TEST QUESTIONS
For Pharmacists:
1. Which of the following can cause a falsely low HbA1c result?
a. Canagliflozin
b. Heavy bleeding
c. Iron deficiency
d. Exercise
2. A patient with cardiovascular disease presents to the pharmacy to refill metformin. She mentions that her physician would like to initiate her on a second agent at her next visit pending the results of her HbA1c test. What drugs might you discuss with this patient as possible options?
a. Thiazolidinediones
b. Sulfonylureas
c. DPP-4 inhibitors
d. Insulin
3. Which is a valid patient safety counseling point regarding insulin pen injectors?
a. Use the outer needle cap to remove the needle after injection
b. Always keep them in the refrigerator
c. Remove the needle immediately after injection to prevent overdose
d. Perform a safety test each time a new pen is opened
4. One of your elderly patients is being started on a GLP-1 RA and the prescriber calls you for a recommendation. You know this patient has dexterity and health literacy issues, so you suggest they may have the easiest time administering:
a. Exenatide extended-release vial
b. Exenatide extended-release pen
c. Lixisenatide
d. Albiglutide
5. Whenever possible, you should suggest prescribers seek alternative treatment when a diabetic patient is prescribed ______.
a. A beta-blocker for hypertension
b. Aspirin for cardioprotective effects
c. Nitrofurantoin for a urinary tract infection
d. A fluoroquinolone antibiotic for pneumonia
6. A diabetic patient is picking up a refill of insulin degludec and an epinephrine auto-injector. He asks what aisle he might find fenugreekto supplement this diabetes therapy. Which of the following is an appropriate response?
a. Are you allergic to peanuts?
b. Are you currently taking levothyroxine?
c. Are your medications causing GI upset?
d. When was your last HbA1c check?
7. A combination of digoxin and ______should raise concern of ______digoxin blood levels.
a. Exenatide, increased
b. Acarbose, increased
c. Miglitol, decreased
d. Canagliflozin, decreased
8. After first use, which insulin pen can be stored at room temperature for up to 56 days?
a. Insulin glargine
b. Insulin detemir
c. Insulin degludec
d. Insulin lispro
9. Over-utilization or early refills of testing supplies could indicate:
a. Frequent hypoglycemia
b. Lack of motivation to test
c. Financial burden
d. Hypoglycemia unawareness
10. Pharmacists should recommend continuous glucose monitoring for patients who:
a. Test once daily and do not want to buy strips and lancets
b. Refuse to prick themselves to get a blood sample
c. Test multiple times daily with inconsistent results
d. Are at a low risk of hypoglycemic episodes
11. Upon refilling insulin glargine for one of your patients, you are presented with a prior authorization reject. The best course of action is to:
a. Fax the prescriber to complete a prior authorization and wait to hear back
b. Contact the plan to find out what alternatives are covered
c. Tell the patient they need to pay out-of-pocket for the medication
d. Suggest that the patient switch to an insurance plan that will cover the insulin
12. Upon drug regimen review, you are presented with a patient taking metformin, albiglutide, lisinopril, and an oral contraceptive (OCP). Which intervention is appropriate?
a. Counsel patient on albiglutide injection technique
b. Contact prescriber for an alternative to albiglutide
c. Contact prescriber for an alternative to lisinopril
d. Counsel patient to separate albiglutide injection from OCP
13. Which of the following pieces of information, when missing, causes Medicare Part B denials most frequently when billing for diabetic testing supplies?
a. An appropriate ICD-10 diagnosis code
b. Whether the patient requires insulin
c. The specific frequency of testing
d. Proof of delivery of supplies to the patient
14. You are completing drug regimen review on a 57-year-old male patient with type 2 diabetes. Following an appointment, his prescriber has continued him on metformin 1,000mg twice daily, sitagliptin 100mg daily, and insulin glargine 10 units. He has been picking up timely refills on all three medications for 15 months. Which of the following is an appropriate reason to contact the prescriber?
a. Suggest discontinuation of metformin
b. Suggest addition of meal-time insulin
c. Inquire about his last HbA1c result
d. Ask what time of day he should take sitagliptin
15. A patient comes to the pharmacy to pick up refills on her non-insulin injectable and warfarin. She is also purchasing a bottle of cinnamon capsules, which she mentions that she heard will help control her blood sugar. What should you do?
a. Confirm that the patient does not have a peanut allergy
b. Suggest that cinnamon may not be a good option
c. Encourage the use of cinnamon as adjunct treatment
d. Explain that it will likely cause her GI upset
16. Upon drug regimen review, you are presented with a patient taking metformin, lixisenatide, lisinopril, hydrochlorothiazide, and an oral contraceptive (OCP). Which is most appropriate to counsel the patient about?
a. Possible hypoglycemia unawareness
b. Potential weight gain from liraglutide
c. Separating OCP and lixisenatide
d. Separating lisinopril and liraglutide
17. A premenopausal woman on combination insulin therapy for diabetes comes in with a prescription for iron, and notes that her HbA1c has been elevated lately. What should you recommend to her prescriber?
a. Discontinue iron, as it will further elevate her HbA1c
b. Re-testing HbA1c once iron level is corrected
c. Re-testing iron level, as diabetes can deplete iron
d. Increase her insulin dose, as iron depletes insulin
18. Which is an appropriate counseling point for a patient initiated on exenatide extended-release pens?
a. Let the pen stand at room temperature for 10 minutes before injecting
b. Firmly tap the pen against the palm of your hand to mix, rotating sides
c. Rock the pen side to side like a windshield wiper 80 times to mix
d. Hold the device against the skin until the needle has retracted
19. One of your diabetic patients also struggles with chronic, recurrent urinary tract infections. Which antihyperglycemic medication should be avoided in this patient?
a. Lixisenatide
b. Rosiglitazone
c. Glipizide
d. Empagliflozin
20. A patient at your pharmacy is picking up a new prescription for linagliptin and inquires about serious side effects that could occur. You advise them to watch out for nausea, vomiting, abdominal pain, tiredness, and trouble breathing, which could indicate:
a. Diabetic ketoacidosis
b. Hypoglycemia unawareness
c. Urinary tract infection
d. Torsades de Pointes
Learning objective: 1, 5
Location: Page 8, Column 1, Paragraph 3
Rationale: SGLT-2 inhibitors are implicated in causing diabetic ketoacidosis. They can also cause increased incidence of UTI, but the list of symptoms do not match that of a UTI. The symptoms listed also do not indicate hypoglycemia or TdP.