A pharmacist is reviewing a new prescription prepared by a pharmacy technician. The prescription label reads: Precose 25mg PO TID x 30 days; Qty: 90 5 Refills. Which of the following acts done by the pharmacist is the most appropriate?
a. Fill as it is.
b. Call the prescriber to verify the Precose dose.
c. Call the prescriber to verify the number of refills.
d. Ask the technician to add an auxiliary label: "Take With Meals".
e. Counsel the patient that this drug may cause "Severe Constipation".
Answer: d. Acarbose (Precose) is an oral alpha-glucosidase inhibitor for use in the management of type 2 diabetes mellitus. It delays the digestion of ingested carbohydrates, thereby resulting in a smaller rise in blood glucose concentration following meals. As a consequence of plasma glucose reduction, Precose reduces levels of glycosylated hemoglobin in patients with type 2 diabetes mellitus.
In contrast to sulfonylureas, Precose does not enhance insulin secretion. The antihyperglycemics action of acarbose results from a competitive, reversible inhibition of pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase enzymes. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine, while the membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and other monosaccharides in the brush border of the small intestine. In diabetic patients, this enzyme inhibition results in a delayed glucose absorption and a lowering of postprandial hyperglycemia.
The recommended starting dosage of Acarbose (Precose) is 25 mg given orally three times daily at the start (with the first bite) of each main meal . However, some patients may benefit from more gradual dose titration to minimize gastrointestinal side effects. This may be achieved by initiating treatment at 25 mg once per day and subsequently increasing the frequency of administration to achieve 25 mg t.i.d.
Hypoglycemia, gas, bloating and diarrhea are commonly reported side effects of Acarbose (Precose).

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