MCQ - Discussion on DM

Dr Aditi Chaturvedi
Prof. and Head
Department of Pharmacology
Some important tips for MCQs
• Biaguanides: Phenformin and metformin
1. Phenformin not used now a days because of higher incidence
of lactic acidosis
2. Metformin causes more megaloblastic anemia due to vit B12
deficiency
• Acarbose:
1. Increases fibrinolytic activity and decreases fibrinogen levels
and are also useful in TYPE-1DM.
• Sulphonylureas:
1. Chlorpropamide, acetohexamide and tolbutamide oldest-1st
generation-more hypoglycemia, cholestatic jaundice, alcohol
flush, shorter acting, less potent
2. Glibenclamide, Glimepride, Glipizide, Gliclazide-2nd
Generation SU.
Drugs not metabolised in liver and
excreted uncganged in urine

• Biguanides
• DPP-IV inhibitors--Sitagliptan
• Q.1 A patient is receving insulin and
acarbose for diabetes mellitus and
developed hypoglycemia. Which of the
following should be used for treatment of
hypoglycemia in this patient?
• a. Sucrose
• b. Maltose
• c. Glucose
• d. Starch
• Q.2 Which of the following anti-diabetic
drug can cause vitamin B12 deficiency?
• a. Glipizide
• b. Acarbose
• c. Metformin
• d. Pioglitazone
• Q.3 True about pioglitazone are all except
• a. Metabolized in the liver by CYP3A4
• b. Selective agonist for the nuclear
peroxisome profil-erator activated receptor
gamma
• c. It causes transcription of gene for
carbohydrate and fat metabolism in the
absence of insulin
• d. It should be avoided in a patient with
cardio-vascular diease
A -45 yr old female weighing 60kg patient suffering from pancreatitis and type-
1-DM and suddenly starts hyperventilating, vomiting, falling BP(80/60) and cold
extremeties, her RBS came out to be 800mg/dl. What is your diagnosis? What
management plan will you decide for this pt and which insulin will you prefer

from these preparartions available with you in ward.

• Q.4 All of the statements about exenatide
are true except
• a. It is GLP-1 analogue
• b. It can be used for treatment of Type 1
diabetes mellitus
• c. It is given subcutaneously
• d. It decreases glucagon
• Q.5 All of the following Statements about
nateglinide are true except?
• a. Decreases post-prandial hyperglycemia
• b. Hypoglycemia is less common than with
sulfonylureas
• c. It decreases insulin resistance
• d. It acts by releasing insulin
• Q.6 Insulin causes all of the following
except
• a. Glycogenesis
• b. Glycolysis
• c. Lipogenesis
• d. Ketogenesis
• Q.7 What will happen if insulin alone is
given rapidly in Diabetic Ketoacidosis?
• a. Hypokalemia
• b. Hyperkalemia
• c. Hypertension
• d. Hyocalacemia
MIXTARD PENFILL 30/70 3ML INSULIN – 1 CARTRIDGE
Identify the device and explain the advantages of this
device. Eneumerate other newer insulin delivery devices
• Q.8 Which of the following statements
regarding acarbose is FALSE?
• a. It acts by inhibiting the enzyme alpha-
glucosidase
• b. It reduces both pre and post prandial
hyperglycemia
• c. It decreases the progression of impaired
glucose tolerance to overt diabetes
mellitus
• d. It reduces fibrinogen level
• Q.9 All of the following preparations of
insulin are rapid and short acting EXCEPT
• a. Lispro
• b. Aspart
• c. Glargine
• d. NPH
• Q.10 Which of the following statements
about biguanides is NOT true?
• a. Do not stimulate insulin release
• b. Decrease hepatic glucose production
• c. Renal dysfunction is not a
contraindication for their use
• d. Can be combined with sulfonylureas
• Q.11 All the following statements about
alpha-glucosidase inhibitors are true
EXCEPT
• a. Reduces intestinal absorption of
carbohydrates
• b. Effective in both type 1 and 2 diabetes
• c. Hypoglycemia is a common and serious
side effect
• d. Can be used with other oral
hypoglycemic agents
Plan an insulin regimen from the given
prepartion for a 60 yr old man weighing
60kg suffering from DM-Type-2 and
BGL not getting controlled with oral
hypoglycemics.
• Q.12 If a diabetic patient being treated
with an oral hypoglycemic agent develops
dilutional hyponatremia, which one of the
following could be responsible for this
effect?
• a. Chlorpropamide
• b. Tolbutamide
• c. Glyburide
• d. Glimepride
• Q.13 All of the following are true about
metformin EXCEPT
• a. Causes little or no hypoglycemia in non
diabetic patients
• b. Acts by increased insulin secretion
• c. Increases peripheral utilization of
glucose and decreases absorption of
glucose from intestine
• d. When given with alcohol, increases risk
of lactic acidosis
• Q.14 Antidiabetic drugs that can be used
safely in renal failure are
• a. Metformin
• b. Glimepiride
• c. Phenformin
• d. Rosiglitazone
• e. Repaglinide
Identify and classify the drug.
Eneumerate the MOA and Side effects
with the same.
• Q.15 The most likely complication of
insulin therapy in ketoacidosis is
• a. Dilutional hyponatremia
• b. Hypoglycemia
• c. Increased bleeding tendency
• d. Pancreatitis
• Q.16 Which of the following drugs
promotes the release of endogenous
insulin?
• a. Acarbose
• b. Glipizide
• c. Metformin
• d. Pioglitazone
• Q.17 Which of the following drugs is taken
during the first part of the meal for the
purpose of delaying absorption of dietary
carbohydrates?
• a. Acarbose
• b. Glipizide
• c. Nateglinide
• d. Pioglitazone
• Q.18 Which of the following patients is most likely to be
treated with intravenous glucagon?
• a. A young man who took cocaine and has a blood
pressure of 190/110 mm Hg
• b. A middle aged man with type II diabetes who has not
taken his regular dose of glipizide for last 4 days
• c. An old man with severe bradycardia and hypotension
resulting from ingestion of overdose of atenolol
• d. An old woman with lactic acidosis as a complication of
severe infection and shock
• Q.19 Insulin acts by stimulation of
• a. Ionotropic receptor
• b. Enzymatic receptor
• c. Metabotropic receptor
• d. Nuclear receptor
• Q.20 The most common route of
administration of insulin is
• a. Intraderal
• b. Subcutaneous
• c. Intramuscular
• d. Intravenous
• Q.21 Human insulin as compared to
pork/beef insulin is
• a. More potent
• b. Rapidly absorbed
• c. Longer acting
• d. More antigenic
• Q.22 Glipizide differs from chlopropamide
in all except
• a. Is more potent
• b. is longer acting
• c. does not lower blood sugar in
nondiabetic subjects
• d. Is less prone to cause hypoglycemic
reaction
• Q.23 Which of the following characteristics
make metformin a preferred Biguanide
than phenformin?
• a. It is more potent
• b. It is less liable to cause lactic acidosis
• c. It does not interfere with vitamin B12
absorption
• d. It is not contraindicated in patients with
kidney disease
• Q.24 Glibenclamide reduces blood
glucose in all of the following EXCEPT
• a. Non diabetics
• b. Type 1 diabetics
• c. Type 2 diabetics
• d. Obese diabetics
Identify the drug and explain the MOA
and side effects of the same.
• Q.25 Glibenclamide is preferred over
chlorpropamide in the treatment of DM
because the latter is more likely to cause
• a. Hypoglycemia
• b. Alcohol intoletrance
• c. Cholestatic jaundice
• d. All of the above
• Q.26 Metformin is NOT effective in
lowering of blood sugar level in which of
the following patients?
• a. Non diabetics
• b. Obese diabetics
• c. Type 2 diabetics
• d. Diabetics not responding to
sulfonylureas
• Q.27 Which of the following statements
about nateglinide is TRUE?
• a. It is long acting hypoglycemic drug
• b. Taken just before meal, it limits post
prandial hyperglycemia in type 2 diabetes
mellitus
• c. It lowers blood glucose in both type 1
and type 2 diabetes mellitus
• d. It acts by opening K+ channels in
myocytes and adipocytes
• Q.28 The correct statement regarding the
present status of oral hypoglycemics in
diabetes mellitus is
• a. They are the first choice drug in all
cases
• b. They should be prescribed only if the
patient refuse insulin injections
• c. They are used in type 1 diabetes
mellitus
• d. They are used first in most cases of
uncomplicated mild to moderate type 2
diabetics
• Q.29 Which of the following drugs is most
likely to cause hypoglycemia when used a
monotherapy in the treatment of type 2
diabetes?
• a. Acarbose
• b. Glipizide
• c. Metformin
• d. Rosiglitazone
• Q.30 Exenatide is a newer drug proposed
to be used in the treatment of
• a. Osteoporosis
• b. Diabetes mellitus
• c. Hyperparathyroidism
• d. Anovulatory infertility
• Q.32 A 54- year old obese patient with
type 2 diabetes mellitus and a history of
alcoholism probably should not receive
metformin because it can increase the risk
of
• a. Disulfiram like reaction
• b. Hypoglycemia
• c. Lactic acidosis
• d. Severe hepatic toxicity
• Q.33 Insulin causes
• a. Na+ entry into cells
• b. K+ exit from cells
• c. Na+ exit/K+ entry
• d. K+ entry into cells
• Q.34 Indication of newer insulins include
all EXCEPT
• a. Insulin resistance
• b. Lipodystrophy
• c. Pregnancy
• d. Diabetic Kidney disease
• Q.35 Which of the following is not used for
the treatment of Insulin induced
hypoglycemia?
• a. Intravenous glucose
• b. Glucagon
• c. Adrenaline
• d. Oral carbohydrates
Identify the drug, classify and give
specific use
• Q.36 Anti-diabetic effect of sulfonylureas is
by reducing
• a. Glucagon production
• b. Insulin secretion
• c. Tissue sensitivity to insulin
• d. Tissue sensitivity to glycogen
• Q.37 Drug used in diabetes is
• a. Salmeterol
• b. Acetohexamide
• c. Benserazide
• d. Methioxamine
• Q.38 Lactic acidosis is common in
• a. Metformin
• b. Phenformin
• c. Repaglinide
• d. Rosiglitazone
• Q.39 Hypoglycemia is caused by
• a. Alcohol intoxication
• b. Thiazide
• c. Diazoxide
• d. Metoclopramide
• Q.40 Long acting insulin is
• a. Lente
• b. Semilente
• c. Ultralente
• d. Lispro insulin
• Q.41 Monocomponent insulin has all the
following advantage except
• a. Can be used in pregnancy
• b. Less hypoglycemic episodes
• c. Longer duration of action
• d. Less chances of lipodystrophy
• Q.42 Which of the following drug is alpha-
glucosidase inhibitor
• a. Pioglitazone
• b. Miglitol
• c. Metformin
• d. Nateglinide
• Q.43 Monotherapy with which of the
following antidiabetic drug can caused
hypoglycemia?
• a. Metformin
• b. Glibenclamide
• c. Pioglitazone
• d. All of the above
• Q.44 Insulin having longest duration of
action is
• a. Isophane insulin
• b. Protamine zinc insulin
• c. Insulin zinc suspension
• d. Plain Insulin
Please give use of this drug.Mention
imprtant side effect of this drug.
• Q.45 cAMP is second messenger for the
following except
• a. TSH
• b. Insulin
• c. LH
• d. FSH
• Q.46 Oral hypoglycemic drug that is less
likely to cause hypoglycemia is
• a. Repaglinide
• b. Gliclazide
• c. Rosiglitazone
• d. Glimipiride
• Q.47 All of the following are true regarding
chlorpropamide except
• a. It is short acting
• b. It can caused hypoglycemia in elderly
• c. Causes weight gain
• d. Associates with alcoholic flush
• Q.48 Long acting insulin preparations are
frequently administered by
• a. Oral route
• b. Intramuscular route
• c. Intradermal route
• d. Subcutaneous route