a-glucosidase & DPP-IV inhibitors

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Author:
jdonaldson
ID:
102333
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a-glucosidase & DPP-IV inhibitors
Updated:
2011-09-17 20:31:38
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james James donaldson Donaldson usp USP diabetes Diabetes
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  1. Which medications are classified as alpha-glucosidase inhibitors?
    • 1. acarbose (Precose)
    • 2. miglitol (Glyset)
  2. What are common adverse fx with alpha-glucosidase inhibitors?
    • Diarrhea and abdominal pain (decrease over time)
    • Flatulence
  3. 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).
  4. 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)
  5. 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
  6. True or False?
    The alpha-glucosidase inhibitors should be taken even if a meal is skipped.
    False
  7. True or False?
    Meglitinides target post-prandial glucose levels.
    True.
  8. True or False?
    Alpha-glucosidase inhibitors target both post-prandial and fasting glucose levels.
    • False.
    • Alpha-glucosidase inhibitors target only post-prandial glucose levels.
  9. 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.
  10. True or False?
    Only patients who consume a diet high in complex carbohydrates will experience significant reductions in BG levels.
    True.
  11. What medications are classified as DPP-IV inhibitors?
    • 1. sitagliptin (Januvia)
    • 2. saxagliptin (Onglyza)
  12. 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)
  13. 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
  14. 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)
  15. 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
  16. Roughly how much will the DPP-IV inhibitors lower A1C?
    0.4 - 0.8 %
  17. 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
  18. When combined with a ________, DPP-IVs cause _______ to a larger extent.
    • 1. TZD
    • 2. peripheral edema
  19. DPP-IV inhibitors may preserve _____ _____ function.
    Beta cell

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