Other Oral Diabetes Medications Flashcards
What is the mechanism of action of thiazolidinediones (TZDs)?
They increase insulin sensitivity
What are examples of TZDs?
pioglitazone (Actos) and rosiglitazone (Avandia)
What is common dosing of TZDs?
pioglitazone (Actos) - 15-45 mg/day
rosiglitazone (Avandia) - 4-8 mg/day
What are considerations for TZDs?
TZDs may cause or worsen CHF. Monitor for edema and weight gain. Increased peripheral fracture risk, Actos may increase the risk for bladder cancer.
How much can TZDs lower A1C?
0.5-1%
What is the mechanism of action for glucosidase inhibitors?
They delay carb absorption
What are examples of glucosidase inhibitors?
acarbose (Precose) and miglitol (Glyset)
What is common dosing for glucosidase inhibitors?
25-100 mg with meals; max dose 300 mg/day
What are considerations for glucosidase inhibitors?
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.
How much can glucosidase inhibitors lower A1C?
1-2%
What is the mechanism of action for meglitinides?
stimulates rapid burst of insulin with meals
What are examples of meglitinides?
repaglinide (Prandin) and neteglinide (Starlix)
What is common dosing of meglitinides?
repaglinide (Prandin) - 0.5-4 mg with meals - metabolized in liver
neteglinide (Starlix) - 60-120 mg with meals - eliminated via kidney
What are side effects of meglitinides?
Hypoglycemia and weight gain
How much can meglitinides lower blood glucose?
1-2%
What is the mechanism of action of dopamine receptor agonists?
Reset the circadian rhythm
What is an example of a dopamine receptor agonist?
bromocriptine mesylate - quick release “QR” cycloset
What is dosing of dopamine receptor agonists?
bromocriptine mesylate - quick release “QR” cycloset 1.6-4.8 mg/day
What are considerations and side effects for dopamine receptor agonists?
Need to take within 2 hours of waking.
Side effects: nausea, headache, fatigue, hypotension, syncope, and somnolence
How much can dopamine receptor agonists lower A1c?
0.6-0.9%
What is the mechanism of action of bile acid sequestrants?
decrease cholesterol and blood glucose levels
What is an example of a bile acid sequestrant?
colesevelam HCL (Welchol)
What is dosing of a bile acid sequestrant?
up to six 625 mg pills (3 in AM and 3 in PM)
3.75 g packet in 4-8 ounces of fluid
When shouldn’t bile acid sequestrants be used?
when there is history of bowel obstruction, triglycerides are greater than 500 or with pancreatitis.
What are other considerations for bile acid sequestrants?
can decrease the absorption of some medications and vitamins. Lowers LDL by 15-30%. Side effects are GI in nature.
How much can bile acid sequestrants lower A1C?
0.5%
