PEBC Part I (MCQ) · Competency 1A Clinical Care (about 50% of Part I)

Diabetes, Thyroid, Bone & Hormones

Endocrine items cover diabetes therapy and safety (hypoglycemia, sick days, renal dosing), thyroid replacement, osteoporosis, contraception and menopause, applying Diabetes Canada, ATA, Osteoporosis Canada and SOGC guidance.

1A Clinical Care2 min read7 sections

Checked against the Diabetes Canada CPG (2018) and 2024 pharmacologic update (Can J Diabetes 2024;48:415); ATA hypothyroidism (2014), hyperthyroidism (2016) and pregnancy (2017) guidelines; Osteoporosis Canada 2023 (CMAJ 2023;195:E1333); SOGC contraception and menopause guidance; checked 13 Oct 2026. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC).

Must-know for the exam

Hypoglycemia is glucose below 4.0 mmol/L in insulin or secretagogue users: 15 g fast carbohydrate, retest in 15 minutes.
Unconscious hypoglycemia: glucagon 1 mg SC/IM (or nasal 3 mg) and call 911; nothing by mouth.
Metformin is contraindicated below eGFR 30; use caution between 30 and 60.
Add an SGLT2 inhibitor or GLP-1 RA with CV benefit in ASCVD, regardless of A1C; prefer SGLT2i in heart failure.
Sick days (SADMANS): hold sulfonylureas, ACEI, diuretics, metformin, ARB, NSAIDs and SGLT2 inhibitors during dehydrating illness.
Basal insulin: start 10 units daily and titrate by 1 unit/day to the fasting target.
Levothyroxine: empty stomach, separate from calcium and iron by about 4 hours; recheck TSH in 6-8 weeks.
Methimazole with fever and sore throat: stop and get a CBC (agranulocytosis); PTU in the first trimester.
Denosumab must not simply be stopped: plan follow-on bisphosphonate therapy.
Estrogen therapy with a uterus needs a progestogen; enzyme inducers reduce hormonal contraceptive effect.

On this page · 7 sections

Traps that cost marks

Treating hypoglycemia with slow-acting foods or waiting too long to retest.
Giving oral fluids to an unconscious person with hypoglycemia.
Requiring symptoms or an OGTT when two abnormal tests already confirm diabetes.
Continuing full-dose metformin as kidney function declines.
Withholding cardioprotective agents because the A1C is at target.
Choosing a GLP-1 RA over an SGLT2 inhibitor when heart failure is the dominant comorbidity.
Starting basal insulin at a high dose or titrating too slowly.
Freezing insulin or leaving it in a hot or cold car.

How this is tested on Part I

Questions use realistic glucose, A1C, TSH and bone density data. Expect calculations (insulin days' supply, weight-based levothyroxine) and counselling (alendronate administration, missed pills).

Type 2 diabetes therapy

A1C target 7.0% or lower for most; relax to 8.0-8.5% in frail older adults.

A1C 1.5% or more above target at diagnosis: consider metformin plus a second agent.

SGLT2 inhibitors: hold 3 days before surgery (euglycemic DKA risk).

Avoid glyburide in older adults; sitagliptin needs renal dose reduction, linagliptin does not.

Long-term metformin: check vitamin B12, especially with neuropathy.

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Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.