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Which medications are classified as alpha-glucosidase inhibitors?
- 1. acarbose (Precose)
- 2. miglitol (Glyset)
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What are common adverse fx with alpha-glucosidase inhibitors?
- Diarrhea and abdominal pain (decrease over time)
- Flatulence
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Alpha-glucosidase inhibitors are contraindicated in pts with...
- - Conditions of the bowel
- - Patients with a SCr > 2 mg/dL?? (units?)
- (some metabolites of acarbose are absorbed and renally excreted. Miglitol is excreted renally unchanged).
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Dosing for acarbose and miglitol -
- Titration method:
- 1. 25 mg po once daily with a meal -->
- 2. 25 mg po ac meals -->
- 3. 50 mg po ac meals -->
- 4. 100 mg po ac meals
- *Take with first bite of meal
- ** Adjustments should be made at 4-8 week intervals
- *** Increase only if pt tolerates current dose (GI side effects)
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What is the dosing caveat with acarbose?
- If pt is ≤ 60 kg, 50 mg TID ac meals is max dose
- If pt is > 60 kg, 100 mg TID ac meals is max dose
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True or False?
The alpha-glucosidase inhibitors should be taken even if a meal is skipped.
False
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True or False?
Meglitinides target post-prandial glucose levels.
True.
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True or False?
Alpha-glucosidase inhibitors target both post-prandial and fasting glucose levels.
- False.
- Alpha-glucosidase inhibitors target only post-prandial glucose levels.
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If hypoglycemia occurs with an alpha-glucosidase inhibitor, how should it be rapidly corrected?
- Treat with glucose tablets/gel or lactose.
- Sucrose or other complex carbs will not be broken down rapidly due to the MOA of the drug.
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True or False?
Only patients who consume a diet high in complex carbohydrates will experience significant reductions in BG levels.
True.
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What medications are classified as DPP-IV inhibitors?
- 1. sitagliptin (Januvia)
- 2. saxagliptin (Onglyza)
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True or False?
1. The DPP-IV inhibitors cause weight gain.
2. The DPP-IV inhibitors may cause hypoglycemia
- 1. False
- 2. True (low risk as monotherapy. Risk increases when added in combo with another agent, especially SUs --> may need to lower dose of SUs)
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Dosing for sitagliptan (Januvia) -
- 100 mg po daily
- *CrCl 30 - < 50 mL/min --> 50 mg po daily
- *CrCl < 30 mL/min --> 25 mg po daily
- *See notes for SCr levels
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Dosing for saxagliptin -
- 5 mg po once daily
- * 2.5 mg po once daily if CrCl ≤ 50 mL/min or if person is taking a strong CYP 3A4/5 inhibitor (ketoconazole, protease inhibs, clarithromycin)
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What should be monitored in a pt taking a DPP-IV inhibitor?
- - renal function q 6-12 months
- - SMBG should occur more frequently at initiation
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Roughly how much will the DPP-IV inhibitors lower A1C?
0.4 - 0.8 %
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True or False?
The DPP-IV inhibitors mostly lower fasting BG levels.
- False.
- The DPP-IV inhibitors lower post-prandial BG by about 40 - 50 mg/dL, while lowering fasting BG by about 10 - 15 mg/dL
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When combined with a ________, DPP-IVs cause _______ to a larger extent.
- 1. TZD
- 2. peripheral edema
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DPP-IV inhibitors may preserve _____ _____ function.
Beta cell
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