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WorksheetsNon Insulin Antidiabetic Medications Quizzing
Total questions: 61
Worksheet time: 32mins
Which effect is a primary mechanism of metformin in type 2 diabetes management?
Directly stimulates insulin secretion
Inhibits pancreatic beta cell function
Decreases hepatic glucose production
Blocks intestinal glucose absorption fully
A patient taking metformin reports hypoglycemia while using it alone. What is the best next consideration?
Assess for another drug or cause
Increase metformin dosing immediately
Advise high carbohydrate snacks routinely
Stop meals to reduce GI upset
Which statement about metformin and insulin release is accurate?
It does not stimulate insulin release
It stimulates insulin regardless of glucose
It replaces insulin in type 1 diabetes
It blocks all endogenous insulin release
Which nursing action is recommended to reduce metformin-related GI upset?
Increase dose during nausea
Switch to bedtime-only dosing
Give on an empty stomach
Administer with meals regularly
Before a contrast dye study, what is the appropriate action for a patient on metformin?
Administer a double morning dose
Give extra fluids with dose
Hold metformin around the study
Continue metformin without change
Long-term metformin therapy is commonly associated with risk of which deficiency?
Vitamin B12 deficiency risk
Vitamin D deficiency risk
Iron deficiency anemia risk
Folate deficiency risk
When used alone, metformin has which effect on hypoglycemia risk?
Risk only in type 1 diabetes
Very high hypoglycemia risk
Minimal to no risk of hypoglycemia
Moderate risk in all patients
Which mechanism best describes sulfonylurea action in glucose control?
Reduces hepatic glucose output
Stimulates pancreatic insulin release
Delays carbohydrate absorption
Increases insulin receptor number
Why do sulfonylureas carry a higher hypoglycemia risk than metformin?
They force insulin release regardless of glucose
They suppress counter-regulatory hormones
They reduce insulin clearance from blood
They only work when glucose is elevated
Which patient would NOT benefit from sulfonylureas due to mechanism requirements?
Obese adult with dietary nonadherence
Type 1 diabetes lacking beta cells
Type 2 diabetes with insulin resistance
Older adult with normal renal function
Which adverse effect is commonly anticipated with sulfonylurea therapy?
Hair loss is common adverse effect
Severe diarrhea is common effect
Photosensitivity is the hallmark effect
Weight gain is common adverse effect
A key nursing priority for patients on sulfonylureas is to:
Avoid all carbohydrates entirely
Ensure consistent meals daily
Encourage meal skipping often
Promote ketogenic dieting quickly
Which monitoring focus is emphasized for patients taking metformin?
Track potassium daily
Check fasting lipids weekly
Monitor liver enzymes only
Monitor renal function regularly
Why are sulfonylureas ineffective in type 1 diabetes?
They require functioning beta cells
They replace insulin injections fully
They increase hepatic ketone production
They block insulin receptors entirely
Which statement best describes the mechanism of meglitinides such as repaglinide?
Short-acting insulin secretagogue taken with meals
GLP-1 receptor agonist increasing satiety signals
Long-acting insulin sensitizer for skeletal muscle
Alpha-glucosidase inhibitor delaying carbohydrate absorption
A patient on repaglinide skips lunch. What is the safest action regarding the dose?
Skip the dose because meal is skipped
Take half the dose with water only
Take full dose to prevent hyperglycemia
Delay the dose until next morning
Compared with sulfonylureas, meglitinides most accurately have which hypoglycemia risk?
No risk due to short half-life
Equal risk independent of meals
Lower risk when dosed with meals
Higher risk regardless of meals
Which patient profile most benefits from meglitinides?
Fasting regimens avoiding daytime calories
Irregular meal schedules needing dosing flexibility
Severe renal failure requiring insulin only
Consistent three-meal routines without snacks
Despite dosing flexibility, a known drawback of meglitinides is which effect?
Anorexia limits further weight gain
Neutral weight with long-term use
Significant weight loss occurs
Weight gain can still occur
Which counseling point prevents hypoglycemia with repaglinide?
Double next dose after a skip
No meal equals no dose
Take on empty stomach nightly
Crush tablets if nauseated
Thiazolidinediones (TZDs) like pioglitazone primarily improve glycemia by which action?
Blocking renal glucose reabsorption in tubules
Increasing insulin sensitivity in muscle and fat
Inhibiting intestinal carbohydrate absorption
Stimulating pancreatic beta-cell insulin release
Which adverse effect requires routine monitoring in patients on TZDs?
Edema and progressive weight gain
Rebound tachycardia and tremor
Photosensitivity and pruritic rash
Hypokalemia and muscle cramps
In which clinical scenario are TZDs contraindicated or should be avoided?
Mild gastroesophageal reflux disease
Symptomatic heart failure with edema
Controlled hypothyroidism on levothyroxine
Seasonal allergic rhinitis on antihistamines
Which property limits TZDs for acute glucose control in hospitalized patients?
Short duration of action
Requirement for fasting state
Slow onset of action
Severe hypoglycemia risk
A patient with type 2 diabetes and worsening dyspnea, leg swelling, and rapid weight gain recently started pioglitazone. What is the most plausible explanation?
Allergic bronchospasm unrelated to volume status
Drug-induced fluid retention exacerbating heart failure
Idiosyncratic hepatic necrosis causing volume loss
Osmotic diuresis leading to dehydration
Which paired counseling statements correctly match drug class and key point?
Meglitinides: long-acting; TZDs: no weight effects
Meglitinides: dose with meals; TZDs: avoid in HF
Meglitinides: take fasting; TZDs: treat acute spikes
Meglitinides: cause fat loss; TZDs: reduce edema
Which class increases insulin secretion only when glucose is elevated, reducing hypoglycemia risk?
GLP-1 receptor agonists are glucose dependent
Thiazolidinediones enhance insulin sensitivity only
Sulfonylureas stimulate insulin regardless of glucose
Basal insulin analogs provide constant background insulin
A patient on sitagliptin develops severe epigastric pain radiating to the back. What complication is most likely?
Biliary colic due to gallstones formation
Acute pancreatitis associated with DPP-4 use
Peptic ulcer perforation causing peritonitis
Diabetic gastroparesis from autonomic neuropathy
Which pairing should generally be avoided due to overlapping mechanisms?
Basal insulin combined with GLP-1 receptor agonist
GLP-1 receptor agonist combined with DPP-4 inhibitor
Metformin combined with SGLT2 inhibitors routinely
SGLT2 inhibitor combined with ACE inhibitor therapy
GLP-1 receptor agonists commonly slow gastric emptying. Which counseling point best addresses this effect early in therapy?
Drink minimal water with meals initially
Skip breakfast to reduce nausea symptoms
Start with small meals and eat slowly
Increase fatty foods to prolong satiety
Which benefit is characteristic of GLP-1 receptor agonists for overweight patients?
Weight loss benefit with significant reductions
Weight neutral with minimal body mass change
Weight gain is frequent with long-term therapy
Weight cycling with alternating gain and loss
Which statement best describes the primary action of SGLT2 inhibitors?
Increase insulin release from pancreatic beta cells
Decrease hepatic gluconeogenesis overnight
Excrete excess glucose via the urine
Slow intestinal glucose absorption postprandially
Which adverse effect is most associated with SGLT2 inhibitors due to glucosuria?
Retinopathy with macular edema
Severe constipation and ileus
Pancreatitis with elevated lipase
Genital yeast infections and UTIs
A patient on an SGLT2 inhibitor presents with nausea, abdominal pain, and Kussmaul respirations but near-normal glucose. What diagnosis fits best?
Acute pancreatitis causing metabolic acidosis
Euglycemic diabetic ketoacidosis likely
Lactic acidosis from metformin toxicity
Hyperosmolar hyperglycemic state present
Which hemodynamic concern should be monitored with SGLT2 therapy?
Portal hypertension due to cirrhosis
Hypertensive urgency from sodium retention
Orthostatic hypotension from volume loss
Pulmonary hypertension at rest
What is a shared safety signal between DPP-4 inhibitors and GLP-1 receptor agonists?
Increased risk of pancreatitis symptoms
Severe hypoglycemia during fasting states
Scleroderma-like skin thickening syndrome
Hyperkalemia requiring potassium binders
Which medication list correctly matches its drug class?
Dulaglutide and exenatide are DPP-4 inhibitors
Empagliflozin and dapagliflozin are SGLT2 inhibitors
Sitagliptin and linagliptin are GLP-1 agonists
Semaglutide and liraglutide are SGLT2 inhibitors
Which feature explains the lower hypoglycemia risk with GLP-1 receptor agonists?
They block renal glucose reabsorption entirely
They increase insulin only with elevated glucose
They suppress cortisol during stress responses
They directly release stored hepatic glycogen
For a patient prone to dehydration, which counseling point is most important when starting an SGLT2 inhibitor?
Use salt restriction to reduce thirst
Increase caffeine to stimulate diuresis
Maintain adequate hydration throughout day
Limit fluids to avoid polyuria symptoms
Which class is described as weight neutral among low hypoglycemia risk agents?
Sulfonylureas such as glipizide
DPP-4 inhibitors such as sitagliptin
GLP-1 agonists such as liraglutide
SGLT2 inhibitors such as empagliflozin
Which clinical clue should prompt immediate evaluation for pancreatitis in patients on incretin-based therapy?
Diffuse chest pain relieved by nitrates
Severe epigastric pain radiating to the back
Right lower quadrant pain with rebound
Crampy lower abdominal pain with diarrhea
Which statement about euglycemic DKA with SGLT2 inhibitors is accurate?
It presents only with glucose above 500 mg/dL
It causes metabolic alkalosis with hypoventilation
It is prevented by taking bedtime insulin only
It can occur with near-normal glucose levels
Why should GLP-1 receptor agonists generally not be combined with DPP-4 inhibitors?
They cause immediate insulin deficiency
They eliminate weight loss advantages
They duplicate incretin pathway mechanisms
They counteract each other’s renal effects
Which practical teaching is most appropriate when initiating GLP-1 therapy to mitigate GI side effects?
Stop all fiber to reduce fullness sensation
Use anticholinergics to speed gastric emptying
Advance doses gradually as tolerated
Eat large high-fat meals at bedtime
Which statement best describes acarbose’s mechanism of action at mealtimes?
Enhances renal glucose excretion rapidly
Stimulates pancreatic insulin secretion
Inhibits hepatic gluconeogenesis strongly
Delays carbohydrate absorption in the gut
A common adverse effect profile for acarbose includes which symptoms?
Bradycardia and hypotension
Gas, bloating, and diarrhea
Rash and photosensitivity
Cough and bronchospasm
When should acarbose be administered to maximize its effect?
Only at bedtime daily
Thirty minutes after meals
Two hours before breakfast
With the first bite of a meal
A patient on acarbose develops hypoglycemia from another agent. The most appropriate treatment is to give:
Intranasal glucagon spray
High-fructose fruit juice
Table sugar cubes promptly
Oral glucose tablets immediately
Why are table sugar and sucrose-containing snacks ineffective for hypoglycemia in patients taking acarbose?
Acarbose raises gastric pH strongly
Acarbose enhances insulin clearance
Acarbose increases sucrose metabolism
Acarbose blocks sucrose breakdown
When used alone, acarbose carries what relative risk of hypoglycemia?
Moderate risk with beta-cell exhaustion
High risk due to potent insulin release
Unpredictable risk from variable absorption
Low risk because it doesn’t stimulate insulin
Pramlintide is best characterized as which type of medication and usage?
Amylin analog used with insulin
GLP-1 agonist used alone
SGLT2 inhibitor for fasting
DPP-4 inhibitor as monotherapy
Which physiologic effect is associated with pramlintide after meals?
Decreases inappropriate glucagon secretion
Accelerates gastric emptying substantially
Stimulates hepatic glycogenolysis strongly
Increases intestinal glucose absorption
A key safety consideration when initiating pramlintide with mealtime insulin is to:
Add high-dose basal insulin immediately
Avoid all carbohydrate intake entirely
Stop checking postprandial glucose levels
Monitor for increased hypoglycemia risk
Which statement about pramlintide’s role in therapy is correct?
It is used only for fasting hyperglycemia
It is an adjunct to mealtime insulin therapy
It is preferred monotherapy in type 2 diabetes
It replaces prandial insulin in many patients
Which hormone is released when blood sugar gets too high?
glucose
glucagon
glycogen
insulin
Insulin is produced by the _________ in the ____________.
alpha cells, pancreas
beta cells, pancreas
alpha cells, liver
beta cells, liver
Insulin moves blood glucose primarily into _____________ cells to be used as energy.
islet (of Langerhans)
fat
muscle
liver
Insulin signals _________ cells to store glucose as glycogen.
islet (of Langerhans)
fat
muscle
liver
Mixed insulins such as Humulin 70/30 contain which of the following ingredients?
70% insulin, 30% protamine
70% NPH, 30% regular
70% regular, 30% NPH
70% protamine, 30% insulin
According to the ADA guidelines, in patients with T2DM, a GLP1 receptor agonist is preferred over insulin.
FALSE
TRUE
[SELECT ALL THAT APPLY] Which of the following approved agents does the ADA guidelines recommend for treatment of youth-onset T2DM?
liraglutide
semaglutide
insulin
glipizide
metformin
