Gliflozin Pharmacology Flashcards
What type of diabetes mellitus do cats get?
type 2
What is the typical signalment of a diabetic cat
fat and middle aged
low insulin with developing pancreatic islet amyloidosis
What is the mechanism of diabetes mellitus type 2
insulin resistance results in increased blood glucose
pancreatic beta cells make more insulin in response but over time become exhausted and stop functioning
resulting in reduced insulin and increasing blood glucose
= diabetes mellitus
What are the main clin path findings of equine metabolic syndrome
they dont usually have a hyperglycemia
hyperinsulinemia
- because very good at making insulin
- causes laminitis
25-50% of PPID horses have EMS
What is the mechanism of SGLT2 inhibitors
They are sodium glucose cotransporter 2 transport proteins
transport proteins that resorb glucose from renal tubules
- SGLT2 resorb 90% of glucose
- found in the proximal convoluted tubule (SGLT1 is found later in the tubules and can compensate for SGLT2)
sodium binds the transport protein and causes a conformational change in the transporter
glucose binds the transport protein after and causes a conformational change that allows both glucose and sodium to enter
- 1:1 intake of glucose and sodium
causes glucose secretion in the urine
List 3 selective SGLT2 inhibitors
ertugliflozins
canagliflozins
velagliflozins
What type of inhibitors are SGLT2 inhibitors
competative inhibitors
should inhibit 90% of glucose resorption but due to SGLT1 receptors it end up being only like 30-50%
What are the impacts of gliflozin drugs? Both positive and negative
weight loss
increased glygemic output
lower bp
increased cardiac output
reduce stoke risk
improve renal outcomes
horses can have hypertriglyceridemia
PU/PD
perineal necrosis
genital fungal infection
cats can get UTI and euglygemic ketoacidosis
What is euglycemic ketoacidosis
increased number of keytones due to reduced energy for cells
does not occur in horses because they make triglycerides instead of keytones
stop the drug if this occurs
give insulin and dextrose and nutritional support (to prevent hepatic lipidosis)
What is canagliflozin used for? Why
off label use in horses
because its cheaper than velagliflozin
effective in low insulin cases
long half life meaning you can have a long dosing interval
What are velagliflozins used for? Give an example?
senvelgo
used in cats SID PO to reduce hyperglycemia in early diabetes
not effective if you are truly insulin dependent
How are gliflozin drugs are used in horses
all extralabel use
What are 3 contraindications of gliflozin drugs in cats
cats on insulin or who previously needed insulin tx
cats with a high risk of dehydration (CKD)
