Incretins Flashcards
What are the 2 classes of drugs found in this group
GLP1 and DPP-4 inhibitors
What is the mechanism of action of GLP1
1) GLP is released by L cells in small intestine in response to meal. GLP stimulates pancreas to secrete insulin.
2) suppresses glucagon secretion
3) delays gastric emptying and increases satiety
What are the general side effects of GLP1
When should you d/c GLP1
1) nausea/vomiting
2) diarrhea (improves overtime)
3) increase heart rate
D/C if abdo pain —> increased risk for pancreatic ca
What is one consideration with GLP1 that you have to tell patients before starting
they are injectables
What are the 2 drugs associated with GLP1 and which one has cardiovascular protection
liraglutide (long lasting + CV protection + targets FBG)
start: 0.6mg OD (1 pen), max: 1.8mg (3 pens)
exenatide (short acting)
start: 5ug BID, max: 20ug
What is one MAJOR consideration with GLP1
BLACK BOX warning of medulla thyroid ca
What are contraindications for GLP1
1) thyroid ca
2) MEN2 (multiple endocrine neoplasia syndrome type 3) GI disease
4) pancreatitis
5) ESRD
What caution should you have when using with other drugs
caution with meds that require fast absorption. Ex: pain meds —> may slow down absorption
What are the benefits for GLP1s
weight loss
What is the mechanism of action of DPP4 inhibitors
inhibit DPP4 –> enzyme that degrades GLP1 so prolonged GLP1 action
What are the side effects of DPP4
1) upper respiratory infections
2) cough
3) pancreatitis
What are the 3 drugs associated with DPP4 inhibitors and dose adjustments
linagliptin (better choice for someone with CKD)
start: 5mg, max: 5mg, no need for dose adjustment is eGFR > 15
sitagliptin
start: 100mg daily, dose adjustment if eGFR 30-50 = 50mg, eGFR <30mg = 25mg
saxagliptin
start: 5mg daily, dose adjust if eGFR 15-50 = 2.5mg
