FINAL ADVANCED PHARMACOLOGY CARE OF
THE FUNDAMENTALS EXAM PAPER 2026
QUESTIONS AND ANSWERS GRADED A+
◉ Preventing Diabetic Nephropathy. Answer: ACE inhibitors, such as
lisinopril. Or ARBs such as losartan if patient cannot tolerate ACEs
◉ ADAs Stepped Care Approach to DM Treatment. Answer: 1.
Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
◉ Biguanides. Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle
receptors to insulin (increased uptake of insulin). Safe in pregnancy.
GI side effects so take with meals. Excreted by kidneys so increased
toxicity (lactic acidosis) if renal impairment. Low risk of
hypoglycemia.
,◉ 1st vs. 2nd Generation Sulfonylurea. Answer: All 1st generation
have been discontinued. 2nd generation (Glipizide) have shorter
duration of action and increased potency.
◉ Sulfonylureas. Answer: glipizide, glyburide, glimepiride. Promote
insulin release by beta cells. Block potassium channels of pancreatic
islets to let calcium in, which stimulates insulin release. Do not take
with ETOH (disulfiram reaction includes flushing, palpitations,
nausea). Hypoglycemia and weight gain are also common side
effects. Do not take if pregnant or breastfeeding. Increased risk of
toxicity if liver or kidneys are impaired.
◉ Meglitinides MOA. Answer: Stimulate a rapid/ short-lived release
of insulin from the pancreas.
◉ Meglitinides (Glinides). Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
◉ Meglitinides patient teaching. Answer: Tell patient to eat within
30 minutes.
◉ Meglitinides (Glinides) precautions. Answer: Hypoglycemia
increased in patients with liver dysfunction 2/2 slower metabolism
of the drug.
, ◉ Meglitinides vs. Sulfonylureas. Answer: -meglitinides are rapid
acting and will have its effect on a single meal-decreasing post
prandial hyperglycemia. Taken with each meal.
-sulfonylureas continuously stimulate insulin release- having most
of its effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
◉ Thiazolidinediones (TZDs). Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
◉ Thiazolidinediones (TZDs) MOA. Answer: Peroxisome
proliferator-activated receptor gamma agonists (PPAR𝜸 agonists)
that increase peripheral insulin sensitivity. Promotes increased
glucose uptake by skeletal and adipose cells.
◉ Thiazolidinediones (TZDs) adverse effects. Answer: Renal
retention of fluid- so not for patients with stage 3 or 4 heart failure.
May also cause upper respiratory infections, headache, and myalgia.
Hepatotoxic. Monitor liver function.
◉ Dipeptidyl Peptidase-4 Inhibitors. Answer: Sitagliptin (Januvia),
gliptins
THE FUNDAMENTALS EXAM PAPER 2026
QUESTIONS AND ANSWERS GRADED A+
◉ Preventing Diabetic Nephropathy. Answer: ACE inhibitors, such as
lisinopril. Or ARBs such as losartan if patient cannot tolerate ACEs
◉ ADAs Stepped Care Approach to DM Treatment. Answer: 1.
Lifestyle changes plus metformin.
2. Lifestyle plus metformin plus a second drug (GLP-1)
3. Lifestyle plus metformin plus 2 more drugs based on patient
characteristics. For example, add SGLT2 inhibitor for patients with
cardiovascular or renal disease.
◉ Biguanides. Answer: Metformin
Initial therapy for DM2. Inhibits glucose production in liver. Reduces
glucose absorption in gut. Sensitized fat and skeletal muscle
receptors to insulin (increased uptake of insulin). Safe in pregnancy.
GI side effects so take with meals. Excreted by kidneys so increased
toxicity (lactic acidosis) if renal impairment. Low risk of
hypoglycemia.
,◉ 1st vs. 2nd Generation Sulfonylurea. Answer: All 1st generation
have been discontinued. 2nd generation (Glipizide) have shorter
duration of action and increased potency.
◉ Sulfonylureas. Answer: glipizide, glyburide, glimepiride. Promote
insulin release by beta cells. Block potassium channels of pancreatic
islets to let calcium in, which stimulates insulin release. Do not take
with ETOH (disulfiram reaction includes flushing, palpitations,
nausea). Hypoglycemia and weight gain are also common side
effects. Do not take if pregnant or breastfeeding. Increased risk of
toxicity if liver or kidneys are impaired.
◉ Meglitinides MOA. Answer: Stimulate a rapid/ short-lived release
of insulin from the pancreas.
◉ Meglitinides (Glinides). Answer: Repaglinide (Prandin)
Nateglinide (Starlix)
◉ Meglitinides patient teaching. Answer: Tell patient to eat within
30 minutes.
◉ Meglitinides (Glinides) precautions. Answer: Hypoglycemia
increased in patients with liver dysfunction 2/2 slower metabolism
of the drug.
, ◉ Meglitinides vs. Sulfonylureas. Answer: -meglitinides are rapid
acting and will have its effect on a single meal-decreasing post
prandial hyperglycemia. Taken with each meal.
-sulfonylureas continuously stimulate insulin release- having most
of its effect on fasting glucose levels.
Both stimulate pancreatic insulin release.
◉ Thiazolidinediones (TZDs). Answer: Pioglitazone (Actos)
Rosiglitazone (Avandia)
◉ Thiazolidinediones (TZDs) MOA. Answer: Peroxisome
proliferator-activated receptor gamma agonists (PPAR𝜸 agonists)
that increase peripheral insulin sensitivity. Promotes increased
glucose uptake by skeletal and adipose cells.
◉ Thiazolidinediones (TZDs) adverse effects. Answer: Renal
retention of fluid- so not for patients with stage 3 or 4 heart failure.
May also cause upper respiratory infections, headache, and myalgia.
Hepatotoxic. Monitor liver function.
◉ Dipeptidyl Peptidase-4 Inhibitors. Answer: Sitagliptin (Januvia),
gliptins
