Incretin Mimetics: Dipeptidyl Peptidase-4 inhibitors and Glucagon-Like Peptide 1 Receptor Agonists

Question 1

Dipeptidyl Peptidase-4 Inhibitors (DPP-4) “-gliptins” MOA

Answer 1

• Inhibit the DPP-4 enzyme, which prolongs the GLP-1 hormone levels - GLP-1 increases insulin secretion and suppresses glucagon secretion

Question 2

DPP-4 “gliptins” ADRs

Answer 2

• GI issues (decrease GI motility - gastroporesis)
• pancreatitis (sitagliptin)
• URI

Question 3

DPP-4s Contraindications

Answer 3

• hx of pancreatitis

- Type 1 DM

Question 4

DPP4s counseling points

Answer 4

• effective only with food

Question 5

Glucagon-Like Peptide 1 Receptor Agonists (GLP-1RA) MOA

Answer 5

injectable medication - synthetic GLP-1 - mimics natural incretins which increase insulin secretion (only when the pt eats), decreases glucagon secretion, and slows gastric emptying
- promotes satiety and wt loss

Question 6

GLP-1RA (Byetta, Trulicity, Victoza) ADRs

Answer 6

• pancreatitis
• thyroid CA
• GI issues (N/V/D)

Question 7

GLP-1RA contraindications

Answer 7

• Black box warning: medullary thyroid CA
• acute pancreatitis
• avoid with gastroparesis
• avoid in pts with severe GI disease (colitis, Crohn’s)

Question 8

GLP-1RA patient education

Answer 8

• Only effective with food

- Administer 60 minutes before meals