Other Oral Diabetes Medications

Question 1

What is the mechanism of action of thiazolidinediones (TZDs)?

Answer 1

They increase insulin sensitivity

Question 2

What are examples of TZDs?

Answer 2

pioglitazone (Actos) and rosiglitazone (Avandia)

Question 3

What is common dosing of TZDs?

Answer 3

pioglitazone (Actos) - 15-45 mg/day
rosiglitazone (Avandia) - 4-8 mg/day

Question 4

What are considerations for TZDs?

Answer 4

TZDs may cause or worsen CHF. Monitor for edema and weight gain. Increased peripheral fracture risk, Actos may increase the risk for bladder cancer.

Question 5

How much can TZDs lower A1C?

Answer 5

0.5-1%

Question 6

What is the mechanism of action for glucosidase inhibitors?

Answer 6

They delay carb absorption

Question 7

What are examples of glucosidase inhibitors?

Answer 7

acarbose (Precose) and miglitol (Glyset)

Question 8

What is common dosing for glucosidase inhibitors?

Answer 8

25-100 mg with meals; max dose 300 mg/day

Question 9

What are considerations for glucosidase inhibitors?

Answer 9

start at a low dose and increase at 4-8 week intervals to decrease GI effects. Use caution with liver or kidney problems. If hypoglycemic treat with glucose tablets.

Question 10

How much can glucosidase inhibitors lower A1C?

Answer 10

1-2%

Question 11

What is the mechanism of action for meglitinides?

Answer 11

stimulates rapid burst of insulin with meals

Question 12

What are examples of meglitinides?

Answer 12

repaglinide (Prandin) and neteglinide (Starlix)

Question 13

What is common dosing of meglitinides?

Answer 13

repaglinide (Prandin) - 0.5-4 mg with meals - metabolized in liver
neteglinide (Starlix) - 60-120 mg with meals - eliminated via kidney

Question 14

What are side effects of meglitinides?

Answer 14

Hypoglycemia and weight gain

Question 15

How much can meglitinides lower blood glucose?

Answer 15

1-2%

Question 16

What is the mechanism of action of dopamine receptor agonists?

Answer 16

Reset the circadian rhythm

Question 17

What is an example of a dopamine receptor agonist?

Answer 17

bromocriptine mesylate - quick release “QR” cycloset

Question 18

What is dosing of dopamine receptor agonists?

Answer 18

bromocriptine mesylate - quick release “QR” cycloset 1.6-4.8 mg/day

Question 19

What are considerations and side effects for dopamine receptor agonists?

Answer 19

Need to take within 2 hours of waking.
Side effects: nausea, headache, fatigue, hypotension, syncope, and somnolence

Question 20

How much can dopamine receptor agonists lower A1c?

Answer 20

0.6-0.9%

Question 21

What is the mechanism of action of bile acid sequestrants?

Answer 21

decrease cholesterol and blood glucose levels

Question 22

What is an example of a bile acid sequestrant?

Answer 22

colesevelam HCL (Welchol)

Question 23

What is dosing of a bile acid sequestrant?

Answer 23

up to six 625 mg pills (3 in AM and 3 in PM)

3.75 g packet in 4-8 ounces of fluid

Question 24

When shouldn’t bile acid sequestrants be used?

Answer 24

when there is history of bowel obstruction, triglycerides are greater than 500 or with pancreatitis.

Question 25

What are other considerations for bile acid sequestrants?

Answer 25

can decrease the absorption of some medications and vitamins. Lowers LDL by 15-30%. Side effects are GI in nature.

Question 26

How much can bile acid sequestrants lower A1C?

Answer 26

0.5%