DM Pharmacology

Question 1

Incretin mimetic GLP-1-R agonist examples

Answer 1

“-glutide”

Lixisenatide

Question 2

Incretin mimetic GLP-1-R agonist MOA

Answer 2

Activates GLP-1 -R (Gs coupled)

Question 3

Incretin mimetic GLP-1-R agonist action on Beta cell

Answer 3

Inc glucose mediated insulin secretion

May also inc beta cell death

Question 4

Incretin mimetic GLP-1-R agonist action on Delta cells

Answer 4

Inc SST –> dec glucagon from alpha cells

Question 5

Incretin mimetic GLP-1-R agonist action on CNS

Answer 5

Inc satiety, dec gastric emptying –> slow glucose absorption

Question 6

Liraglutide - special notes

Answer 6

Approved for obesity

redux in CV mortality in T2Dm pts w estb CVD

Question 7

Incretin Mimetic GLP-1-R agonist AE

Answer 7

• NVD
• Risk of thryoid c-cell tumor/cancer
• Risk of pancreatitis

Question 8

Incretin Mimetic GLP-1-R agonist considerations

Answer 8

1. Administer SQ

2. Off-label use in T1DM

Question 9

Incretin Mimetic GLP-1-R agonist CI

Answer 9

medullary
thyroid cancer (MTC)

multiple endocrine
neoplasia 2A or 2B

Question 10

Incretin Mimetic DPP4-Inhib examples

Answer 10

“gliptin”

Question 11

Incretin Mimetic DPP4-Inhib MOA

Answer 11

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

Question 12

Incretin Mimetic DPP4-Inhib action on beta cell

Answer 12

Inc cAMP –> –> inc “glucose mediated” insulin secretion

Question 13

Incretin Mimetic DPP4-Inhib AE

Answer 13

1. Inc risk of upper respiratory infection
2. Rash
3. Angioedema
4. Joint pain (arthralgias)

Saxagliptin - CHF

Generally well tolerated

Question 14

Incretin Mimetic DPP4-Inhib Considerations

Answer 14

Use caution in patients w history of or risk factors for HF –> Inc hospitalization for HF

Question 15

SGLT-2 Inhib examples

Answer 15

“gliflozin”

Question 16

SGLT-2 Inhib MOA

Answer 16

Inhib SGLT-2 in proximal tubule –> Inc UglucoseV

Also inhib SGLT-2 on pancreatic alpha cells –> inc glucagon

Question 17

SGLT-2 Inhib Special Therapeutic effects

Answer 17

Dec BP

Dec CV risk

Question 18

Empaglifozin special note

Answer 18

approved for redux of CV mortality in T2DM w estb CVD

Question 19

SGLT-2 Inhib AE

Answer 19

Genitourinary/yeast infections
HoTN
AKI 
Euglycemic DKA 
Inc risk of lower limb amputations (canagliflozin)

Question 20

SGLT-2 Inhib Considerations

Answer 20

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

Question 21

SGLT-2 Inhib CI

Answer 21

Severe renal impairment (eGFR < 45-60 ml/min)

Question 22

Alpha Glucosidase Inhibitor examples

Answer 22

Acarbose

Miglitol

Question 23

Alpha glucosidase MOA

Answer 23

Delayed glucose hydrolysis & absorption –> dec postprandial glucose

Question 24

Alpha glucosidase Inhib AE

Answer 24

AGIs reversibly inhibit intestinal brush border:

• GI upset
• Slower glucose absorption

Question 25

Pt ed for SGLT-2-I

Answer 25

Dehydration
Dizziness (esp elderly)
Yeast infection
UTI

Question 26

CI for SGLT-2-I

Answer 26

NSAIDs

Question 27

What should be monitored for GLP-1 -R ag

Answer 27

Pancreatitis

Self monitoring blood glucose

Question 28

Sitagliptin excretion

Answer 28

79% unchanged in urine

Question 29

Saxagliptin excretion

Answer 29

Parent & active metabolite

Question 30

Linagliptin

Answer 30

90% unchanged enterohepatic

Question 31

Synthetic Amylin Analog example

Answer 31

Pramlintide

Question 32

Synthetic Amylin Analog MOA

Answer 32

Reduce post prandial glucagon secretion

Slows gastric emptying

Question 33

Synthetic Amylin Analog need to monitor ____

Answer 33

BG, esp before driving

Question 34

Synthetic Amylin Analog AE

Answer 34

Hypoglycemia (BBW)

NV