"Newer" Non-Insulin Analogues Flashcards Preview

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

List the 3 "newer" options of non-insulin analogues.

- GLP-1 agonist
- DPP-IV inhibitor
- SGLT2 inhibitor

2

What are incretins?

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

3

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

4

DPP-IV MOA

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

5

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

-Exenatide
-Semaglutide (PO or SC)
-Liraglutide
-Lixisenatide
-Dulaglutide

6

GLP-1 Agonist Indications

-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

GLP-1 Agonist Pearls

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

8

GLP-1 Agonist Precautions/CI

-CKD
-**Slows gastric emptying--> CI in mod-severe gastroparesis!
-Thyroid issue--> refer to JB

9

GLP-1 Agonist ADRs

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

10

What are the DPP-IV Inhibitors?

-Sitagliptin*
-Saxagliptin
-Linagliptin*
-Alogliptin

11

DPP-IV Inhibitors Indications

-Mono/combo therapy

12

DPP-IV Inhibitor Pearls

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

13

DPP-IV ADRs

-Caution w CKD
-Hypersensitivity rxn (urticaria)
-**Acute pancreatitis/cancer
-Severe joint pain (rare)

14

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

Empagliflozin

15

SGLT2 Inhibitor MOA

-SGLT2 is transmembrane protein in kidney
-SGLT2 inhibition dec glucose/Na reabsorption, inc urinary glucose/Na, and dec [BG]/BP

16

SGLT2 Inhibitors Indications

-Mono/combo therapy
-HFrEF

17

When should your patient take their empagliflozin?

Before the first meal of the day

18

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

-NSAIDs
-Diuretics
-ACE/ARB
-Monitor renal fcn

19

SGLT2 Pearls

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

20

SGLT2 ADRs

-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