MCA 1-2: diabetes

Question 1

α-Glucosidase Inhibitors

Answer 1

acarbose (Precose)
miglitol (Glyset)

Question 2

α-Glucosidase Inhibitors
1. MoA
2. SE
3. Considerations

Answer 2

1. Delays absorption of complex carbohydrates (starches) from GI tract
2. Gas, abdominal pain, diarrhea
3. Take with the first bite of each main meal.

Question 3

Biguanides

Answer 3

metformin
(Fortamet Glucophage, Glucophage XR, Glumetza, Riomet)

Question 4

Biguanides
1. MoA
2. SE
3. Considerations

Answer 4

1. ↓ Liver glucose production. ↑ Insulin sensitivity. Improves glucose uptake by tissues, especially muscles
2. Diarrhea, lactic acidosis
3. • Must be held 1–2 days before IV contrast media given and for 48 hr after.
     - Take with food to minimize GI side effects.

Question 5

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

Answer 5

alogliptin (Nesina)

linagliptin (Tradjenta)

saxagliptin (Onglyza)

sitagliptin (Januvia)

Question 6

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
1. MoA
2. SE
3. Considerations

Answer 6

1. ↑ Activity of incretins. ↑ Insulin release from pancreatic β-cells. ↓ Liver glucose production
2. Pancreatitis, allergic reactions
3. Take with or without food.

Question 7

Dopamine Receptor Agonists

Answer 7

bromocriptine (Cycloset)

Question 8

Dopamine Receptor Agonists
1. MoA
2. SE
3. Considerations

Answer 8

1. Activates dopamine receptors in central nervous system. Unknown how it improves glucose levels
2. Orthostatic hypotension, nausea, headache, fatigue
3. Take with food at the same time each day.
   Teach the patient to change positions slowly.

Question 9

Meglitinides

Answer 9

nateglinide repaglinide

Question 10

Meglitinides
1. MoA
2. SE
3. Considerations

Answer 10

1. Stimulates a rapid and short-lived release of insulin from the pancreas
2. Weight gain, hypoglycemia
3. -Take any time from 30 min before each meal right up to the time of the meal.

• They should not be taken if a meal is skipped.

Question 11

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

Answer 11

canagliflozin (Invokana)

dapagliflozin (Farxiga)

empagliflozin (Jardiance)

ertugliflozin (Steglatro)

Question 12

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors
1. MoA
2. SE
3. Considerations

Answer 12

1. ↓ Renal glucose reabsorption. ↑ Urinary glucose excretion
2. Increased risk of genital and urinary tract infections, hypoglycemia
3. • Take in the morning before the first meal of the day.

• Teach the patient to drink 1–2 glasses of water each day above their normal intake.

Question 13

Sulfonylureas

Answer 13

glimepiride (Amaryl)

glipizide (Glucotrol, Glucotrol XL)

glyburide (DiaBeta, Glynase)

Question 14

Sulfonylureas
1. MoA
2. SE
3. Considerations

Answer 14

1. ↑ Insulin release from pancreatic islets. ↓ Glycogenolysis and gluconeogenesis. Enhances cellular sensitivity to insulin
2. Weight gain, hypoglycemia
3. • Take 30 min before meals.

• Avoid alcohol use.

Question 15

Thiazolidinediones

Answer 15

pioglitazone (Actos) rosiglitazone (Avandia)

Question 16

Thiazolidinediones
1. MoA
2. SE
3. Considerations

Answer 16

1. ↑ Glucose uptake in muscle. ↓
   Endogenous glucose production
2. Weight gain, edema. pioglitazone: ↑ Risk for bladder cancer and worsen heart failure. rosiglitazone: ↑ Risk for cardiovascular events (e.g., myocardial infarction, stroke)
3. Taken with or without food.

Question 17

Combination Oral Therapy

Answer 17

• Actoplus Met, Actoplus Met XR
• Duetact
• Glucovance
• Glyxambi
• Invokamet, Invokamet XR
• Janumet, Janumet XR
• Jentadueto, Jentadueto XR
• Kazano
• Kombiglyze
• Oseni
• PrandiMet
• Qtern
• Qternment XR
• Segluromet
• Steglujan
• Synjardy, Synjardy XR
• Trijardy
• Xigduo

Question 18

Actoplus Met, Actoplus Met XR
1. MoA
2. SE
3. Considerations