1. Mr. Wright is 4 months status-post myocardial infarction. His past medical history is also significant for type 2 diabetes mellitus and hypertension. In addition to better controlling his blood pressure, he now also takes a high-intensity statin (HMG Co-A reductase inhibitor) in addition to his metformin. His A1C today in clinic is 7.0%. He asks if there are any other medications he should use to reduce his risk of experiencing another major adverse cardiovascular event. As his pharmacist, which response is most accurate?

2. Mrs. Bean has been living with type 2 diabetes for the past 15 years. Although she has struggled to manage her hyperglycemia in the past, her A1C is now near goal at 7.2% using metformin 500 mg by mouth 3 times daily and dulaglutide 1.5 mg SC weekly. Unfortunately, her kidney function has continued to decline. Today her eGFR is 50 mL/min, SrCr 1.2, and urine-albumin creatinine ratio is 160 mg/g. As her pharmacist, what drug therapy modifications do you recommend at this time as supported by the current Standards of Medical Care in Diabetes?

3. A patient with type 2 diabetes presents to your pharmacy counter complaining of dizziness when standing quickly. His seated blood pressure is 134/88 mm Hg. His standing blood pressure is 110/76 mm Hg. Which of the following medications is most likely to cause or exacerbate this symptom?

4. Mrs. CW is concerned about her heart health, although she has no past medical history for cardiovascular disease. However, she well knows that she should quit smoking, lose some weight, and better control her high blood pressure. Still, her A1C is 8.2%. Which of the medications listed below currently has the best evidence supporting its use to lower her risk for experiencing a major adverse cardiovascular event (MACE) considering she is “high risk” but has not yet experienced a CV event?

5. Mr. GI has a very sensitive gut. In fact, he often avoids foods or situations that will knowingly make him feel nauseous. However, he wants to add another therapy to better manage his type 2 diabetes and lower his body weight. He has seen commercials on television and is interested in trying a product from the GLP-1 RA class. In addition to patient education about eating slowly and to stop eating once full, which specific GLP-1 RA product might be best for him to try?

Evaluation Questions

6. How confident are in your treatment choices for the patients in this posttest?

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