No chew or crush take with food to avoid GI upset Dehydration decreases renal

No chew or crush take with food to avoid gi upset

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No chew or crush, take with food to avoid GI upset, Dehydration decreases renal function and causes lactic acidosis Monitor wt gain, swelling of ankle, drowsiness or SOB Alpha-glucosidase Inhibitors Acarbose (Precose), Miglitol (Glyset) Thiazolidinediones (TZD) Pioglitazone (Actos), rosiglitazone (Avandia) MOA Inhibit absorption of complex carbohydrates (CHO) from small bowel, lowering BG after meals; Adjunctive therapy; No stimulating beta cell, no weight gain Improve target cell response to insulin by activating receptor cell proteins that improve insulin action; Increase utilization of insulin by liver & muscle cells; reduce liver glucose production Contra- indicatio n Inflammatory bowel dz, obstruction; renal impairment; pregnancy; children Chronic liver dz; NYHA class III-IV (d/t fluid retention exacerbates HF & cardio toxicity); Pregnancy C ADRs (most common) flatulence Cardiovascular effects: wt gain, HTN, HF, MI, Lipid profiles (increase TG, HDL, LDL), interacti on Acarbose: digoxin; Miglitol: propranolol, ranitidine Birth control requiring higher dosing; Watch for drugs metabolized by CYP 3A4: Coricidin, corticosteroids, ketoconazole Clinical use Useful for high postprandial BG levels with first bite of each meal Initial dose 25mg tid, increase dose in 4-8 wk intervals Adjunctive therapy w/ sulfonylurea (monitor BG) or insulin (10-25% use of insulin decrease) Monitor Baseline & annual renal & hepatic function every 3m0 for the first yr Liver enzymes at start of therapy, indication of MI or HF Educatio n Mild-mod hypoglycemia-use glucose (dextrose) not sucrose (cane sugar); severe—IV glucose or glucagon Take once daily in the morning Meglitinides Dipeptidyl Peptidase-4 Inhibitors
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Nateglinide (Starlix), repaglinide (Prandin) (DPP4s) “Gliptins” Sitagliptin (Januvia), Saxagliptin (Onglyza), linagliptin, alogliptin MOA Increases insulin release from beta cells by closing potassium channels, which leads to the opening of calcium channels and it is the influx of calcium that releases the insulin Lowering postprandial BG only, short acting act on the incretin hormone system to have an indirect effect on increasing insulin production Break down GLP-1 & gastric inhibitory polypeptide releasing in response to a meal Suppress the release of glucagon by the pancreas Promotes pre & post prandial glucose, mild wt. loss Contra- indicatio n Cautious use in hepatic impairment & severe renal/ adrenal/pituitary impairment (low glucose); Pregnancy C Cautious use in renal impairment; Saxagliptin reverse progression of proteinuria after 2 yr use; Pregnancy C; not approved in children ADRs Hypoglycemia in A1c < 8%, no use of prior oral agents; wt gain (most common) edema, HA, UTI; hypoglycemia for combined with secretagogues interacti on CYP 3A4 and CYP 2C9 inducers increase meglitinide metabolism; Antifungals (ketoconazole) and antimicrobials (erythromycin) inhibit metabolism, increasing risk for hypoglycemia ACEIs: increase risk of angioedema DGX CYP3A4 & CYP 2C8 Clinical use Monotherapy or combination therapy w/ TZD, metformin Monotherapy for sitagliptin and saxagliptin &
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  • Spring '14
  • Henrikson,J
  • Hypoglycemia

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