[PHARMA] GOOD SPIRITS

1.James is an obese 52-year-old Type 2 diabetic (280 lbs, 5'10"), currently being treated with glyburide and metformin who comes to your office complaining about frequent episodes of hypoglycemia. After discussing the need for lifestyle changes, and the different possible therapeutic options, you decide to replace his glyburide with: A. Glipizide B. Rosuvastatin C. Exenatide D. Sitagliptin E. Rosiglitazone

Exenatide

3.A 49-year-old woman is referred to you for co-management of her uncontrolled diabetes. She is diagnosed with dyslipidemia earlier in the year and was difficult to control. She started on a stepwise approach, and her LDL-C and triglycerides is now controlled with combination high-dose rosuvastatin, ezetimibe, fenofibrate, colestipol and niacin. HbA1c prior to dyslipidemia treatment was 7.0%, while on twice-daily metformin. Her current HbA1c is 9.9%. She is concerned one of her medications caused this. Which drug is the most likely culprit? A. Rosuvastatin B. Niacin C. Ezetimibe D. Colestipol

Niacin

5.John is a 52-year-old Type 2 diabetic patient who has been treated with corticosteroids for severe inflammatory bowel disease (IBD) for the past few months. Recently he found to have normal morning (pre-breakfast) blood glucose levels, but progressively elevated pre-lunch and pre-dinner glucose. Which of the following medication he is currently taking should be adjusted to achieve the BEST response? A. Insulin Detemir B. Glyburide C. Insulin Aspart D. Insulin Glargine E. Metformin

Insulin Aspart

9.Which of the following antidiabetic drugs may cause angioedema as well as urticarial and immune-mediated dermatologic effects? A. Empagliflozin B. Linagliptin C. Repaglinide D. Glimepiride

Linagliptin

10.A 60/M came into the ER for slurred speech and left sided weakness. He was noted to be eating one hour prior when he suddenly had difficulty speaking and lifting his left hand. He was immediately brought to the emergency room for examination. On arrival, there was no note of any deficits. Physical examination was also unremarkable, with note of stable vitals and regular rhythm. Cranial CT scan turned out to be negative as well. Aside from lifestyle modification, which of the following is the most appropriate management? A. No statin therapy is indicated at this time B. Atorvastatin 80mg tablet 1 tablet once a day, give 1st dose now C. Atorvastatin 80mg tablet 4 tablets chewed and swallowed, now D. Simvastatin 80mg tablet, 1 tablet once a day, give 1st dose now E. Simvastatin 80mg tablet, 4 tablets chewed and swallowed, now

Atorvastatin 80mg tablet 1 tablet once a day, give 1st dose now

34.A 52/M is consulting for evaluation of a 2-month-old ulcer on his right great toe. The ulcer has not improved after taking a course of antibiotics. The patient is a 37-pack year smoker, known diabetic (>15 years) and takes glipizide and rosiglitazone. PE reveals obesity pattern with temperature 38.8°C, pulse 96/min, respirations 12/min, and blood pressure 150/85 mmHg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of 0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli. Vibration sense is absent. Pulses are diminished in both feet. Urinalysis discloses 3+ protein. HbA1c was noted to be at 8.5%. The latest eGFR was 52 ml/min, and latest K was 4.2 mEq/L. Which of the following is the best way to address his diabetes at this time? A. Metformin plus Gliclazide B. Metformin plus Empagliflozin C. Insulin glargine and Insulin glulysine D. Metformin monotherapy E. Insulin glargine and Insulin degludec

Insulin glargine and Insulin glulysine

47.You have an elderly diabetic patient taking insulin NPH 25 units SC twice a day, at 8AM and 11PM, and insulin Lispro 15 units premeals. Which insulin should be adjusted if he presents with the following SMBG monitoring: Fasting 69, 69, 61 mg/dL

Prelunch 110, 115, 103 mg/dL

Predinner 101, 121, 92 mg/dL

At bedtime 126, 124, 121 mg/dL? A. Long acting bedtime insulin B. Long acting pre-breakfast insulin C. Short acting pre-supper insulin D. Short acting pre-breakfast insulin

Long acting bedtime insulin

49.An increase in the number of LDL receptors on target tissues is achieved by which drug class? A. Omega-3 fatty acids B. Colestipol C. PCSK9 inhibitors D. Ezetimibe

PCSK9 inhibitors

53.What is the usual cut-off level for LDL-C to be considered hypercholesterolemia if patient does not have an elevated risk for ASCVD? A. 175 mg/dL B. 200 mg/dL C. 190 mg/dL D. 220 mg/dL

190 mg/dL

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5.John is a 52-year-old Type 2 diabetic patient who has been treated with corticosteroids for severe inflammatory bowel disease for the past few months. Recently he is found to have normal morning pre-breakfast fasting blood glucose levels, but progressively elevated pre-lunch and pre-dinner glucose levels. Which of the following medication he is currently taking should be adjusted to achieve the BEST response? A. Insulin Detemir B. Glyburide C. Insulin Aspart D. Insulin Glargine E. Metformin

C. Insulin Aspart

6.Exogenous cholesterol is targeted by which drug class? A. Stanols B. Omega-3 fatty acids C. Fibrates D. Cholestyramine

D. Cholestyramine

7.You have a 59/M patient admitted for his DM foot ulcer. He was referred to you by the nurse for 5:30AM CBG of 63mg/dL. You went to see the patient and noted that he was comfortably sitting at the bedside, denying any symptom. Vital signs were stable. Aside from holding due prebreakfast insulin, what is the BEST management in this case? A. Inject 1mg glucagon subcutaneously and reassess B. Ask patient to eat his breakfast now (rice and vegetables) C. Ask the patient to take hard candy or half glass of cola now D. Inject 25mg intravenous glucose as bolus and then reassess E. Observe for now and retake CBG after 1 hour

C. Ask the patient to take hard candy or half glass of cola now

8.DD, a 61-year-old morbidly obese patient with Type 2 DM, presents with poor glycemic control despite compliance with previous oral medications. Eating patterns previously were inconsistent. He refuses surgical treatment of obesity. Which of the following would you consider to be the best option for curbing his appetite and promoting weight loss? A. Pioglitazone 30mg/tab, 1 tab once daily after supper B. Semaglutide 0.25mg subcutaneously once a week, to titrate to 1mg/week over 2 months C. Insulin glargine 10 units SC, daily at bedtime D. Gliclazide MR 60 mg/tab, 1 tab once a day before breakfast

B. Semaglutide 0.25mg subcutaneously once a week, to titrate to 1mg/week over 2 months

11.Which of the following drugs for treating DM/hyperglycemia can be used without having to consider renal function? A. Insulin B. Gliclazide C. Linagliptin D. Metformin

A. Insulin

12.Given that all of them have an LDL-C of 150mg/dL, which of the following will MOST benefit from statin therapy? A. Filipino 46/F, with BP of 130/80 mmHg B. Filipino 46/M, with fasting blood sugar of 92 mg/dL C. Filipino 46/F, with HDL of 35 mg/dL D. Filipino 46/M, with waist circumference of 84cm E. Choice 5

C. Filipino 46/F, with HDL of 35 mg/dL

13.A 59-year-old woman is rushed to the ER for persistent epigastric pain radiating to the back. She is diagnosed with dyslipidemia earlier in the year and was difficult to control. She is started on a stepwise approach, and her LDL-C and triglycerides is now controlled with combination high-dose rosuvastatin, ezetimibe, fenofibrate, colestipol and niacin. Further workup revealed elevated lipase (10x) and ALP (5x). STAT hepatobiliary ultrasound revealed a dilated common bile duct and presence of multiple cholelithiases. Which of the following medication could have been the culprit? A. Colestipol B. Ezetimibe C. Niacin D. Rosuvastatin E. Fenofibrate

E. Fenofibrate

14.Hypoglycemia is an intrinsic complication of which drug for diabetes? A. Metformin B. Sitagliptin C. Repaglinide D. Voglibose

C. Repaglinide

16.You have a 59/M patient admitted for his DM foot ulcer. He was referred to you by the nurse for 5:30AM CBG of 63mg/dL. You went to see the patient and noted that vital signs were stable. However, he was complaining of some lightheadedness, and you also noted that he is having mild tremors. Aside from holding due prebreakfast insulin, what is the BEST management in this case? A. Ask patient to take hard candy or half glass of cola now. B. Inject 1mg glucagon subcutaneously and reassess. C. Inject 25mg intravenous glucose as bolus and then reassess. D. Observe for now and retake CBG after 1 hour. E. Ask patient to eat his breakfast now (rice and vegetables).

C. Inject 25mg intravenous glucose as bolus and then reassess

17.A 42-year-old man who was started on niacin sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the niacin. How would you proceed on the therapy of this patient? A. Change the sustained-release niacin to immediate-release niacin. B. Administer aspirin 30 minutes prior to taking niacin. C. Administer aspirin 30 minutes after taking niacin. D. Discontinue Niacin. E. Increase the dose of niacin to 1000 mg.

B. Administer aspirin 30 minutes prior to taking niacin

19.Which antihyperlipidemic drug is NOT RECOMMENDED for patients with hypertriglyceridemia as it can cause INCREASE in TG? A. PCSK9 inhibitors B. Niacin C. Resins D. Fibrates

C. Resins

21.GG, a 60-year old patient with diet-controlled Type 2 DM presents with persistently elevated fasting glucose levels. For most of the day, her blood glucose levels fall within the range of 160-180 mg/dL. Before sleeping, her glucose level was measured at 165 mg/dL. She did not eat anything after measurement. The following morning, her blood glucose was elevated at 225 mg/dL. Which of the following is the best prescription for this patient, assuming she has no other comorbidities? A. Canagliflozin 100 mg/tab, 1 tab once a day before breakfast. B. Metformin 1000 mg/tab, 1 tab twice a day after breakfast and supper. C. Gliclazide 80 mg/tab, 1 tab twice a day before breakfast and supper. D. Sitagliptin 100 mg/tab, 1 tab once a day before breakfast.

B. Metformin 1000 mg/tab, 1 tab twice a day after breakfast and supper

22.A 60/M came into the ER for slurred speech and left sided weakness. He was noted to be eating one hour prior when he suddenly had difficulty speaking and lifting his left hand. He was immediately brought to the emergency room for examination. On arrival, there was no note of any deficits. Physical examination was also unremarkable, with note of stable vitals and regular rhythm. Cranial CT scan turned out to be negative as well. Aside from lifestyle modification, which of the following is the most appropriate management? A. Simvastatin 80mg tablet, 1 tablet once a day, give 1st dose now. B. Atorvastatin 80mg tablet 4 tablets chewed and swallowed, now. C. Simvastatin 80mg tablet, 4 tablets chewed and swallowed, now. D. No statin therapy is indicated at this time. E. Atorvastatin 80mg tablet 1 tablet once a day, give 1st dose now.

E. Atorvastatin 80mg tablet 1 tablet once a day, give 1st dose now

23.A 64/F hypertensive, diabetic patient x 20 years consults the diabetes clinic for follow-up. She has been frustrated on her DM control having an HbA1c of 13% despite being on metformin 1g twice a day, Gliclazide 60mg tab once a day, Empagliflozin 25mg/tab once a day, and Linagliptin 5mg/tab once a day. She weighs 70kg. What is the next best step to managing her diabetes? A. Discontinue gliclazide and start insulin glargine at 28 units at bedtime. B. Discontinue gliclazide and start insulin 70/30 34 units prebreakfast and 17 units predinner. C. Discontinue gliclazide and start insulin NPH 34 units prebreakfast and 17 units predinner. D. Continue gliclazide and start patient on regular self-monitoring of blood glucose with as-needed insulin glulisine with insulin sliding scale.

A. Discontinue gliclazide and start insulin glargine at 28 units at bedtime

24.A 58-year-old woman is evaluated during a follow-up visit for a 5-year history of stage G3b/A1 chronic kidney disease caused by chronic NSAID use. History is also pertinent for hypertension. She takes amlodipine and no longer takes NSAIDs. On PE, BP is 125/70 mmHg, HR 82/min. Rest of the PE is unremarkable. Pertinent lab investigations are as follows: creatinine 1.8 mg/dL (159.1 umol/L), estimated GFR 33 mL/min/1.73 m2, Na 140 mEq/L, K 5.2 mEq/L, Cl 110 mEq/L, ABG pH 7.36, pCO2 35 mmHg, HCO3 18 mEq/L. Her latest lipid profile reveal: LDL-C 95mg/dL, Triglyceride 130mg/dL, HDL-C 55mg/dL. 2h-OGTT reveal 2-hour glucose level of 160mg/dl after 2 measurements. She is currently on Atorvastatin 20mg/tab 1 tablet once a day. How will you proceed with her treatment? A. Maintain Atorvastatin at 20mg/tab 1 tablet once a day. B. Discontinue Atorvastatin 20mg/tab 1 tablet once a day and reassess in 2 months. C. Increase Atorvastatin to 40mg/tab 1 tablet once a day. D. Shift Atorvastatin 20mg to Simvastatin 40mg/tab 1 tab once a day. E. Shift Atorvastatin 20mg to Rosuvastatin 10mg/tab 1 tab once a day.

C. Increase Atorvastatin to 40mg/tab 1 tablet once a day

25.In terms of consistent plasma glucose lowering, which of the following drugs has the SLOWEST effect? A. Biguanides B. GLP-1 receptor agents C. Sulfonylureas D. DPP-IV inhibitors

A. Biguanides

26.Diane is a 58-year-old overweight woman with a history of Type 2 diabetes that has been well controlled with metformin and glyburide until recently. Her record of glucose readings indicates normal morning fasting glucose levels (80-100 mg/dL), but a progressively increasing high glucose level before lunch (>110 mg/dL) and before dinner (190-200 mg/dL). Her lab values are all within normal limits, and she has no history of kidney or heart disease. Dianne states that she has a strong distaste for needles and would prefer sticking to oral medications. Which medication would be appropriate for addressing Diane's problem with glucose control? A. Exenatide. B. Empagliflozin. C. Sitagliptin. D. Glimepiride. E. Rosiglitazone.

C. Sitagliptin

27.A 57-year-old is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, and dyslipidemia. He manages his diabetes with diet, exercise, and metformin. Other medications are aspirin, metoprolol, atorvastatin and as needed sublingual nitrates. His inpatient pre-meal plasma glucose values are 190 to 220 mg/dL. Results of all other laboratory studies are normal. Which of the following is the most appropriate treatment for this patient’s diabetes while hospitalized? A. Metformin and prandial insulin. B. Metformin and glipizide. C. Basal and prandial insulin. D. “Sliding-scale” insulin.

C. Basal and prandial insulin

28.TA, 45 years old, is diagnosed with Type 2 DM. She is concerned about her medication regimen, disclosing that she is taking heart failure medications as well. Her eGFR is at 40 ml/min/1.73 m2. She is currently on Metformin 500mg/tab 1 tab twice a day, and her last HbA1c is 9.0%. Which of the following is the best intervention? A. Semaglutide 0.5 mg subcutaneously once a week, to titrate to 1 mg/week over 2 months. B. Increase Metformin 500 mg/tab, 2 tab twice a day after breakfast and dinner. C. Dapagliflozin 10 mg/tab, 1 tab once a day before breakfast. D. Insulin glargine 8 units subcutaneously, daily at bedtime.

C. Dapagliflozin 10 mg/tab, 1 tab once a day before breakfast

29.Simvastatin at starting dose of 20mg can be effective to achieve what intensity of LDL-C control? A. Moderate B. High C. Low D. Not appropriate drug for LDL-C control

A. Moderate

30.A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. She is independent in daily activities and denies any symptoms. Medications are amlodipine and enalapril, taken with missed doses. On physical examination, she is afebrile, BP is 130/70 mmHg, HR is 68/min, BMI is 32. The lungs are clear to auscultation, and no murmurs are noted. A bruit is heard over the left femoral artery. The right ankle-brachial index is 1.2 and the left is 0.81. Her latest LDL-C result showed 90mg/dl. HbA1c was at 5.0%. Which of the following is the most appropriate management? A. Statin therapy is not yet indicated at this time. B. Simvastatin 80mg/tab 1 tab once daily, at bedtime. C. Atorvastatin 40mg/tab 1 tab once daily, at bedtime. D. Rosuvastatin 10mg/tab 1 tab once daily, at bedtime. E. Atorvastatin 20mg/tab 1 tab once daily, at bedtime.

C. Atorvastatin 40mg/tab 1 tab once daily, at bedtime

31.Which Omega-3 fatty acid is used to treat elevated TG? A. DHA B. EPA C. ALA D. CLA

B. EPA

32.A 59-year-old woman is referred to you for co-management of her dyslipidemia. Ancillary history reveal that she had myocardial infarction three months ago and her current LDL-C is 3 times above target. She is started on a stepwise approach, and her LDL-C and triglycerides is now controlled with combination high-dose rosuvastatin, ezetimibe, fenofibrate, colestipol and niacin. For this consult, however, she complains of persistently unbearable muscle pains. Which pair of drugs should be immediately discontinued? A. Rosuvastatin and fenofibrate. B. Fenofibrate and ezetimibe. C. Rosuvastatin and ezetimibe. D. Rosuvastatin and colestipol. E. Fenofibrate and colestipol.

A. Rosuvastatin and fenofibrate

33.A 29-year-old medical resident is admitted for acute pancreatitis. Past medical history is unremarkable. An MRCP shows no evidence of lithiasis and gallbladder disease. He had an unremarkable hospital stay and is discharged improved. On follow up, a lipid profile shows: TG 1830 mg/dL, HDL-C 26.7 mg/dL, LDL-C 97 mg/dL. What is the preferred drug in this case? A. Colestipol B. Fenofibrate C. Bempedoic acid D. Inclisiran E. Fish oil

B. Fenofibrate

35.The incretin effect is seen with which class of OHA? A. SGLT2 inhibitors B. All of the choices are correct answers. C. Alpha glucosidase inhibitors D. GLP-1 receptor agonist

D. GLP-1 receptor agonist

36.A 45/F company executive, T2DM maintained on multiple OHAS has been started on a new medication. She returns for a teleconsult complaining of persistent bloatedness and increased flatulence. What could have caused this problem? A. Pioglitazone. B. Acarbose. C. Exenatide. D. Glipizide.

B. Acarbose

39.Euglycemic DKA has been observed in individuals treated with which of the following OHAs? A. Canagliflozin. B. Linagliptin. C. Glimepiride. D. Pioglitazone.

A. Canagliflozin

42.A 72-year-old female who is treated for hyperlipidemia with Pravastatin for the past 6 months consulted your OPD clinic for follow-up. She was admitted last year for inferior wall MI, and had undergone a bypass surgery. Despite maximum tolerated dose, she is still not able to achieve target LDL-C level. Which of the following choices is the best add-on therapy? A. Fenofibrate. B. Fish oil. C. Ezetimibe. D. Niacin. E. Inclisiran.

C. Ezetimibe

43.A 50/M obese company executive complaining of polyphagia, polydipsia and polyuria underwent an executive check up. HbA1c was noted to be 8% revealing T2DM. Which of the following agents is LEAST desirable as first line medication? A. Empagliflozin. B. Metformin. C. Linagliptin. D. Glyburide. E. Exenatide.

D. Glyburide

44.78/M known DM, s/p CVD x 6 months ago with right sided residuals, coming in for decrease in sensorium. He was noted to have poor oral intake for 2 weeks with generalized weakness. At the ER, he is lethargic with dry oral mucosa and poor skin turgor. VS BP 80/60 HR 132 bpm RR 18 cpm Temp 38 C O2 90%. Lungs show decreased breath sounds R base, otherwise clear. Baseline labs revealed the following: CBC: Hb 162g/L, Hct 52%, WBC 11,790 cells/mcL, Pc 412,000/mcL, Crea 2.3 mg/dL, Na 126 mmol/L, K 4.8 mmol/L. RBS 698 mg/dL Ketones 0.8 mmol/L. ABG: pH 7.32, HCO3 22 mmol/L, pCO2 40 mmHg, pO2 80 mmHg. CXR: cardiomegaly

(+) consolidation in right lower lobe. 12L ECG: sinus tachycardia

t/c old inferior wall infarct. Which of the following is the most appropriate treatment for this patient’s diabetes at this specific time? A. Metformin and basal insulin. B. “Sliding-scale” insulin. C. Basal and prandial insulin. D. Insulin drip. E. Metformin and glipizide.

D. Insulin drip

45.Which of the following IS NOT an absolute indication to start statin therapy? A. LDL-C > 130 mg/dL B. Chronic kidney disease C. Familial hypercholesterolemia D. Diabetes mellitus

A. LDL-C > 130 mg/dL

55.After prescribing both a long acting and short acting insulin to one of your patients for blood sugar control, she asked you if she can mix the two together. Which of the following advice is most appropriate? A. Different insulin formulations should be allowed to stand prior to injection to ensure adequate mixing. B. Follow the same routine in terms of insulin mixing and administration. C. Insulin glargine can be mixed with insulin aspart. D. Insulin can be stored as a mixture preconcocted by a licensed pharmacist.

B. Follow the same routine in terms of insulin mixing and administration

56.What degree of statin intensity is regarded as high intensity in terms of % LDL-C reduction? A. >40% B. >50% C. >30% D. >20%

B. >50%

58.A 72-year-old male who is treated for hyperlipidemia with antihyperlipidemic agent for the past 6 months. He also has a history of severe constipation. His most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, and high level of triglycerides of 510 mg/dL, and there is no change in HDL cholesterol. Which of the following drugs did this patient use? A. Gemfibrozil. B. Colestipol. C. Niacin. D. Fish oil. E. Ezetimibe.

B. Colestipol

59.Which of the following IS NOT recommended as a lifestyle modification to reduce cardiovascular risk? A. Replacing cigarette smoking with e-cigarettes. B. Low-fat, low-cholesterol diet C. All of the choices are recommended. D. Adequate duration, frequency of exercise

A. Replacing cigarette smoking with e-cigarettes

61.A 45-year-old man comes to the emergency room due to chest pain. He has hypertension and is on losartan and carvedilol. He presents with a 4-hour history of chest pain associated with dyspnea and diaphoresis. On arrival, he is hypotensive and has bibasal crackles. He is started on dobutamine and is given morphine sulfate for the pain. ECG showed ST-segment depression on leads V5-V6. His troponins are elevated. Which of the following is the most appropriate statin he should receive? A. Simvastatin 80mg tablet, 1 tablet once a day, give 1st dose now. B. Atorvastatin 80mg tablet 4 tablets chewed and swallowed, now. C. Atorvastatin 80mg tablet 1 tablet once a day, give 1st dose, now. D. Atorvastatin 80mg tablet 4 tablets chewed and swallowed, now. E. Simvastatin 80mg tablet, 4 tablets chewed and swallowed, now.

B. Atorvastatin 80mg tablet 4 tablets chewed and swallowed, now

63.What is the most common side effect of metformin? A. Lactic acidosis. B. Weight gain. C. Hypoglycemia. D. Stomach discomfort.

D. Stomach discomfort

65.Increased risk for acute pancreatitis is seen at what level of elevated fasting plasma triglyceride? A. > 150 mg/dL B. > 1500 mg/dL C. > 500 mg/dL D. > 1000 mg/dL

C. > 500 mg/dL

68.Metformin, as a preventive strategy in delaying the onset of diabetes mellitus may be considered in which of the following conditions? A. BMI < 35 kg/m2. B. HbA1c < 5.6% C. Age > 60 years old. D. History of gestational DM.

A. BMI < 35 kg/m2

69.Your 21/F diabetic female patient was admitted electively for a gynecologic procedure and referred to you for co-management. The attending OB-GYN estimated that the surgical procedure last <2h. How would you adjust her insulins during the perioperative period? A. Reduce basal insulin by 50%, withhold prandial bolus insulin. B. No adjustments to insulin needed. C. Reduce basal insulin by 20%, maintain prandial bolus insulin. D. Maintain basal insulin, withhold prandial bolus insulin.

C. Reduce basal insulin by 20%, maintain prandial bolus insulin

70.Which of the following produces CNS-mediated effects to decrease hunger and delay gastric emptying, suppresses the release of glucagon, and can be used along with insulin in both Type1 and Type 2 diabetic patients? A. Rolletide. B. Exenatide. C. Saxagliptin. D. Pramlintide. E. Miglitol.

D. Pramlintide

71.A 65-year-old postmenopausal woman with a 30-pack year smoking history asks about screening for dyslipidemia. BP is 125/70 mmHg, HR 88/min, with rest of PE unremarkable. Her LDL-C was noted to be 136mg/dl. Her latest FBS was at 110mg/dL. Aside from smoking cessation and lifestyle change, which of the following is the most appropriate management? A. Rosuvastatin 10mg/tab 1 tab once daily, at bedtime. B. Rosuvastatin 5mg/tab 1 tab once daily, at bedtime. C. Simvastatin 10mg/tab 1 tab once daily, at bedtime. D. Statin therapy is not yet indicated at this time. E. Atorvastatin 10mg/tab 1 tab once daily, at bedtime.

C. Simvastatin 10mg/tab 1 tab once daily, at bedtime

73.A 59-year-old woman is referred to you for co-management of her uncontrolled diabetes. She is diagnosed with dyslipidemia earlier in the year and was difficult to control. She is started on a stepwise approach, and her LDL-C and triglycerides is now controlled with combination high-dose rosuvastatin, ezetimibe, fenofibrate, colestipol and niacin. However, she complains of persistently painful right big toe at this follow up visit. Which medication is the most likely culprit? A. None of these B. Ezetimibe. C. Colestipol. D. Rosuvastatin. E. Niacin.

E. Niacin

74.A 61/M with Type 2 DM was brought to ER for decrease in sensorium. Wife said he was noted to be have cold sweats, dizziness and pallor prior to loss of consciousness. Current medications include acarbose 100mg TID, sitagliptin + metformin 100/1000mg OD, glimepiride 2mg TID and dapagliflozin + metformin 10/1000mg OD. Spot CBG was 43mg/dl. Which of the following is the most probable cause? A. Acarbose. B. Sitagliptin. C. Glimepiride. D. Dapagliflozin.

C. Glimepiride

75.A 60/M T2DM for 20 years consults the diabetes clinic for follow-up. He was recently started on chronic hemodialysis because of increasing creatinine trend. He was lost to follow-up for 5 years and was previously on Metformin and Gliclazide. His last HbA1c was 14%. How would you treat this patient? A. Discontinue Metformin and Gliclazide and start patient on insulin NPH PLUS insulin lispro B. Continue Metformin and shift Gliclazide to low-dose insulin NPH. C. Resume Metformin and Gliclazide at renally adjusted doses. D. Shift Metformin to Linagliptin and continue Gliclazide.

A. Discontinue Metformin and Gliclazide and start patient on insulin NPH PLUS insulin lispro

76.A 60/F teacher newly diagnosed with T2DM was prescribed with an unrecalled medication. She comes back to the OPD complaining of increased vaginal itchiness. What medication could have caused this symptom? A. Acarbose. B. Sitagliptin. C. Empagliflozin. D. Repaglinide.

C. Empagliflozin

77.A 60-year-old man is referred to you for preoperative risk assessment prior to cholecystectomy. On history, he has smoked 2 packs of cigarettes every day since he was 25 years old. He has hypertension controlled on amlodipine. He does not complain of cough, chest pain, or dyspnea. BP is 125/85 mmHg, HR 78/min, RR 18/min, the rest of the PE is unremarkable. Latest labs reveal LDL-C 110mg/dL, HbA1c 7.5%. Creatinine, AST and ALT are within normal limits. Which of the following is the most appropriate management? A. Simvastatin 80mg/tab 1 tab once daily, at bedtime B. Atorvastatin 20mg/tab 1 tab once daily, at bedtime. C. Rosuvastatin 10mg/tab 1 tab once daily, at bedtime. D. Atorvastatin 40mg/tab 1 tab once daily, at bedtime. E. Statin therapy is not yet indicated at this time.

D. Atorvastatin 40mg/tab 1 tab once daily, at bedtime

80.Which of the following long acting insulins has the longest effective duration? A. Glargine. B. Detemir. C. Degludec. D. NPH.

C. Degludec

82.Your 21/F diabetic female patient who was admitted for a 2-hour gynecologic procedure has been discharged on 30 units of Insulin Degludec at bedtime and 10 units of insulin glulisine before each meal. She was advised self-monitoring of blood glucose. How would you advise her if she presents to you this log? A. Increase insulin glulisine dose pre-breakfast. B. Decrease insulin degludec dose before bedtime and Increase insulin glulisine dose pre-breakfast C. Decrease insulin degludec dose before bedtime, Decrease insulin glulisine dose pre-supper, and Increase insulin glulisine dose pre-breakfast. D. Decrease insulin degludec dose before bedtime. E. Decrease insulin glulisine dose pre-supper.

B. Decrease insulin degludec dose before bedtime and Increase insulin glulisine dose pre-breakfast

85.A 54-year-old obese patient with type 2 diabetes has a history of alcoholism. In this patient, metformin should either be avoided or used with extreme caution because the combination of metformin and ethanol increases the risk of which of the following? A. A disulfiram-like reaction B. Serious hepatotoxicity. C. Excessive weight gain. D. Hypoglycemia. E. Lactic acidosis

E. Lactic acidosis

87.A 21/F previously healthy female, college student consults the IM OPD for fatigue. She has been experiencing increased urination and is feeling thirsty everytime. She had also unintentionally lost 5kg over 1 month. PE reveals a lean female, weight of 60kg, BMI was 17kg/m2, and rest of PE was unremarkable. HbA1c testing done = 14%. What is the optimal dose of insulin to start this patient on? A. Insulin glargine 12 units SC at bedtime. B. Insulin glargine 30 units SC at bedtime and insulin aspart 10 units SC premeals (B/L/D). C. Insulin glargine 21 units SC at bedtime and insulin aspart 7 units SC premeals (B/L/D). D. Insulin glargine 14 units SC PLUS Insulin aspart 7 units SC prebreakfast

Insulin aspart 7units SC prelunch, Insulin glargine 7 units SC + insulin aspart 7 units SC predinner.

C. Insulin glargine 21 units SC at bedtime and insulin aspart 7 units SC premeals (B/L/D)

88.Thiazolinediones are associated with which of the following agent-specific side-effects? A. Pancreatitis. B. Higher risk for fractures. C. Flatulence. D. Hypoglycemia.

B. Higher risk for fractures

89.Which one of the following antidiabetic agents acts in a glucose-dependent manner? A. Acarbose. B. Sitagliptin. C. Gliclazide. D. Metformin.

B. Sitagliptin

90.In which of the following patients will treatment of fibrates be most beneficial? A. 50/M, diabetic, with controlled LDL-C on Rosuvastatin 20mg/tab at night, with LDL-C of 30mg/dL and triglyceride 160mg/dL. B. 50/F, diabetic, postmenopausal, with controlled LDL-C on Rosuvastatin 20mg/tab at night, with LDL-C of 40mg/dL and triglyceride 210mg/dL. C. 50/M, non-diabetic, with controlled LDL-C on Rosuvastatin 20mg/tab at night, with LDL-C of 40mg/dL and triglyceride 210mg/dL. D. 50/M, diabetic, with controlled LDL-C on Rosuvastatin 20mg/tab at night, with LDL-C of 40mg/dL and triglyceride 210mg/dL.

D. 50/M, diabetic, with controlled LDL-C on Rosuvastatin 20mg/tab at night, with LDL-C of 40mg/dL and triglyceride 210mg/dL

92.Which of the following regimens offers the best blood glucose control for persons with type 1 diabetes? A. Once daily insulin injections B. Three or four injections per day of different types of insulin. C. A single oral anti-diabetes drug D. A combination of oral anti-diabetic medications

B. Three or four injections per day of different types of insulin

94.82/F chronic type 2 diabetes with stage 5 chronic kidney disease referred for HbA1c of 8%. Patient was previously on unrecalled oral maintenance anti-diabetes medications which she self-discontinued due to hypoglycemia symptoms >2 years ago. Which is the best treatment to start, considering her age? A. Metformin. B. Empagliflozin. C. Teneligliptin. D. Insulin glargine.

C. Teneligliptin

95.Which of the following drugs used to treat hyperglycemia and DM DOES NOT target the pancreas? A. SGLT2 inhibitors B. Meglitinides C. Sulfonylureas D. Exogenous insulin

A. SGLT2 inhibitors

97.Flushing of the skin as a side effect is seen in which drug used in dyslipidemia? A. Statins B. Ezetimibe C. Fibrates D. Niacin

D. Niacin

98.Metformin may be given with dose adjustment to CKD patients with GFR of A. <15. B. <60. C. <45. D. <30.

C. <45

99.Dietary carbohydrate restriction most impacts which lipid profile component? A. TG B. LDL-H C. LDL-C D. Total cholesterol

A. TG