EXAM 4 Drugs Pt2 Dr. Hess

Question 1

MOA of DPP-4 inhibitors

Answer 1

blocking Dipeptidyl peptidase-4
-> DPP-4 is enzyme that degrades endogeounes GLP-1 and GIP

GLP-1 works on the pancreas an increases insulin release and decreases glucagon release

Question 2

How is the endogenous GLP-1 different from GLP-1 receptor agonists?

Answer 2

the GLP-1 receptor agonist also decreases and suppresses appetite and increases satiety

Question 3

Which drug should not be used together with DPP-4 inhibitors?

Answer 3

GLP-1 receptor agonists -> overlay in the MOA
-no synergistic effect

-also insulin and Sulfonylurea -> increase the risk for hypoglycemia (despite alone having a low risk of hypoglycemia)

Question 4

What is the efficacy of DPP-4-i?

Answer 4

0.5 - 0.8% (moderate)
Low hypoglycemia risk (glucose-dependent activity of endogenous GLP-1)

Question 5

ADE of DPP-4-i

Answer 5

not many
in rare cases:
-upper respiratory infection
-skin reactions
-joint pain

Question 6

How are DPP-4 inhibitors dosed?

Answer 6

-daily dose
-no titration
-may need dose adjustment (except from Tradjenta (linagliptin))

Question 7

Which DPP-4 inhibitor does not require any renal dose adjustments?

Answer 7

Tradjenta

Question 8

Which DPP 4 inhibitors increase the risk for HF hospitalization?

Answer 8

Onglyza (Saxagliptin)
Nesina

Question 9

MOA of TZDs

Answer 9

activating nuclear transcription factor PPARγ -> increases the synthesis of GLUT4 transporter
-> enhances insulin sensitivity

Question 10

On which cell do TZDs work?

Answer 10

not in the pancreas
-Muscle cells
-Adipose tissue
-Liver cell (like metformin)

Question 11

How long does it take for TZDs to reach their effect?

Answer 11

6-8 weeks

can be used with metformin (both insulin sensitizers)

Question 12

What are the precautions for Pioglitazone?

Answer 12

in patients with NYHF class III & IV
-hx of HF
-LFT > 2.5x ULN

Question 13

What is the BBW for Pioglitazone?

Answer 13

can cause exercabtion of HF

Question 14

Side effects of TZDs

Answer 14

-edema, weight gain
-macular edema
-HF
-bone fractures
-bladder cancer

Question 15

MOA for Sulfonylureas

Answer 15

closes ATP-K channels on ß-cells -> leading to glucose INDEPENDENT insulin secretion

Question 16

What is the efficacy of Sulfonylureas?

Answer 16

reduces A1c by 1-2% (high efficacy)

-secondary failure due to the pancreas losing the ability to secrete insulin as T2DM progresses

Question 17

Side effects of Sulfonylurea

Answer 17

-Hypoglycemia
-weight gain
-Photosensitivity (it contains sulfa)

Question 18

Contraindications of Sulfonylurea

Answer 18

-T1DM: it doesn’t work bc they don’t produce insulin
-DKA

Question 19

What decreases the risk of hypoglycemia, induced by Sulfonylurea?

Answer 19

taking it with food
-delayed meals or skipping meals is the number 1 risk factor for hypoglycemia

Question 20

Which of the Sulfonylureas have metabolites?

Answer 20

-metabolites increase the risk for hypoglycemia in patients with renal impairment (avoid in eGFR <60)

-Glipizide: zero (0) metabolites - preferred in renal impairment

-gli(me)piride): me - 1 - metabolite (caution in eGFR <60)

-glyburide: by - 2 - metabolites (avoid in eGFR <60)

Question 21

How are Sulfonylureas dosed?

Answer 21

-once daily
-need titration to reduce the risk of hypoglycemia

Question 22

At what glucsoe concentration does a patient experience the cognitive effects of hypoglycemia?

Answer 22

<54 mg/dl

-Headache
-behavior changes
-blurred, impaired, or double vision
-Crabbiness or confusion
-drowsiness, weakness
-difficulty talking

mild symptoms: <70 mg/dl
-Hunger
-Sweating
-Feeling shaky, nervous

Question 23

What should be given to patients with severe symptoms of Hypoglycemia?

Answer 23

Glucagon

Symptoms:
-Unresponsive
-Loss of consciousness
-Seizure activity

Question 24

Interventions in patients with mild or moderate Hypoglycemia

Answer 24

treat with fast-acting sugar (15g of carbs)
-4-8 ounces of fruit juice
-6 ounces of soda
-1 tablespoon of sugar in water
-3-4 chewable glucose tablets (pharmacy)
-1 dose of glucose gel
-1 tablespoon of honey
-2-4 pieces of hard candy

-> wait 15 minutes and repeat if blood glucose is still <70 mg/dl

Question 25

Which drug is preferred when it comes to saving costs?

Answer 25

Sulfonylurea
-> don’t use it if you want to avoid hypoglycemia

Question 26

What diabetes medications would you recommend for someone minimizing hypoglycemia?

Answer 26

GLP-1
Metformin
DPP-4