Diabetes Medications Question Bank PDF

1. Which rapid-acting insulin has a peak time of 1-1.5 hours? a) Glargine b) Lispro Correct: b) Lispro Rationale: Lispro is a rapid-acting insulin with peak time of 1-1.5 hours and duration of 3-4 hours, used for meal coverage and correction of high blood glucose. 2. What is the primary conc...

1. Which rapid-acting insulin has a peak time of 1-1.5 hours? a) Glargine b) Lispro Correct: b) Lispro Rationale: Lispro is a rapid-acting insulin with peak time of 1-1.5 hours and duration of 3-4 hours, used for meal coverage and correction of high blood glucose. 2. What is the primary concern when giving metformin to a patient receiving contrast dye? a) B12 deficiency b) Lactic acidosis Correct: b) Lactic acidosis Rationale: Contrast can cause nephropathy, reducing renal function. Since metformin is excreted by kidneys, reduced function can lead to metformin buildup and potentially fatal lactic acidosis. 3. Which mnemonic helps remember rapid-acting insulins? a) "Regular and Short" b) "Do not LAG" Correct: b) "Do not LAG" Rationale: LAG stands for Lispro, Aspart, and Glulisine - the three rapid-acting insulins. 4. How long do long-acting insulins typically last? a) 16 hours b) 24 hours Correct: b) 24 hours Rationale: Long-acting insulins (Glargine, Detemir) last 24 hours and provide basal insulin replacement without peak times. 5. Which adverse effect is associated with SGLT2 inhibitors? a) Pancreatitis b) Urinary tract infections Correct: b) Urinary tract infections Rationale: SGLT2 inhibitors cause glucosuria, increasing risk of UTIs and vaginal yeast infections. 6. What is the duration of action for NPH insulin? a) 4-6 hours b) 10-16 hours Correct: b) 10-16 hours Rationale: NPH is an intermediate-acting insulin with peak at 8 hours and duration of 10-16 hours. 7. Which adverse effect is most concerning with Thiazolidinediones? a) Heart failure b) Lactic acidosis Correct: a) Heart failure Rationale: TZDs can cause fluid retention leading to heart failure and increased fracture risk. 8. What is the mechanism of sulfonylureas? a) Inhibit hepatic gluconeogenesis b) Increase insulin release Correct: b) Increase insulin release Rationale: Sulfonylureas increase insulin release by depolarizing potassium channels. 9. Which medication requires B12 monitoring? a) Metformin b) Acarbose Correct: a) Metformin Rationale: Metformin can cause B12 deficiency and requires regular monitoring. 10. What is the mechanism of alpha-glucosidase inhibitors? a) Inhibit intestinal enzyme b) Increase insulin sensitivity Correct: a) Inhibit intestinal enzyme Rationale: They inhibit intestinal brush border alpha-glucosidases, preventing carbohydrate breakdown. 11. How do GLP-1 agonists work? a) Block glucose reabsorption b) Potentiate insulin release Correct: b) Potentiate insulin release Rationale: GLP-1 agonists enhance insulin release and inhibit glucagon secretion. 12. Which medication ends in "-glipton"? a) Sitagliptin b) Pioglitazone Correct: a) Sitagliptin Rationale: DPP-4 inhibitors end in -glipton, helping identify this drug class. 13. When should metformin be held? a) Before contrast studies b) Before meals Correct: a) Before contrast studies Rationale: Metformin should be held before contrast due to risk of contrast-induced nephropathy. 14. Which drug class causes pancreatitis? a) GLP-1 agonists b) SGLT2 inhibitors Correct: a) GLP-1 agonists Rationale: GLP-1 agonists have a known risk of pancreatitis as an adverse effect. 15. What is the duration of rapid-acting insulins? a) 3-4 hours b) 6-8 hours Correct: a) 3-4 hours Rationale: Rapid-acting insulins have short duration of 3-4 hours for meal coverage. 16. What unique side effect do SGLT2 inhibitors cause? a) B12 deficiency b) Glucosuria Correct: b) Glucosuria Rationale: SGLT2 inhibitors prevent glucose reabsorption, leading to glucose in urine. 17. Which medication works through PPAR-gamma? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: Thiazolidinediones work through PPAR-gamma to increase insulin sensitivity. 18. What is the mnemonic for GLP-1 agonists? a) "Do not LAG" b) "Gulping down TIDE" Correct: b) "Gulping down TIDE" Rationale: Helps remember drugs ending in -TIDE belong to GLP-1 agonist class. 19. Which insulin has no peak time? a) NPH b) Glargine Correct: b) Glargine Rationale: Long-acting insulins like Glargine have no peak, providing steady basal coverage. 20. What is the first-line oral medication for Type 2 diabetes? a) Sulfonylurea b) Metformin Correct: b) Metformin Rationale: Metformin is first-line due to efficacy and safety profile. 21. Which medication requires monitoring for bone fractures? a) Metformin b) Pioglitazone Correct: b) Pioglitazone Rationale: Thiazolidinediones increase fracture risk and require bone health monitoring. 22. What is the primary mechanism of metformin? a) Inhibits hepatic gluconeogenesis b) Increases insulin release Correct: a) Inhibits hepatic gluconeogenesis Rationale: Metformin primarily works by reducing liver glucose production. 23. Which class of medications ends in "-flozin"? a) DPP-4 inhibitors b) SGLT2 inhibitors Correct: b) SGLT2 inhibitors Rationale: All SGLT2 inhibitors end in -flozin (canagliflozin, dapagliflozin, empagliflozin). 24. What adverse effect is associated with alpha-glucosidase inhibitors? a) GI upset and bloating b) Lactic acidosis Correct: a) GI upset and bloating Rationale: These drugs prevent carbohydrate breakdown, leading to GI symptoms. 25. Which medication is a synthetic amylin? a) Pramlintide b) Linagliptin Correct: a) Pramlintide Rationale: Pramlintide is a synthetic amylin that works alongside insulin. 26. What is the peak time for regular insulin? a) 1 hour b) 2.5 hours Correct: b) 2.5 hours Rationale: Regular insulin peaks at 2.5 hours and lasts 4-6 hours. 27. Which drug class requires monitoring for respiratory infections? a) DPP-4 inhibitors b) Sulfonylureas Correct: a) DPP-4 inhibitors Rationale: DPP-4 inhibitors can increase risk of respiratory infections. 28. What is the mnemonic for NPH insulin? a) "Do not LAG" b) "Not Particularly Hasty" Correct: b) "Not Particularly Hasty" Rationale: Helps remember NPH is intermediate- acting. 29. Which medication can cause disulfiram reaction? a) Sulfonylureas b) Meglitinides Correct: a) Sulfonylureas Rationale: Sulfonylureas can cause disulfiram-like reaction with alcohol. 30. When does rapid-acting insulin peak? a) 1-1.5 hours b) 2.5 hours Correct: a) 1-1.5 hours Rationale: Rapid-acting insulins peak quickly for meal coverage. 31. Which medication works in the proximal tubule? a) Metformin b) Canagliflozin Correct: b) Canagliflozin Rationale: SGLT2 inhibitors work in kidney proximal tubule. 32. What characterizes long-acting insulin? a) No peak time b) Peak at 8 hours Correct: a) No peak time Rationale: Long-acting insulins provide steady basal coverage without peaks. 33. Which drug requires monitoring for heart failure? a) Rosiglitazone b) Sitagliptin Correct: a) Rosiglitazone Rationale: TZDs can worsen heart failure through fluid retention. 34. What distinguishes GLP-1 agonists from DPP-4 inhibitors? a) Route of administration b) Mechanism of action Correct: a) Route of administration Rationale: GLP-1 agonists are injectable while DPP-4 inhibitors are oral. 35. When should sulfonylureas be used with caution? a) Elderly patients b) Young adults Correct: a) Elderly patients Rationale: Higher risk of hypoglycemia in elderly patients. 36. What is the primary action of GLP-1? a) Increases glucagon b) Promotes insulin release Correct: b) Promotes insulin release Rationale: GLP-1 promotes insulin release and inhibits glucagon. 37. When is metformin contraindicated? a) Severe renal impairment b) Mild hyperglycemia Correct: a) Severe renal impairment Rationale: Risk of lactic acidosis in renal impairment. 38. Which drug class works through nuclear receptors? a) Sulfonylureas b) Thiazolidinediones Correct: b) Thiazolidinediones Rationale: TZDs work through PPAR- gamma nuclear receptors. 39. What is a common side effect of SGLT2 inhibitors? a) Respiratory infection b) Dehydration Correct: b) Dehydration Rationale: Increased urination can lead to dehydration. 40. How do meglitinides differ from sulfonylureas? a) Duration of action b) Basic mechanism Correct: a) Duration of action Rationale: Shorter duration but similar mechanism. 41. Which insulin type is best for basal coverage? a) NPH b) Glargine Correct: b) Glargine Rationale: Long-acting provides steady 24-hour coverage. 42. What monitoring is needed with DPP-4 inhibitors? a) Renal function b) Liver function Correct: a) Renal function Rationale: Dose adjustment needed in renal impairment. 43. How does acarbose work? a) Blocks glucose absorption b) Delays carbohydrate digestion Correct: b) Delays carbohydrate digestion Rationale: Inhibits enzyme breaking down carbohydrates. 44. What is a risk of TZD use? a) Bone fractures b) Pancreatitis Correct: a) Bone fractures Rationale: Increases fracture risk, especially in women. 45. Which medication requires contrast precautions? a) Sitagliptin b) Metformin Correct: b) Metformin Rationale: Hold for contrast studies due to nephropathy risk. 46. When is NPH insulin most likely to peak? a) 2 hours b) 8 hours Correct: b) 8 hours Rationale: NPH peaks at 8 hours as an intermediate-acting insulin. 47. Which medication requires frequent urinary infection monitoring? a) Canagliflozin b) Linagliptin Correct: a) Canagliflozin Rationale: SGLT2 inhibitors increase UTI risk due to glucosuria. 48. What is the primary action of DPP-4 inhibitors? a) Direct insulin release b) Prevent GLP- 1 breakdown Correct: b) Prevent GLP-1 breakdown Rationale: Blocks enzyme that degrades GLP-1. 49. Which drug class requires fracture risk monitoring? a) Sulfonylureas b) Thiazolidinediones Correct: b) Thiazolidinediones Rationale: TZDs increase fracture risk, especially in postmenopausal women. 50. What is the duration of regular insulin? a) 4-6 hours b) 10-16 hours Correct: a) 4-6 hours Rationale: Short-acting insulin lasts 4-6 hours.  51. Which medication works by blocking intestinal enzymes? a) Acarbose b) Metformin Correct: a) Acarbose Rationale: Alpha-glucosidase inhibitors block carbohydrate breakdown enzymes. 52. What characterizes rapid-acting insulins? a) Long duration b) Quick peak Correct: b) Quick peak Rationale: Peak at 1-1.5 hours for meal coverage. 53. Which side effect is associated with GLP-1 agonists? a) Pancreatitis b) Lactic acidosis Correct: a) Pancreatitis Rationale: Known risk of pancreatitis requiring monitoring. 54. What is the key benefit of long-acting insulin? a) Meal coverage b) Basal coverage Correct: b) Basal coverage Rationale: Provides steady 24-hour background insulin. 55. Which medication requires B12 monitoring? a) Metformin b) Sitagliptin Correct: a) Metformin Rationale: Can cause B12 deficiency over time. 56. What determines SGLT2 inhibitor dosing? a) Liver function b) Renal function Correct: b) Renal function Rationale: Kidney function affects drug efficacy and safety. 57. Which medication increases insulin sensitivity? a) Pioglitazone b) Glipizide Correct: a) Pioglitazone Rationale: TZDs improve insulin sensitivity through PPAR-gamma. 58. What is a contraindication for TZDs? a) Heart failure b) Hypertension Correct: a) Heart failure Rationale: TZDs can worsen heart failure through fluid retention. 59. When should Glargine be administered? a) Same time daily b) With meals Correct: a) Same time daily Rationale: Consistent timing maintains steady basal coverage. 60. Which drug requires close potassium monitoring? a) Empagliflozin b) Sitagliptin Correct: a) Empagliflozin Rationale: SGLT2 inhibitors can cause hyperkalemia. Would you like me to continue? 61. What is the primary mechanism of sulfonylureas? a) Blocks glucose absorption b) Stimulates insulin release Correct: b) Stimulates insulin release Rationale: Acts on pancreatic beta cells to release insulin. 62. When should alpha-glucosidase inhibitors be taken? a) With meals b) At bedtime Correct: a) With meals Rationale: Must be present when carbohydrates are consumed. 63. Which medication requires monitoring for yeast infections? a) Dapagliflozin b) Linagliptin Correct: a) Dapagliflozin Rationale: SGLT2 inhibitors increase risk of fungal infections. 64. What is a benefit of GLP-1 agonists? a) Weight loss b) Weight gain Correct: a) Weight loss Rationale: Reduces appetite and slows gastric emptying. 65. Which insulin is best for correction doses? a) Glargine b) Lispro Correct: b) Lispro Rationale: Rapid-acting insulins work quickly to lower high blood glucose. 66. Which medication can cause lactic acidosis? a) Metformin b) Acarbose Correct: a) Metformin Rationale: Risk increases with renal dysfunction. 67. What is the timing for NPH insulin peak? a) 2 hours b) 8 hours Correct: b) 8 hours Rationale: Intermediate-acting insulin peaks at 8 hours. 68. How do DPP-4 inhibitors affect GLP-1? a) Increase breakdown b) Prevent breakdown Correct: b) Prevent breakdown Rationale: Inhibits enzyme that degrades GLP-1. 69. When are SGLT2 inhibitors contraindicated? a) Severe renal failure b) Mild hypertension Correct: a) Severe renal failure Rationale: Requires functioning kidneys for efficacy. 70. Which medication requires contrast precautions? a) Metformin b) Glipizide Correct: a) Metformin Rationale: Hold for contrast studies due to nephropathy risk. 71. What is the mnemonic for DPP-4 inhibitors? a) "Do not LAG" b) "Lipton makes you PP- 4" Correct: b) "Lipton makes you PP-4" Rationale: Helps remember drugs ending in - glipton. 72. Which insulin provides 24-hour coverage? a) Regular b) Glargine Correct: b) Glargine Rationale: Long-acting insulin for basal needs. 73. What is a side effect of TZDs? a) Bone fractures b) Pancreatitis Correct: a) Bone fractures Rationale: Increases fracture risk. 74. When should sulfonylureas be taken? a) With meals b) At bedtime Correct: a) With meals Rationale: Maximizes effectiveness for meal-related glucose control. 75. Which drug increases peripheral glucose uptake? a) Metformin b) Acarbose Correct: a) Metformin Rationale: One of metformin's multiple mechanisms. 76. What is the primary concern with elderly patients on sulfonylureas? a) GI upset b) Hypoglycemia Correct: b) Hypoglycemia Rationale: Higher risk due to altered counter- regulatory responses. 77. Which medication inhibits hepatic gluconeogenesis? a) Metformin b) Pioglitazone Correct: a) Metformin Rationale: Primary mechanism of metformin. 78. What characterizes SGLT2 inhibitor action? a) Insulin release b) Glucose excretion Correct: b) Glucose excretion Rationale: Blocks kidney glucose reabsorption. 79. When do rapid-acting insulins peak? a) 1-1.5 hours b) 2.5 hours Correct: a) 1-1.5 hours Rationale: Quick onset for meal coverage. 80. Which medication works through PPAR-gamma? a) Rosiglitazone b) Sitagliptin Correct: a) Rosiglitazone Rationale: TZDs activate PPAR-gamma nuclear receptors. 81. Which medication helps with weight loss? a) GLP-1 agonists b) Sulfonylureas Correct: a) GLP-1 agonists Rationale: Reduces appetite and slows gastric emptying. 82. What is the duration of rapid-acting insulin? a) 3-4 hours b) 6-8 hours Correct: a) 3-4 hours Rationale: Short duration for meal coverage. 83. Which drug requires heart failure monitoring? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: TZDs can worsen heart failure. 84. What causes glucosuria? a) Metformin b) SGLT2 inhibitors Correct: b) SGLT2 inhibitors Rationale: Blocks glucose reabsorption in kidneys. 85. When should long-acting insulin be given? a) With meals b) Same time daily Correct: b) Same time daily Rationale: Maintains consistent basal coverage. 86. What is the mnemonic for sulfonylureas? a) "Not Particularly Hasty" b) "I'd take your sulfonylurea" Correct: b) "I'd take your sulfonylurea" Rationale: Helps remember drugs ending in -IDE. 87. When is metformin discontinued? a) Severe renal failure b) Mild hyperglycemia Correct: a) Severe renal failure Rationale: Risk of lactic acidosis increases. 88. What is pramlintide's mechanism? a) Synthetic amylin b) Insulin release Correct: a) Synthetic amylin Rationale: Works alongside insulin as amylin analog. 89. When do alpha-glucosidase inhibitors work? a) Intestinal absorption b) Kidney filtration Correct: a) Intestinal absorption Rationale: Blocks carbohydrate breakdown enzymes. 90. Which medication requires UTI monitoring? a) Empagliflozin b) Linagliptin Correct: a) Empagliflozin Rationale: SGLT2 inhibitors increase infection risk. 91. Which drug acts on the potassium channel? a) Nateglinide b) Acarbose Correct: a) Nateglinide Rationale: Meglitinides work through K+ channel. 92. What distinguishes NPH insulin? a) 8-hour peak b) No peak Correct: a) 8-hour peak Rationale: Intermediate-acting with distinct peak. 93. When monitoring TZDs, what's crucial? a) B12 levels b) Heart failure Correct: b) Heart failure Rationale: Risk of fluid retention. 94. What characterizes GLP-1 agonists? a) Injectable b) Oral tablets Correct: a) Injectable Rationale: Administered subcutaneously. 95. Which causes hyperkalemia risk? a) SGLT2 inhibitors b) DPP-4 inhibitors Correct: a) SGLT2 inhibitors Rationale: Affects electrolyte balance. 96. What is metformin's key monitoring requirement? a) Renal function b) Liver function Correct: a) Renal function Rationale: Prevents lactic acidosis risk. 97. Which insulin is best for meals? a) Glargine b) Lispro Correct: b) Lispro Rationale: Rapid-acting matches meal timing. 98. What defines GLP-1 action? a) Insulin release b) Glucose excretion Correct: a) Insulin release Rationale: Promotes insulin, inhibits glucagon. 99. When do DPP-4 inhibitors need dose adjustment? a) Renal impairment b) Mild hypertension Correct: a) Renal impairment Rationale: Cleared by kidneys. 100. Which medication delays carb absorption? a) Acarbose b) Metformin Correct: a) Acarbose Rationale: Blocks digestive enzymes. 101. What's a unique side effect of SGLT2 inhibitors? a) Lactic acidosis b) Yeast infections Correct: b) Yeast infections Rationale: Due to urinary glucose excretion. 102. How long does regular insulin last? a) 4-6 hours b) 10-16 hours Correct: a) 4-6 hours Rationale: Short-acting duration. 103. Which drug increases insulin sensitivity? a) Rosiglitazone b) Glipizide Correct: a) Rosiglitazone Rationale: TZD mechanism. 104. What requires contrast precautions? a) Metformin b) Glimepiride Correct: a) Metformin Rationale: Risk of lactic acidosis. 105. When do meglitinides peak? a) 1 hour b) 8 hours Correct: a) 1 hour Rationale: Quick-acting like sulfonylureas. 106. What's the key effect of GLP-1 agonists? a) Weight gain b) Weight loss Correct: b) Weight loss Rationale: Reduces appetite. 107. Which requires bone health monitoring? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: TZDs increase fracture risk. 108. What's metformin's effect on B12? a) Deficiency b) Elevation Correct: a) Deficiency Rationale: Requires B12 monitoring. 109. Which has 24-hour duration? a) NPH b) Glargine Correct: b) Glargine Rationale: Long-acting insulin. 110. What's SGLT2 inhibitors' action site? a) Pancreas b) Kidney Correct: b) Kidney Rationale: Blocks renal glucose reabsorption. 111. What's the main GI side effect of acarbose? a) Nausea b) Bloating Correct: b) Bloating Rationale: Due to undigested carbohydrates. 112. Which insulin matches meal timing? a) Lispro b) NPH Correct: a) Lispro Rationale: Rapid-acting onset. 113. What causes disulfiram reaction? a) Sulfonylureas b) Meglitinides Correct: a) Sulfonylureas Rationale: Interaction with alcohol. 114. When to monitor potassium with SGLT2? a) Monthly b) Regularly Correct: b) Regularly Rationale: Risk of hyperkalemia. 115. Which affects glucose uptake? a) Metformin b) Acarbose Correct: a) Metformin Rationale: Increases peripheral uptake. 116. What distinguishes long-acting insulin? a) Peak action b) No peak Correct: b) No peak Rationale: Steady basal coverage. 117. When to check B12 with metformin? a) Annually b) Monthly Correct: a) Annually Rationale: Long-term deficiency risk. 118. Which works on nuclear receptors? a) TZDs b) DPP-4 inhibitors Correct: a) TZDs Rationale: PPAR-gamma activation. 119. What's unique about pramlintide? a) Amylin analog b) Insulin secretagogue Correct: a) Amylin analog Rationale: Synthetic amylin hormone. 120. Which requires rapid discontinuation if heart failure? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: Worsens fluid retention. 121. What causes respiratory infections risk? a) DPP-4 inhibitors b) SGLT2 inhibitors Correct: a) DPP-4 inhibitors Rationale: Known side effect. 122. When to give mealtime insulin? a) 15 minutes before b) 2 hours after Correct: a) 15 minutes before Rationale: Allows peak to match food absorption. 123. Which reduces glucagon? a) GLP-1 agonists b) Meglitinides Correct: a) GLP-1 agonists Rationale: Dual action on insulin/glucagon. 124. What timing for NPH peak? a) 8 hours b) 12 hours Correct: a) 8 hours Rationale: Intermediate-acting peak. 125. Which causes dehydration risk? a) SGLT2 inhibitors b) DPP-4 inhibitors Correct: a) SGLT2 inhibitors Rationale: Increased urination. 126. What affects metformin absorption? a) Renal function b) Liver function Correct: a) Renal function Rationale: Kidney excretion pathway. 127. Which has fastest onset? a) Lispro b) Regular insulin Correct: a) Lispro Rationale: Rapid-acting formulation. 128. When to monitor for pancreatitis? a) GLP-1 agonists b) SGLT2 inhibitors Correct: a) GLP-1 agonists Rationale: Known complication. 129. What's TZD monitoring priority? a) Heart failure b) Blood pressure Correct: a) Heart failure Rationale: Fluid retention risk. 130. Which requires UTI prevention? a) Dapagliflozin b) Linagliptin Correct: a) Dapagliflozin Rationale: Glucosuria increases infection risk. 131. How to prevent DPP-4 infections? a) Monitor symptoms b) Antibiotics Correct: a) Monitor symptoms Rationale: Early detection key. 132. What defines basal insulin? a) Steady coverage b) Peak action Correct: a) Steady coverage Rationale: 24-hour baseline. 133. When to stop metformin? a) eGFR < 30 b) eGFR < 60 Correct: a) eGFR < 30 Rationale: Severe renal impairment. 134. Which causes fracture risk? a) TZDs b) GLP-1 Correct: a) TZDs Rationale: Bone density effects. 135. What's alpha-glucosidase timing? a) With meals b) Before bed Correct: a) With meals Rationale: Blocks carb digestion. 136. What's the evening insulin timing? a) With dinner b) Same time daily Correct: b) Same time daily Rationale: Consistent basal coverage. 137. Which needs fluid monitoring? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: Heart failure risk. 138. What's sulfonylurea peak? a) 1 hour b) 2-3 hours Correct: b) 2-3 hours Rationale: Intermediate onset. 139. When to check ketones? a) High glucose b) Low glucose Correct: a) High glucose Rationale: DKA risk. 140. Which affects GLP-1 levels? a) DPP-4 inhibitors b) Meglitinides Correct: a) DPP- 4 inhibitors Rationale: Prevents breakdown. 141. When does lactic acidosis risk increase? a) Renal failure b) Hyperglycemia Correct: a) Renal failure Rationale: Metformin accumulation. 142. What's unique about glargine? a) No peak b) Quick peak Correct: a) No peak Rationale: Steady release. 143. Which requires contrast holding? a) Metformin b) Glipizide Correct: a) Metformin Rationale: Nephropathy risk. 144. What affects SGLT2 dosing? a) Renal function b) Liver function Correct: a) Renal function Rationale: Kidney-dependent action. 145. Which causes weight loss? a) GLP-1 agonists b) Sulfonylureas Correct: a) GLP-1 agonists Rationale: Appetite reduction. 146. What's most important in DKA? a) Insulin b) Fluids Correct: b) Fluids Rationale: Initial volume restoration crucial. 147. When to adjust sulfonylureas? a) Elderly b) Young adults Correct: a) Elderly Rationale: Higher hypoglycemia risk. 148. Which blocks carb absorption? a) Acarbose b) Metformin Correct: a) Acarbose Rationale: Enzyme inhibition. 149. What's TZD contraindication? a) Heart failure b) Hypertension Correct: a) Heart failure Rationale: Fluid retention risk. 150. When monitor B12? a) Metformin use b) Insulin use Correct: a) Metformin use Rationale: Deficiency risk. 151. What's rapid insulin onset? a) 15 minutes b) 2 hours Correct: a) 15 minutes Rationale: Quick action for meals. 152. Which requires potassium monitoring? a) SGLT2 inhibitors b) DPP-4 inhibitors Correct: a) SGLT2 inhibitors Rationale: Electrolyte changes. 153. When to check renal function? a) Metformin b) Acarbose Correct: a) Metformin Rationale: Lactic acidosis risk. 154. What's GLP-1 effect? a) Slows digestion b) Speeds digestion Correct: a) Slows digestion Rationale: Satiety increase. 155. Which needs bone monitoring? a) TZDs b) GLP-1 Correct: a) TZDs Rationale: Fracture risk. 156. What causes yeast infections? a) SGLT2 inhibitors b) DPP-4 inhibitors Correct: a) SGLT2 inhibitors Rationale: Glucosuria effect. 157. When check ketones? a) Blood sugar >250 b) Blood sugar >180 Correct: a) Blood sugar >250 Rationale: DKA risk level. 158. Which has infection risk? a) Dapagliflozin b) Glimepiride Correct: a) Dapagliflozin Rationale: Urinary glucose. 159. What's NPH duration? a) 10-16 hours b) 24 hours Correct: a) 10-16 hours Rationale: Intermediate-acting. 160. Which affects glucagon? a) GLP-1 agonists b) Meglitinides Correct: a) GLP-1 agonists Rationale: Suppresses secretion. 161. What's metformin's primary action? a) Hepatic glucose b) Insulin release Correct: a) Hepatic glucose Rationale: Reduces gluconeogenesis. 162. When hold TZDs? a) Heart failure b) Hypertension Correct: a) Heart failure Rationale: Fluid retention. 163. Which causes B12 issues? a) Metformin b) Sitagliptin Correct: a) Metformin Rationale: Long-term deficiency. 164. What's SGLT2 mechanism? a) Kidney excretion b) Insulin release Correct: a) Kidney excretion Rationale: Blocks reabsorption. 165. Which needs daily timing? a) Glargine b) Lispro Correct: a) Glargine Rationale: Consistent basal. 166. What's elderly sulfonylurea risk? a) UTI b) Hypoglycemia Correct: b) Hypoglycemia Rationale: Reduced awareness. 167. When adjust DPP-4? a) Renal decline b) Liver disease Correct: a) Renal decline Rationale: Kidney clearance. 168. Which increases GLP-1? a) Sitagliptin b) Glipizide Correct: a) Sitagliptin Rationale: DPP-4 inhibition. 169. What's acarbose timing? a) With meals b) Before bed Correct: a) With meals Rationale: Blocks digestion. 170. Which needs UTI monitoring? a) Empagliflozin b) Linagliptin Correct: a) Empagliflozin Rationale: Glucose excretion. 171. What's pramlintide action? a) Amylin analog b) Insulin release Correct: a) Amylin analog Rationale: Synthetic amylin. 172. When stop SGLT2? a) Severe UTI b) Mild UTI Correct: a) Severe UTI Rationale: Infection risk. 173. Which affects insulin sensitivity? a) Pioglitazone b) Glimepiride Correct: a) Pioglitazone Rationale: PPAR-gamma activation. 174. What's contrast precaution? a) Metformin b) Glyburide Correct: a) Metformin Rationale: Nephropathy risk. 175. Which needs fluid monitoring? a) TZDs b) DPP-4 Correct: a) TZDs Rationale: Heart failure risk. 176. What's rapid insulin's duration? a) 3-4 hours b) 6-8 hours Correct: a) 3-4 hours Rationale: Short action time. 177. When check electrolytes? a) SGLT2 use b) DPP-4 use Correct: a) SGLT2 use Rationale: Potassium changes. 178. Which causes pancreatitis? a) GLP-1 agonists b) Sulfonylureas Correct: a) GLP-1 agonists Rationale: Known risk. 179. What's metformin clearance? a) Kidneys b) Liver Correct: a) Kidneys Rationale: Renal excretion. 180. Which prevents GLP-1 breakdown? a) Sitagliptin b) Glipizide Correct: a) Sitagliptin Rationale: DPP-4 inhibition. 181. What's GLP-1 administration? a) Injection b) Oral Correct: a) Injection Rationale: Subcutaneous only. 182. When monitor bone health? a) TZD therapy b) GLP-1 therapy Correct: a) TZD therapy Rationale: Fracture risk. 183. Which blocks carb enzymes? a) Acarbose b) Metformin Correct: a) Acarbose Rationale: Digestive inhibition. 184. What's glargine timing? a) Same time daily b) With meals Correct: a) Same time daily Rationale: Consistent basal. 185. Which needs renal monitoring? a) SGLT2 inhibitors b) Sulfonylureas Correct: a) SGLT2 inhibitors Rationale: Kidney-dependent. 186. What's NPH peak time? a) 2 hours b) 8 hours Correct: b) 8 hours Rationale: Intermediate-acting. 187. When monitor yeast infections? a) SGLT2 therapy b) DPP-4 therapy Correct: a) SGLT2 therapy Rationale: Glucosuria risk. 188. Which reduces appetite? a) GLP-1 agonists b) Meglitinides Correct: a) GLP-1 agonists Rationale: Satiety effect. 189. What's TZD mechanism? a) PPAR activation b) Insulin release Correct: a) PPAR activation Rationale: Nuclear receptor. 190. Which causes fluid retention? a) Pioglitazone b) Sitagliptin Correct: a) Pioglitazone Rationale: TZD effect. 191. What's lactic acidosis risk? a) Renal failure b) Hyperglycemia Correct: a) Renal failure Rationale: Metformin accumulation. 192. When check heart failure? a) TZD use b) DPP-4 use Correct: a) TZD use Rationale: Fluid retention. 193. Which increases fracture risk? a) Rosiglitazone b) Sitagliptin Correct: a) Rosiglitazone Rationale: Bone density effect. 194. What's insulin storage? a) Refrigerated b) Room temperature Correct: a) Refrigerated Rationale: Stability requirement. 195. Which requires contrast hold? a) Metformin b) Glipizide Correct: a) Metformin Rationale: Nephropathy risk. 196. What's GLP-1 monitoring? a) Pancreatitis b) Bone density Correct: a) Pancreatitis Rationale: Inflammation risk. 197. When adjust elderly dosing? a) Sulfonylureas b) Metformin Correct: a) Sulfonylureas Rationale: Hypoglycemia risk. 198. Which blocks glucose uptake? a) SGLT2 inhibitors b) DPP-4 inhibitors Correct: a) SGLT2 inhibitors Rationale: Renal reabsorption. 199. What's basal insulin purpose? a) Background coverage b) Meal coverage Correct: a) Background coverage Rationale: 24-hour control. 200. Which requires B12 monitoring? a) Metformin b) Sitagliptin Correct: a) Metformin Rationale: Deficiency risk.