1. Combination basal insulin and GLP-1 RA products are available in the United States in the following formulations:
A. Glargine and albiglutide, detemir and liratglutide
B. Degludec and dulaglutide, glargine and liraglutide
C. Glargine and lixisenatide, degludec and liraglutide
D. Degludec and exenatide and glargine and exenatide
2. A patient presents to the pharmacy today and is picking up his first fill of his glargine/lixisenatide (Soliqua) 100/33 pen. The patient states he eats 3 meals per day at 9am, 2pm and 6:30pm. The patient is aware that he should only be using this pen once daily, but asks what time of the day he should be using this pen. Based on the counseling points regarding this product, which of the following would be the most appropriate recommendation; You should administer your dose of glargine/lixisenatide (Soliqua) 100/33 within one hour of your:
A. First meal
B. Second meal
C. Third meal
D. It does not matter what time you take your dose
3. Patient MT is a 49-year-old female with T2DM, hypertension, and hyperlipidemia. Her A1C is close to goal at 7.6%, but her provider is targeting an A1C less than 6.5% due to her long life expectancy and relative good health. Given her A1C is 7.6% her biggest problem is post prandial elevations at this time. She is currently taking lisinopril 10 mg daily, atorvastatin 40 mg daily, metformin ER 1,500 mg once daily, and glargine U100 insulin 36 units daily. To avoid clinical inertia, and reach target goal, which of the following would be an appropriate next step in MTs therapy?
A. Increase metformin ER to 2,000 mg once daily and increase U100 glargine to 50 units daily
B. Increase metformin ER to 2,000 mg once daily, discontinue U100 glargine and switch to U300 glargine 36 units daily
C. Continue metformin ER 1,500 mg once daily, discontinue U100 glargine, and add glargine/lixisenatide (Soliqua) 100/33 starting at 15 units daily
D. Increase metformin ER to 2,000 mg once daily, discontinue U100 glargine, and add glargine/lixisenatide (Soliqua) 100/33 starting at 30 units daily
4. Which of the following counseling points regarding glargine/lixisenatide (Soliqua) 100/33 and degludec/liraglutide (Xultophy) 100/3.6 is accurate?
A. The maximum dose of degludec/liraglutide (Xultophy) 100/3.6 is 50 units
B. Degludec/liraglutide (Xultophy) 100/3.6 should be titrated by 2-4 units weekly
C. Glargine/lixisenatide (Soliqua) 100/33 can be given once a day at any time of the day regardless of food
D. Oral contraceptives should be given 1 hour before or 11 hours after degludec/liraglutide (Xultophy) 100/3.6 is injected
5. Which of the following is an example of clinical inertia?
A. A patient with an A1C of 6.3% on oral medication with follow-up every 6 months
B. A patient with an A1C of 7.3% being treated with basal insulin with follow-up in 6 months
C. A patient with an A1C of 8.6% who had basal insulin added to their regiment with a follow-up in 3 months
D. Any patient who remains on metformin monotherapy after one year of treatment
6. Which of the following statements regarding expiration date and storage of the combinationproducts glargine/lixisenatide (Soliqua) 100/33 and degludec/liraglutide (Xultophy) 100/3.6 is true?
A. Both products should be stored in the refrigerator once opened
B. Both products should be stored at room temperature once opened
C. Both products expire after 14 days once opened
D. Both products expire after 21 days once opened
7. Which of the following statements regarding combination therapy with a basal insulin and a GLP-1 RA is true?
A. Although this combination is not as good at basal-bolus insulin therapy for glycemic control, it results in less injections weekly (7 vs. 21) and better adherence
B. The combination therapy has similar hypoglycemic risk as basal-bolus insulin therapy
C. The combination therapy has more GI side effects than basal-bolus insulin therapy
D. The combination therapy has similar weight gain to basal-bolus insulin therapy
8. Which of the following describes an appropriate patient for combination therapy with a basal insulin/GLP-1 RA product?
A. A patient with an A1C no more than 2% higher than goal
B. A patient who is uncontrolled on oral medications (no injectables)
C. A patient with Type 1 or Type 2 diabetes if their A1C is within 1-1.5% of goal
D. A patient who is at fasting blood sugar goal with a basal insulin but not at goal post meals
9. Patient RS is a 52-year-old female that presents with an A1C of 8.2%. According to AACE recommendations, what is an appropriate course of action for this patient?
A. Initiate metformin and reassess after 3 months
B. Initiate metformin and dapagliflozin. Reassess after 3 months
C. Initiate insulin glargine and lixisenatide. Reassess after 6 months
D. Initiate exenatide and reassess after 6 months
10. Which of the following factors can decrease patient adherence to treatment for diabetes?
A. Visual impairment
B. Fixed-dose combination treatment regimens
C. Informing patients that nausea is associated with treatment
D. Early discussion of insulin use with patients
