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Thrombocytopenia, nausea, vomiting, diarrhea, GLP-1 also lowers glucagon secretion from
anaphylaxis reactions and anorexia are reported pancreatic alpha cells, leading to reduced hepatic
side effects of the drug. glucose production.

90.(e) Since creatinine clearance helps predicting By increasing and prolonging active incretin levels,
renal function of patients, the periodic monitoring Januvia increases insulin release and decreases
of it is required for a nephrotoxic drug like glucagon levels in the circulation in a glucose-
Methotrexate. dependent manner.

Checking the SGPT level helps monitoring the liver It is indicated as an adjunct to diet and exercise to
function. improve glycemic control in adults with type 2
diabetes mellitus. The recommended dose of
Whole blood counts may help predicting the bone Januvia is 100 mg once daily. Januvia can be taken
marrow suppression that has been frequently with or without food. Hypoglycemia is commonly
reported with high doses of Methotrexate. reported side effect of Januvia.

91.(d) The active ingredient found in Paregoric is In combination with Metformin, it is available under
camphorated opium tincture. Paregoric is indicated the brand names Janumet and Janumet XR.
for the treatment of diarrhea. This medication
should not be used by patients having diarrhea 93. (a) Humalog (Insulin Lispro) is human insulin
associated with food poisoning or drug-induced analog that is a rapid-acting blood glucose lowering
ulcerative colitis, since in such cases it reduces the agent. It is indicated for the treatment of diabetes
motility of the intestine which further causes a mellitus. It has a more rapid onset (about 10 to 15
delay in the removal of toxin from the G.I. tract. minutes) and a shorter duration of action than
human regular insulin.
92.(c) Januvia (Sitagliptin phosphate) is an orally-
active inhibitor of the dipeptidyl peptidase-4 (DPP- Pharmacokinetic studies showed Humalog to be
4) enzyme. Each film-coated tablet of Januvia equipotent to human regular insulin (i.e., one unit
contains 25, 50, or 100 mg Sitagliptin. Sitagliptin is a of Humalog has the same glucose-lowering
DPP-4 inhibitor, which is believed to exert its capability as one unit of human regular insulin), but
actions in patients with type 2 diabetes by slowing with more rapid activity. The quicker glucose-
the inactivation of incretin hormones. lowering effect of Humalog is related to the more
rapid absorption rate from subcutaneous tissue.
Incretin hormones, including glucagon-like peptide-
1 (GLP-1) and glucose-dependent insulinotropic When used as a meal-time insulin, Humalog should
polypeptide (GIP), are released by the intestine be given within 15 minutes before or immediately
throughout the day, and levels are increased in after a meal. Human regular insulin is best given 30
response to a meal. to 60 minutes before a meal. To achieve optimal
glucose control, the amount of longer-acting insulin
These hormones are rapidly inactivated by the being given may need to be adjusted when using
enzyme, DPP-4. When blood glucose concentrations Humalog. Hypoglycemia is the principal side effect
are normal or elevated, GLP-1 and GIP increase of the drug.
insulin synthesis and release from pancreatic beta
cells by intracellular signaling pathways involving 94.(e) Marplan (Isocarboxazid), Nardil (Phenelzine)
cyclic AMP. and Parnate (Tranylcypromine) are MAO-A
inhibitors. They inhibit the Monoamine oxidase
enzyme which is responsible for metabolism of
serotonin and catecholamines. They are indicated

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