Flashcards in "Newer" Non-Insulin Analogues Deck (20)
List the 3 "newer" options of non-insulin analogues.
- GLP-1 agonist
- DPP-IV inhibitor
- SGLT2 inhibitor
What are incretins?
Gut peptides that modulate insulin secretions in response to nutrients in the bowel
GLP-1 Agonist MOA
-Stimulate GLP-1 receptor in incretin system
-**Stimulates insulin secretion, inhibition of glucagon secretion, hepatic glucose production, gastric emptying, and appetite
-Prevent peptide inactivation by DPP-IV --> inc active levels of incretin hormones
What are the GLP-1 Agonists? Which is the only PO option?
-Semaglutide (PO or SC)
GLP-1 Agonist Indications
-Weight loss aid (higher dose liraglutide) w/ diet and exercise
-10# weight loss at 1 yr
-Approved for pts with or without DM and BMI 30 or higher or 27 or higher and weight-related condition
GLP-1 Agonist Pearls
-**Dec A1c 1-1.5%, weight loss/appetite suppression (sema, lira dula, ER exenatide > others)
-**Store in fridge
-Antibodies may develop
GLP-1 Agonist Precautions/CI
-**Slows gastric emptying--> CI in mod-severe gastroparesis!
-Thyroid issue--> refer to JB
GLP-1 Agonist ADRs
-GI intolerance (nausea) IR >ER
-BBW thyroid cancer
-**Acute pancreatitis/pancreatic CA--> monitor high risk pts
What are the DPP-IV Inhibitors?
DPP-IV Inhibitors Indications
DPP-IV Inhibitor Pearls
-Dec A1c 0.5-1.0%
-**More effective at reducing postprandial BG than fasting BG
-Caution w CKD
-Hypersensitivity rxn (urticaria)
-Severe joint pain (rare)
You want to put your DMII patient on an SGLT2 inhibitor. Which one will you choose?
SGLT2 Inhibitor MOA
-SGLT2 is transmembrane protein in kidney
-SGLT2 inhibition dec glucose/Na reabsorption, inc urinary glucose/Na, and dec [BG]/BP
SGLT2 Inhibitors Indications
When should your patient take their empagliflozin?
Before the first meal of the day
A patient is at increased risk of AKI if they are on an SGLT2 inhibitors + what other drugs?
-Monitor renal fcn
-Some wt loss
-Dec A1c 0.5-1.0%, dec fasting and post-prandial BG