Meglitinides DI

Question 1

Meglitinides (GLN) MoA

Answer 1

Same as sulfonylureas- stimulate insulin release from beta cells!

(They’re just shorter-acting versions of SUs)

Question 2

Meglitinides site of action

Answer 2

Beta cells

Question 3

GLN products

Answer 3

Nateglinide (Starlix), repaglinide (Prandin)

Question 4

Brand name for nateglinide

Answer 4

Starlix

Question 5

Brand name for repaglinide

Answer 5

Prandin

Question 6

Nateglinide (Starlix) dosing

Answer 6

60-120mg PO before meals

Question 7

Repaglinide (Prandin) dosing

Answer 7

If A1C <8%- 0.5mg PO before meals
If A1C >8%- 1-2mg PO before meals

MDD- 4mg/dose or 16mg/day

Question 8

If a patient isn’t going to eat/skips a meal, should they still take their GLN?

Answer 8

Nope. Skip a meal, skip the dose.

Question 9

GLN side effects

Answer 9

Hypoglycemia (less than SUs), GI disturbances, weight gain, headache

Question 10

Nateglinide drug interactions

Answer 10

Mifepristone- don’t use within 14 days

Pazopanib (whatever this drug is idk)

Question 11

Repaglinide drug interactions

Answer 11

Mifepristone- don’t use within 14 days
Gemfibrozil- increased repaglinide levels
NPH insulin- NEVER USE TOGETHER, increased risk of MI

Question 12

GLNs CI

Answer 12

hypersensitivity, T1DM, DKA

Question 13

GLNs precautions

Answer 13

Severe renal disease, impaired liver function, use with insulin

Question 14

GLN counseling points

Answer 14

Administered before meals (repaglinide- 15-30 minutes prior, nateglinide- 1-30 minutes prior)

Skip a meal, skip the dose

Avoid alcohol use

Question 15

What should you ask about at every GLN refill?

Answer 15

Hypoglycemia and weight gain

Question 16

GLN A1C lowering

Answer 16

Low (0.6-1%)

Question 17

GLN effects on CKD, HF, ASCVD

Answer 17

Neutral

Question 18

Renal dosing for GLN

Answer 18

Not required

Question 19

GLN monitoring

Answer 19

PPG, hypoglycemia, A1C, weight gain

Question 20

Peak effect of GLN

Answer 20

4-6 weeks

Question 21

ADA guidelines on GLN

Answer 21

GLNs are nowhere in the guidelines

Question 22

AACE guidelines on GLN

Answer 22

Lumped in with SUs (last-line option for monotherapy, somewhere in the middle for dual and triple therapy)