Fixed Dose Quiz

1. Fixed dose combination tablets have been shown to:

A) Reduce financial burden

B) Reduce tablet burden

C) Improve the long-term adherence of diabetes management

D) All the above

Correct! Wrong!

2. Glucovance is a combination of what two individual medicines.

A) Metformin and Glibenclamide

B) Metformin and Gliclazide

C) Metformin and Glimepiride

D) Metformin and Glipizide

Correct! Wrong!

3. Side effects of Avandamet include:

A) Gastrointestinal symptoms such as nausea, vomiting, diarrhoea, abdominal pain,

B) Increased risk of myocardial ischaemia

C) Diabetic Ketoacidosis

D) A and C

E) A and B

Correct! Wrong!

4. Mr Rogers is a regular customer in your pharmacy. Of late you have noticed he seems distracted, always in a rush and quite stressed. Today he seems more relaxed when he comes to pick up his metformin MR and saxagliptin medication. You notice on the dispense history that these are not being dispensed at regular intervals and you take the time to chat about how things are going with his diabetes management. Mr Rogers discloses he has recently separated from his long-term partner and is struggling financially, and things are getting on top of him. Which of the following scenarios best suits Mr Rogers long term health outcomes?

A) You emphasise that he has had a difficult year with his separation and financial issues. You note that he is on multiple other medications and invite him for a Diabetes MedsCheck. You explain that there are combination medications available that will not only lower the cost but also lower the tablet burden for him. You ask if he would like you to communicate this to his doctor. Login to Pharmacy Diabetes portal for resources you may need. Log all interventions using the Electronic Intervention Log. Refer to allied health and for blood glucose monitoring if appropriate.

B) You empathise with him. You give him a CMI on KOMBIGLYZE MR and suggest he speak with the GP since this is reasonable option which will decrease financial and tablet burden for him.

C) You empathise with him. You dispense his medicine and tell him you are always free for a chat if he needs.

D) You are not sure what to say. After all his medication is important if he wants to stay healthy.

Correct! Wrong!

5. Which of the following about Galvumet is true:

D) People with type 1 diabetes are prescribed this to help with their management.

A) You need to counsel about hypoglycaemia with those who are Galvumet.

B) There is no dose reduction for those individuals who have renal insufficiency.

C) Individuals should be informed there is a small risk of lactic acidosis. The onset of lactic acidosis is often subtle and may be accompanied by non-specific symptoms such as malaise, myalgia, respiratory distress, increasing somnolence and non-specific abdominal distress. There may be associated hypothermia, hypotension and resistant bradyarrhythmias with more marked acidosis.

Correct! Wrong!

6. Which of the following is true of Xigduo XR?

It is a combination of metformin and dapagliflozin. Side effects may include lactic acidosis, urinary tract infections, nausea, vomiting, intermittent diarrhoea and genital infections.

It is a combination of metformin XR and dapagliflozin. Side effects may include lactic acidosis, urinary tract infections, nausea, vomiting, intermittent diarrhoea and genital infections.

It is a combination of Metformin and empagliflozin. Side effects may include lactic acidosis, urinary tract infections, nausea, vomiting, intermittent diarrhoea and genital infections.

It is a combination of metformin XR and empagliflozin. Side effects may include lactic acidosis, urinary tract infections, nausea, vomiting, intermittent diarrhoea and genital infections.

Correct! Wrong!

7. Mrs Jose has recently had her Janumet XR 100/1000 mg script changed from one tablet daily to one tablet twice a day. She comes into the pharmacy to get the second script filled. She tells you this adjustment was made because “her diabetes is not being managed well at present since she is under a lot of stress.” She also tells you she is not aware of what her glucose levels are since she “has no time to monitor”. Which of the following scenarios is in Mrs Jose best interest with respect to her diabetes management?

Dispense the prescription. Ensure Mrs Jose understands to take her tablets after food to prevent gastrointestinal side effects. Provide her with a CMI if she did not get one when it was dispensed the last time.

Look at the PI for Janumet XR. Determine the recommended daily dose for metformin XR and sitagliptin. Communicate with Mrs Jose’s doctor to reduce dose back to one tablet daily. Log in to Pharmacy Diabetes to log interventions and ensure Mrs Jose has any resources she may need.

Review the PI for Janumet XR to determine the recommended daily dose for metformin XR and sitagliptin. Communicate with Mrs Jose’s doctor the need to reduce the dose back to one tablet daily as the dose for sitagliptin has exceeded the recommended daily dose. If Mrs Jose is eligible for a Diabetes Medscheck, invite her to participate for further education to ensure she understands why her dose has been reduced. Refer to allied health professionals and GP for further intervention regarding diabetes management and blood glucose monitoring.

Send Mrs Jose back to GP immediately since you do not want her to continue at this dose.

Correct! Wrong!

8. The following can be said of Qtern

Qtern does not need to be ceased before or during surgery. In fact, it is suggested it be continued during surgery to stabilize glucose levels during these times of stress.

Individuals starting on this medication do not need to be counselled on diabetic ketoacidosis.

Probiotics are the best course of action for anyone on this medication that gets repeated genital infections.

Qtern is a combination of saxagliptin and dapagliflozin

Correct! Wrong!

9. Which of the is true when discussing Trajentamet?

Is a combination of metformin and linagliptin

Gastrointestinal side effects are common and include nausea, and diarrhoea but sometimes can include constipation. Lowering the dose can sometimes alleviate the effects.

Should be ceased before surgery, when an individual is unwell or not eating nor drinking adequately. Referral to appropriate health care professional for advice should be sought.

All of above

Correct! Wrong!

10. Which is true when discussing Nesinamet?

It is a combination of metformin and alogliptin.

It is a combination of metformin XR and alogliptin.

It can be used in children as young as 10.

It can cause hypoglycaemia and therefore pharmacists should counsel all those starting on this medicine how to treat any blood glucose level under 4mmol/L with 15gm of refined sugar followed by some long-acting carbohydrate.

Correct! Wrong!

11. You are a HMR pharmacist currently doing a review for Mrs Black who has had diabetes for over twenty years. Along with a list of all her medications, you are privy to receive a copy of her latest blood results. Despite having had diabetes for a significant time, Mrs Black is doing well, understands her diabetes, is monitoring her levels once a day before breakfast and is up to date with all her health reviews. The one long term health issue she has is some kidney damage from her diabetes. Latest results show her eGFR is 43 ml/min/1.73m2. Her last HbA1c is 7.3% (56 mmol/mol IFCC, appropriate for her age at 73 years old and length of diabetes). Her diabetes management includes healthy eating, physical activity, stress management and Janumet. Based on your information, what is the correct dose for Mrs Black’s kidney function.

JANUMET 50 mg/1000 mg once a day at breakfast

JANUMET 50 mg/1000 mg once at breakfast and once with the evening meal

JANUMET 50 mg/850 mg once a day at breakfast

JANUMET 50 mg/850 mg once at breakfast and once with the evening meal

Correct! Wrong!

12. Glyxambi tablets are the combination of which two medicines used for the treatment of type 2 diabetes.

A) Sitagliptin and metformin

B) Linagliptin and metformin

C) Sitagliptin and empagliflozin

D) Linagliptin and empagliflozin

Correct! Wrong!

Fixed Dose Quiz

Better luck ! next time..

1. Fixed dose combination tablets have been shown to:

2. Glucovance is a combination of what two individual medicines.

3. Side effects of Avandamet include:

5. Which of the following about Galvumet is true:

6. Which of the following is true of Xigduo XR?

8. The following can be said of Qtern

9. Which of the is true when discussing Trajentamet?

10. Which is true when discussing Nesinamet?

12. Glyxambi tablets are the combination of which two medicines used for the treatment of type 2 diabetes.

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