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1. A 56-year-old man with type 2 diabetes mellitus (T2DM) and hypertension (HTN) develops unexplained bouts of hypoglycemia. He is currently taking only metformin for his T2DM and Lisinopril for HTN. The individual never experienced hypoglycemia before, but after you review his medication history, you see that using amoxicillin for 5 days offered no improvement in a presumed sinus infection, so he was then started on levofloxacin. What is the most likely etiology for these new episodes of hypoglycemia?

A. Amoxicillin B. Metformin C. Levofloxacin D. Lisinopril

2. A woman, 64 years of age, with long-standing T2DM controlled with lifestyle modifications and metformin for years presents to you with a concern that her recent HbA1c lab result does not seem to correlate with her test results from the previous 2 years. The patient has had no changes in weight, diet, exercise frequency, or medications. You study her chart and note that she was recently released from the hospital with a new prescription for ferrous sulfate 325 mg 3 times a day for iron deficiency anemia. What might you tell this patient in a counseling session?

A. You refer her to a dietitian because you suspect her eating habits are the reason for her A1C fluctuations. B. She has to stop the ferrous sulfate because this drug can create blood glucose (BG) fluctuations. C. Counsel her about anemia possibly causing a falsely elevated A1C and that she will have to closely monitor her BG levels. D. Tell her to discontinue the metformin because this drug may cause fluctuations in the A1C level.

3. A patient with schizophrenia but without diabetes who started clozapine a few months ago comes into the pharmacy complaining of frequent urination and weight loss despite adequate oral intake. The person also mentions feeling lethargic lately. You contact the patient's health care provider and relay your concerns that:

A. This patient has a potentially serious urinary tract infection (UTI) B. You suspect the patient is being nonadherent with her medications C. You suspect the patient has inadequate nutrition secondary to a poor diet D. You suspect medication-induced hyperglycemia

4. A woman, 43 years of age with T2DM, chronic obstructive pulmonary disease (COPD), and anxiety presents to the pharmacy with a prescription for prednisone 20 mg twice a day for 10 days to help with a recent COPD exacerbation. What are some warnings/precautions that you may want to convey to this patient?

A. Prednisone will likely cause hyperglycemia, so she should more strictly monitor her daily finger-stick BG levels. B. The prednisone will improve glycemic control, so consider stopping or lowering her oral antihyperglycemic medications. C. There are no special precautions to be taken with prednisone because it has no significant adverse events. D. Suggest that the patient take one-half the dose prescribed to avoid complications.

5. A patient with diabetes is newly diagnosed with HIV. What plan would be optimal to put in place with this person prior to beginning treatment for HIV?

A. This patient would require a plan to more closely monitor BG and potentially increase diabetes medication if necessary because he/she will most likely be put on a protease inhibitor as part of HIV therapy. B. The patient should be cautioned about potential hypoglycemia, which may result from HIV treatment. C. Patients with diabetes should never be prescribed protease inhibitors as part of their HIV regimen. D. There is no association with HIV drugs, so no counseling is required.

6. What patient population is at especially high risk for adverse drug reactions?

A. Patients who have had previous adverse drug reactions B. Patients with a family history of drug allergies C. The senior population D. Patients with a lower socioeconomic status

7. A man, 48 years of age with obesity, T2DM, HTN, and hyperlipidemia asks you to fill a new prescription for high-dose atorvastatin. He is currently taking lisinopril, metformin, aspirin (81 mg), and glipizide. What counseling should be offered to him at this visit?

A. He is at risk for polypharmacy-related adverse drug reactions and should ask his health care provider to discontinue the lisinopril and metformin. B. He is at risk for elevated fasting BG levels secondary to starting the high-dose statin. C. The combination of lisinopril and atorvastatin puts him at high risk for hypoglycemia. D. No additional counseling is required at this time.

8. A 48-year-old woman with end-stage renal disease secondary to lupus received a renal transplant 1 month ago and presents today asking you to fill a prescription for tacrolimus. What type of medication counseling should be given at this visit?

A. Patients with lupus are less likely to have adverse medication events. B. Patients starting tacrolimus are at high risk for developing insulin resistance and diabetes and should be closely monitored. C. Tacrolimus has a protective effect for the pancreas and, therefore, the patient can consume more high-glycemic-index foods without worry. D. Patients should start taking folic acid along with the tacrolimus to prevent drug-associated adverse events.

9. A man, 76 years of age, with poorly controlled HTN, and T2DM presents to you with a concern about worsening diabetes control. His BG level averaged 140mg/dl month ago, but in the past 2 weeks it has been higher than 200mg/dl. He does not have any symptoms of infection, denies changes in his diet, and has been adherent with his medications. The patient was just started on (HCTZ) 25 mg daily for his uncontrolled HTN and also takes metformin and tamsulosin. What is the most likely explanation for his sudden change in glycemic control?

A. Tamsulosin in combination with metformin has been shown to cause impaired metabolism of the metformin and, therefore, elevated BG levels. B. Medication nonadherence leading to poor glycemic control and uncontrolled HTN C. Dietary indiscretion leading to higher BG levels D. The recent addition of HCTZ is causing the aberrant BG elevations.

10. A man, 22 years of age with diabetes and on insulin therapy, presents to you for a refill of his medications. He is excited because he will be attending his first fraternity party at a nearby college. What advice should you provide this young patient at this particular time to make sure he does not experience adverse events?

A. Marijuana has been shown to improve glycemic control, so if it is available at the party he should try some. B. Alcohol consumption has been shown to impair the body's natural response to hypoglycemia, so extreme caution should be exercised to closely monitor BG. C. Alcohol affects the absorption of insulin and, therefore, insulin should be taken 2 hours after consuming the alcoholic beverage. D. Beer has abundant calories, so the patient does not have to eat if he is drinking beer.