Chapter 36 — Quiz
22 items. Answer key at the bottom. All items are dated to the chapter's frame: as of this writing, in 2026.
1. Why can this chapter not rate a claim about whether triple agonists will prevent more cardiovascular events than dual agonists?
- A. Because the compounds are proprietary
- B. Because no evidence can exist for the claim yet, and a rating requires evidence
- C. Because cardiovascular endpoints are unreliable
- D. Because the author lacks access to the trial data
2. Which of the following is a checkable, present-tense claim rather than a prediction?
- A. "Retatrutide will transform obesity treatment"
- B. "Oral small-molecule agonists are the future"
- C. "Retatrutide is in late-stage trials as of 2026"
- D. "The next generation will be far better than what exists now"
3. What does the 🔬 rating mean?
- A. Approval is likely within five years
- B. The compound has passed phase 2
- C. A serious question is being asked seriously, with no implied probability of success
- D. Evidence is mixed but leaning positive
4. The chapter states that most 🔬 becomes which rating?
- A. ✅
- B. ⚠️
- C. ❌
- D. It stays 🔬 indefinitely
5. Which single question does the chapter say to ask if you can only ask one?
- A. What phase, actually?
- B. What endpoint?
- C. Against what comparator?
- D. What is the base rate?
6. "Phase 2 optimism" refers to:
- A. Deliberate misreporting of phase 2 results
- B. The systematic tendency of phase 2 results to be more favorable than the phase 3 results that follow
- C. Investor enthusiasm during mid-stage development
- D. The higher approval rate of compounds that complete phase 2
7. A trial shows a drug significantly improves a blood biomarker. Which statement is correct?
- A. The drug has been shown to help patients
- B. The drug has been shown to move a biomarker
- C. The biomarker result is meaningless
- D. The result is equivalent to a hard outcome if the biomarker is well validated
8. Why does Chapter 28's sacubitril/valsartan result carry particular weight in this chapter's argument?
- A. It was the largest trial ever run
- B. Its comparator was an active drug already known to work
- C. It used a surrogate endpoint efficiently
- D. It was funded independently
9. Which of these is not a legitimate reason to move off the base rate for a specific compound?
- A. It is in phase 3 rather than preclinical
- B. A hard outcome has already been demonstrated for the same molecule in a related indication
- C. Approved drugs in the same mechanistic class have a track record
- D. The mechanism is elegant and well described
10. "Topline results" in a company press release are:
- A. A peer-reviewed publication
- B. A sponsor-selected summary of headline numbers, released before full data
- C. A regulatory filing
- D. The complete dataset, minus safety information
11. What does SNAC do in oral semaglutide?
- A. It is the active drug
- B. It binds the GLP-1 receptor with higher affinity
- C. It transiently raises local pH and promotes absorption across the gastric epithelium
- D. It extends half-life by binding albumin
12. Oral semaglutide's bioavailability is approximately:
- A. 1 percent
- B. 10 percent
- C. 40 percent
- D. 90 percent
13. What is orforglipron?
- A. A modified peptide with an absorption enhancer
- B. A non-peptide, small-molecule GLP-1 receptor agonist in late-stage development
- C. An amylin analog
- D. A monoclonal antibody
14. According to §36.4, which mechanism can engineering not defeat by extending a drug's duration?
- A. Renal filtration
- B. Proteolysis by DPP-4
- C. Receptor desensitization and downregulation
- D. Hepatic metabolism
15. Which best states the chapter's position on longer dosing intervals?
- A. Longer is better, and the trend should continue
- B. Longer is worse and should be resisted
- C. Duration is a trade-off being optimized, not a scale being climbed
- D. Duration is irrelevant once weekly dosing is achieved
16. Which pair correctly describes retatrutide and cagrilintide?
- A. Both are dual GLP-1/GIP agonists
- B. Retatrutide is a triple GLP-1/GIP/glucagon agonist; cagrilintide is a long-acting amylin analog
- C. Both are amylin analogs
- D. Retatrutide is an amylin analog; cagrilintide is a triple agonist
17. A new compound produces more weight loss than tirzepatide. What has been established about cardiovascular events?
- A. Proportionally greater benefit
- B. Equivalent benefit
- C. Nothing; that is a separate claim requiring its own trial
- D. Benefit can be inferred if the weight difference is large enough
18. Regarding lean mass loss during substantial weight loss, which statement is established?
- A. It is specific to GLP-1 drugs
- B. It occurs with weight loss from any cause and has been documented for decades
- C. It has been shown to cause functional impairment in most patients
- D. It is fully prevented by resistance training
19. What endpoint would actually settle whether a muscle-preserving agent helps?
- A. Lean mass on DEXA
- B. Percent body fat
- C. Function — strength, mobility, falls, independence
- D. Serum myostatin concentration
20. Peptide receptor radionuclide therapy consists of:
- A. A cytotoxic peptide given intravenously
- B. A somatostatin-analog peptide, a chelator, and a therapeutic radioisotope
- C. An antibody carrying a radioisotope
- D. A peptide delivered into the cerebrospinal fluid
21. Why do GLP-1 drugs produce central effects without crossing the blood-brain barrier in bulk?
- A. They are small enough to diffuse across
- B. Circumventricular organs lack a complete barrier, and vagal afferents provide an indirect route
- C. They are actively transported by the transferrin receptor
- D. They do not actually produce central effects
22. What does generic entry after patent expiry change?
- A. The strength of the evidence that a drug works
- B. The size of the treatment effect
- C. Price and access, but not any evidence about efficacy
- D. The population in which the drug was studied