Deck 21: Drugs for the Treatment of Diabetes Mellitus

Question 1

More and more cases of type II diabetes are being reported in persons younger than 20 years because of:

A) an increased incidence of autoimmune disorders.
B) a much more sedentary lifestyle and lack of exercise.
C) illicit use of legal drugs.
D) environmental changes and global warming.

Answer 1

a much more sedentary lifestyle and lack of exercise.

Question 2

Which of the following statements is true of metformin?

A) It is a member of the a-glucosidase inhibitor group of antidiabetic agents.
B) It lowers blood glucose but, used alone, does not produce hypoglycemia.
C) It decreases hepatic and peripheral insulin sensitivity, resulting in increased hepatic glucose production.
D) Lactic acidosis is a common, but benign side effect.

Answer 2

It lowers blood glucose but, used alone, does not produce hypoglycemia.

Question 3

Which of the following statements is true concerning oral surgical procedures for the adult patient with diabetes?

A) The procedure should be performed before breakfast, and the patient should have taken regular diabetes medication.
B) The procedures should be performed 1 1/2 to 2 hours after the patient has eaten a normal breakfast and has taken regular antidiabetes medication.
C) The procedure should be performed after lunch, and the patient has taken regular diabetes medication.
D) The procedure should be performed after lunch, and the patient should skip regular diabetes medication.

Answer 3

The procedures should be performed 1 1/2 to 2 hours after the patient has eaten a normal breakfast and has taken regular antidiabetes medication.

Question 4

The primary goal of treating diabetes is to maintain hemoglobin A1C levels:

A) at zero.
B) as close to normal as possible (<7%).
C) at a level of 40%.
D) as high as possible.

Question 5

All of the following are likely reasons why diabetics have a higher incidence of periodontal disease except which one?

A) Enhanced collagenase activity
B) Loss of capillary basement membrane integrity
C) Changes in glucose tolerance factor
D) Microangiopathy of the tissues
E) Altered polymorphonuclear leukocyte (PMN)function

Question 6

Adverse reactions to metformin occur primarily in the:

A) pancreas.
B) GI tract.
C) oral cavity.
D) cardiovascular system.

Question 7

Type I and type II diabetics are at greater risk for caries. This risk is attributed to the higher concentration of glucose in their saliva.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true; the second statement is false.
D) The first statement is false; the second statement is true.

Question 8

Which of the following statements is true regarding systemic complications of diabetes?

A) Hypolipidemia is common in patients with diabetes.
B) Neuropathy is a complication of diabetes.
C) Gangrene can occur in peripheral extremities.
D) Both a and b are true.
E) Both b and c are true.

Question 9

Which form of insulin has a faster onset of action as a consequence of exchanging two amino acids in its structure?

A) Pork insulin
B) NPH insulin
C) Prompt zinc insulin
D) Lispro insulin
E) Protamine zinc insulin

Question 10

Which of the following symptoms of hypoglycemia can be explained by glucose deprivation of the brain rather than the adrenal glands: (1)blurred vision, (2)incoherent speech, (3)sweating, (4)tachycardia?

A) 1, 2, 3, 4
B) 1, 2, 3
C) 1, 2
D) 3, 4

Question 11

The mechanism of action of the sulfonylureas includes _____ of the release of insulin from the beta cells of the pancreas, _____ of glucose from the liver and serum glucagon levels, and a(n)_____ in the sensitivity of the target tissues to insulin.

A) stimulation; increase; increase
B) stimulation; increase; reduction
C) stimulation; reduction; increase
D) stimulation; reduction; reduction
E) inhibition; reduction; reduction

Question 12

Which oral antidiabetic agent produces lactic acidosis as a significant adverse effect?

A) Tolbutamide
B) Metformin
C) Repaglinide
D) Acarbose
E) Pioglitazone

Question 13

Contributing factors to gangrene in the extremities of diabetic patients include:

A) poor eyesight.
B) poor circulation.
C) reduced sensation in the extremities.
D) all of the above.
E) none of the above.

Question 14

The most common adverse reaction associated with any insulin product is:

A) hypoglycemia.
B) hyperglycemia.
C) intestinal stasis.
D) bradycardia.

Question 15

Diabetic gastroparesis can be treated with:

A) amitriptyline.
B) carbamazepine.
C) ranitidine.
D) metoclopramide.

Question 16

Which of the following pancreatic hormones promotes fuel mobilization?

A) Insulin
B) Glucagon
C) Islet amyloid polypeptide (IAPP; amylin)
D) Pancreatic peptide

Question 17

Insulin resistance develops because of prolonged _____ and resulting _____.

A) hyperglycemia; hyperinsulinemia
B) hyperglycemia; hypoinsulinemia
C) hypoglycemia; hyperinsulinemia
D) hypoglycemia; hypoinsulinemia

Question 18

Human insulin is made from pork insulin by:

A) recombinant DNA synthesis.
B) gene splicing in Escherichia coli.
C) transpeptidation.
D) transamination.
E) glycosylation.

Question 19

Which of the following choices is recommended for the treatment of hypoglycemia if the patient is unconscious and lacks a swallowing reflex?

A) Fruit juice
B) Cake icing
C) Intravenous dextrose (50%)
D) Glucose gel

Question 20

Insulin is usually administered:

A) orally.
B) by subcutaneous injection.
C) by intramuscular injection.
D) by intravenous injection.

Question 21

Exenatide (Byetta)is the first of a new class of drugs called:

A) incretin mimetics.
B) oral hypoglycemic agents.
C) euglycemic agents.
D) oral antidiabetic agents.

Question 22

Acarbose (Precose)slows the breakdown of ingested carbohydrates so that postprandial hyperglycemia is reduced.

Question 23

The glycosylated hemoglobin test more accurately measures the patient's overall serum glucose control than the serum glucose test.

Question 24

The U.S. Food and Drug Administration (FDA)recommends checking serum alanine aminotransferase (ALT)levels before starting therapy with _____ and periodically thereafter.

A) biguanides
B) thiazolidinediones
C) a-glucosidase inhibitors
D) nonsulfonylurea secretagogues

Question 25

Which of the following statements is true of pramlintide (Symlin)?

A) It is an oral dipeptidyl-peptidase-4 (DPP-4)inhibitor.
B) Use leads to decreased caloric intake and potential weight loss.
C) It is approved for type I diabetes as an adjunct treatment in patients who use mealtime insulin therapy and who have failed to achieve desired glucose control despite optimal insulin therapy.
D) Both a and b are true.
E) Both b and c are true.

Question 26

Acarbose lowers blood glucose by:

A) slowing glucose absorption.
B) enhancing insulin secretion.
C) decreasing hepatic glucose production.
D) increasing peripheral glucose uptake.

Question 27

Which oral antidiabetic agent requires administration for 6 to 14 weeks to achieve maximal therapeutic effect?

A) Tolbutamide
B) Exenatide
C) Metformin
D) Rosiglitazone
E) Glimepiride

Question 28

The hemoglobin A1C level should be more than 50% to reduce the incidence and progression of microvascular complications in patients with diabetes.

Question 29

Insulin is a pancreatic hormone that promotes insulin storage.

Question 30

More people are diagnosed with type II diabetes in the United States than are diagnosed with type I diabetes.

Question 31

Diabetes is the major cause of blindness in adults.

Question 32

Which of the following oral antidiabetic agents is a bile-acid sequestrant used to lower low-density lipoprotein (LDL)cholesterol?

A) Pramlintide
B) Colesevelam
C) DPP-4s
D) Glucagon

Question 33

Which of the following statements is the mechanism of action of nonsulfonylurea secretagogues such as repaglinide (Prandin)and nateglinide (Starlix)?

A) They are competitive, reversible inhibitors of GI tract enzymes: intestinal a-glucosidase and pancreatic a-amylase.
B) They increase the insulin sensitivity of adipose tissue, skeletal muscle, and the liver.
C) They increase hepatic and peripheral insulin sensitivity, resulting in decreased hepatic glucose production.
D) They bind to adenosine triphosphate (ATP)sensitive potassium channels on beta cells and increase insulin resistance.

Question 34

Which of the following types of medications can react with sulfonylureas to produce a decrease in serum glucose levels?

A) Penicillin
B) Methotrexate
C) Aspirin
D) Mepivacaine