Oral Diabetes Meds

Question 1

Pioglitazone

Answer 1

TZD

Insulin Sensitizer

1x/day with or without food 15mg to 45mg/day titration (max dose)
** titration won’t occur for 4 wks, may take up to 12 wks

Question 2

Rosiglitazone

Answer 2

TZD

Insulin Sensitizer

4mg QD (max dose) or 2 mg BID

Question 3

Metformin

Answer 3

Biguanide

Starting: 500mg QD
Adjusting: weekly as tolerated Dosing regimen: 1-3x/day (max 2000- 2550mg)

Question 4

Glyburide

Answer 4

Sulfonylurea

Insulin Secretagogue

1x-2x/day with breakfast
5mg initial dose;
20 mg for max clinical effect
40mg max

*not recommended for CrCl<60; avoid use in renal impairment

Question 5

Glipizide (micronized)

Answer 5

Sulfonylurea

Insulin Secretagogue

1.5mg initial
6mg max clinical effect
12mg max

*drug of choice in moderate renal insufficiency (IR formula 30min prior to food)

Question 6

Glipizide (non-micronized)

Answer 6

Sulfonylurea

Insulin Secretagogue

1x-2x/day
2.5-5mg initial
10mg max clinical
20 mg max

*drug of choice in moderate renal insufficiency (IR formula 30min prior to food)

Question 7

Glimepiride

Answer 7

Sulfonylurea

Insulin Secretagogue

QD with breakfast or first main meal
1-2mg initial
5mg max clinical effect
8mg max

*start with 1mg in renal insufficiency

Question 8

Nateglinide

Answer 8

Meglitinides

Insulin Secretagogue

120mg TID within 30min of meal
If close to A1c goal: 60mg TID start

*no renal/hepatic dosing adjustment

Question 9

Repaglinide

Answer 9

Meglitinides

Insulin Secretagogue

30 min prior to meal (up to 3x/day)
A1c <8% –> 0.5mg TID
A1c>8%–>1-2 mg TID
Max dose: 16mg/day Titration according to BG

• CrCl 20-40mL: start with 0.5mg
• clopidrogel –> 0.5mg max 4mg/day
• cyclosporine –>max 6mg/day

Question 10

Sitagliptine

Answer 10

DPP-4 Inhibitors

GFR>/= 45: 100mg QD
GFR< 45 and > 30: 50mg QD GFR <30: 25mg QD

Question 11

Saxagliptin

Answer 11

DPP-4 Inhibitors

2. 5 mg-5mg QD
   * eGFR<45 –> 2.5mg QD

Question 12

Linagliptin

Answer 12

DPP-4 Inhibitors

5mg QD
*no dosage adjustment for renal/hepatic impairment

Question 13

Alogliptin

Answer 13

DPP-4 Inhibitors

25mg QD
CrCl>/=30 too <60–>12.5mg QD CrCl <30–>6.25mg QD

Question 14

Thiazolidinediones (TZD)

Answer 14

Insulin sensitizer

Improves insulin sensitivity
enhance glucose uptake in muscle/adipose tissue
Inhibit gluconeogenesis
Selective agonist for PPAR-gamma

Question 15

Sulfonylurea

Answer 15

Insulin Secretagogue

stimulates insulin secretion from pancreatic beta cells
reduces glucose output from liver
improves insulin sensitivity and periphery

Question 16

Meglitinide

Answer 16

Insulin Secretagogue

Stimulates insulin release from pancreas

Question 17

DPP-4 Inhibitors

Answer 17

Enhances incretin system (GLP-1)
Glucose dependent insulin synthesis and secretion
Reduces glucagon

Question 18

Biguanide

Answer 18

Insulin Sensitizer

Decreases hepatic glucose production
Decreases intestinal absorption of glucose
Increases insulin sensitivity by increasing peripheral glucose uptake/utilization