of Gliclazide by 50% or stop it.
Switch Gliclazide to a DPP-4 inhibitor.
A 65-year-old man with T2DM and an eGFR of 28 mL/min/1.73m² requires intensification of his glucose-lowering therapy. He is currently on metformin, which is being continued at a reduced dose. According to renal dosing guidance, which of the following is the most appropriate choice?
Start canagliflozin 100 mg OD.
Start metformin MR 1000 mg OD.
Start linagliptin 5 mg OD.
Start gliclazide 80 mg OD without dose adjustment.
Start exenatide 5 mcg BD.
A 45-year-old man with a BMI of 38 kg/m² and type 2 diabetes mellitus (T2DM) has an HbA1c of 8.8% (73 mmol/mol) despite taking triple therapy with Metformin, a DPP-4 inhibitor, and a sulfonylurea. He is struggling with his weight and is frustrated with his glucose control. What is the most appropriate next step in his management?
Add pioglitazone.
Switch the DPP-4 inhibitor for a GLP-1 receptor agonist.
Add acarbose.
Start a basal insulin regimen.
Add repaglinide.
A 35-year-old man is diagnosed with T2DM. He has no other comorbidities. According to the 2025 recommendations, what is the most appropriate initial pharmacotherapy for this patient?
Metformin monotherapy.
SGLT2 inhibitor monotherapy.
A combination of Metformin and an SGLT2 inhibitor.
Lifestyle changes only for 6 months.
A combination of Metformin and a DPP-4 inhibitor.
A patient with T2DM is being considered for a GLP-1 receptor agonist. During the consultation, he mentions that his father was diagnosed with medullary thyroid carcinoma. Based on this information, which of the following GLP-1 RAs is absolutely contraindicated for this patient?
Exenatide (twice daily)
Lixisenatide
Liraglutide
All GLP-1 RAs are contraindicated.
Only the oral formulation of Semaglutide is contraindicated.
A 58-year-old woman with T2DM and established atherosclerotic cardiovascular disease (ASCVD) is being managed with Metformin and an SGLT2 inhibitor. Her HbA1c remains above target at 8.2% (66 mmol/mol). According to the 2025 recommendations, what is the most appropriate next step?
Add a sulfonylurea.
Add a DPP-4 inhibitor.
Add subcutaneous semaglutide.
Start basal insulin.
Add pioglitazone.
A 25-year-old man presents with polyuria, polydipsia, and unexpected weight loss. His random blood glucose is 28 mmol/L, and he is positive for ketones. Type 1 Diabetes is confirmed. What is the first-line insulin regimen for this adult patient?
Twice-daily mixed (biphasic) insulin.
Once-daily basal insulin glargine.
Multiple daily injection basal-bolus insulin regimen.
Insulin pump therapy.
Premixed insulin once daily.
A patient with T2DM has been on a stable dose of metformin and insulin glargine. Her HbA1c has been between 7.0–7.5% (53–58 mmol/mol) for the past year. At her annual review, her HbA1c is found to be 8.5% (69 mmol/mol). The clinician notes this but does not make any changes to her therapy. What is the term for this lack of action, and why is it a problem?
Clinical negligence; it is a breach of duty of care.
Therapeutic inertia; it is a failure to intensify therapy when treatment goals are not met.
Patient non-adherence; the patient is likely not taking their medication.
Treatment failure; the current regimen is no longer effective for any patient.
Glycaemic memory; it reflects the long-term legacy of past poor control.
