DM Pharmacology Flashcards
Incretin mimetic GLP-1-R agonist examples
“-glutide”
Lixisenatide
Incretin mimetic GLP-1-R agonist MOA
Activates GLP-1 -R (Gs coupled)
Incretin mimetic GLP-1-R agonist action on Beta cell
Inc glucose mediated insulin secretion
May also inc beta cell death
Incretin mimetic GLP-1-R agonist action on Delta cells
Inc SST –> dec glucagon from alpha cells
Incretin mimetic GLP-1-R agonist action on CNS
Inc satiety, dec gastric emptying –> slow glucose absorption
Liraglutide - special notes
Approved for obesity
redux in CV mortality in T2Dm pts w estb CVD
Incretin Mimetic GLP-1-R agonist AE
- NVD
- Risk of thryoid c-cell tumor/cancer
- Risk of pancreatitis
Incretin Mimetic GLP-1-R agonist considerations
- Administer SQ
2. Off-label use in T1DM
Incretin Mimetic GLP-1-R agonist CI
medullary thyroid cancer (MTC)
multiple endocrine
neoplasia 2A or 2B
Incretin Mimetic DPP4-Inhib examples
“gliptin”
Incretin Mimetic DPP4-Inhib MOA
Inhib DPP4 enzyme on the surface of capillary endothelium of most cells –> –> inc endogenous efects of GLP-1 but not exactly the same as GLP-1 agonists
Incretin Mimetic DPP4-Inhib action on beta cell
Inc cAMP –> –> inc “glucose mediated” insulin secretion
Incretin Mimetic DPP4-Inhib AE
- Inc risk of upper respiratory infection
- Rash
- Angioedema
- Joint pain (arthralgias)
Saxagliptin - CHF
Generally well tolerated
Incretin Mimetic DPP4-Inhib Considerations
Use caution in patients w history of or risk factors for HF –> Inc hospitalization for HF
SGLT-2 Inhib examples
“gliflozin”
SGLT-2 Inhib MOA
Inhib SGLT-2 in proximal tubule –> Inc UglucoseV
Also inhib SGLT-2 on pancreatic alpha cells –> inc glucagon
SGLT-2 Inhib Special Therapeutic effects
Dec BP
Dec CV risk
Empaglifozin special note
approved for redux of CV mortality in T2DM w estb CVD
SGLT-2 Inhib AE
Genitourinary/yeast infections HoTN AKI Euglycemic DKA Inc risk of lower limb amputations (canagliflozin)
SGLT-2 Inhib Considerations
Off label for T1DM Drink plenty of fluid Caution w NSAIDs, ARBs, ACEIs Baseline renal fx/monitor Euglycemic DKA risk factors Caution in neuropathy, foot deformities, PAD
SGLT-2 Inhib CI
Severe renal impairment (eGFR < 45-60 ml/min)
Alpha Glucosidase Inhibitor examples
Acarbose
Miglitol
Alpha glucosidase MOA
Delayed glucose hydrolysis & absorption –> dec postprandial glucose
Alpha glucosidase Inhib AE
AGIs reversibly inhibit intestinal brush border:
- GI upset
- Slower glucose absorption
Pt ed for SGLT-2-I
Dehydration
Dizziness (esp elderly)
Yeast infection
UTI
CI for SGLT-2-I
NSAIDs
What should be monitored for GLP-1 -R ag
Pancreatitis
Self monitoring blood glucose
Sitagliptin excretion
79% unchanged in urine
Saxagliptin excretion
Parent & active metabolite
Linagliptin
90% unchanged enterohepatic
Synthetic Amylin Analog example
Pramlintide
Synthetic Amylin Analog MOA
Reduce post prandial glucagon secretion
Slows gastric emptying
Synthetic Amylin Analog need to monitor ____
BG, esp before driving
Synthetic Amylin Analog AE
Hypoglycemia (BBW)
NV
