"Newer" Non-Insulin Analogues Flashcards Preview

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Flashcards in "Newer" Non-Insulin Analogues Deck (20)
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1
Q

List the 3 “newer” options of non-insulin analogues.

A
  • GLP-1 agonist
  • DPP-IV inhibitor
  • SGLT2 inhibitor
2
Q

What are incretins?

A

Gut peptides that modulate insulin secretions in response to nutrients in the bowel

3
Q

GLP-1 Agonist MOA

A
  • Stimulate GLP-1 receptor in incretin system
  • **Stimulates insulin secretion, inhibition of glucagon secretion, hepatic glucose production, gastric emptying, and appetite
4
Q

DPP-IV MOA

A

-Prevent peptide inactivation by DPP-IV –> inc active levels of incretin hormones

5
Q

What are the GLP-1 Agonists? Which is the only PO option?

A
  • Exenatide
  • Semaglutide (PO or SC)
  • Liraglutide
  • Lixisenatide
  • Dulaglutide
6
Q

GLP-1 Agonist Indications

A
  • Mono/combo therapy
  • 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
7
Q

GLP-1 Agonist Pearls

A
  • **Dec A1c 1-1.5%, weight loss/appetite suppression (sema, lira dula, ER exenatide > others)
  • Rare hypoglycemia
  • **Store in fridge
  • Antibodies may develop
8
Q

GLP-1 Agonist Precautions/CI

A
  • CKD
  • **Slows gastric emptying–> CI in mod-severe gastroparesis!
  • Thyroid issue–> refer to JB
9
Q

GLP-1 Agonist ADRs

A
  • GI intolerance (nausea) IR >ER
  • BBW thyroid cancer
  • **Acute pancreatitis/pancreatic CA–> monitor high risk pts
  • Biliary/GB dz?
10
Q

What are the DPP-IV Inhibitors?

A
  • Sitagliptin*
  • Saxagliptin
  • Linagliptin*
  • Alogliptin
11
Q

DPP-IV Inhibitors Indications

A

-Mono/combo therapy

12
Q

DPP-IV Inhibitor Pearls

A
  • Dec A1c 0.5-1.0%
  • **More effective at reducing postprandial BG than fasting BG
  • Weight neutral
13
Q

DPP-IV ADRs

A
  • Caution w CKD
  • Hypersensitivity rxn (urticaria)
  • **Acute pancreatitis/cancer
  • Severe joint pain (rare)
14
Q

You want to put your DMII patient on an SGLT2 inhibitor. Which one will you choose?

A

Empagliflozin

15
Q

SGLT2 Inhibitor MOA

A
  • SGLT2 is transmembrane protein in kidney

- SGLT2 inhibition dec glucose/Na reabsorption, inc urinary glucose/Na, and dec [BG]/BP

16
Q

SGLT2 Inhibitors Indications

A
  • Mono/combo therapy

- HFrEF

17
Q

When should your patient take their empagliflozin?

A

Before the first meal of the day

18
Q

A patient is at increased risk of AKI if they are on an SGLT2 inhibitors + what other drugs?

A
  • NSAIDs
  • Diuretics
  • ACE/ARB
  • Monitor renal fcn
19
Q

SGLT2 Pearls

A
  • No hypoglycemia
  • Some wt loss
  • Dec A1c 0.5-1.0%, dec fasting and post-prandial BG
20
Q

SGLT2 ADRs

A
  • Careful in CKD
  • **UTI
  • Fournier’s Gangrene
  • **Bladder cancer (dapagliflozin)
  • Careful using in pts who are high risk for amputation
  • **Volume depletion/hypotension
  • Inc fracture risk
  • **Euglycemic DKA