Non-Insulin Pharmacologic Agents for Diabetes

Question 1

therapy for T2DM is generally additive. What is the progression?

Answer 1

1. diet and exercise
2. OHA monotherapy
3. OHA combo
4. Insulin-OHA combo
5. insulin simple
6. advanced insulin monotherapy

Question 2

outline the frame work and goals for treatment of type II DM

Answer 2

1. if a person has elevated A1C, but NOT 1.5% above target, do lifestyle changes. Attain A1c by 3 months
2. if person has elevaetd A1C>1.5%, start metformin. attain A1C by three months.
3. if symptomatic hyperglycemia or metabolic decompensation, start insulin and metformin.
   - IF THE A1C IS NOT AT TARGET AT 3 MONTHS:
4. start metformin
5. adjust or advance therapy
6. reassess A1C in 3-6 months

Question 3

metfomin is a ___ class OHA that reduces hepatic ___ ___, improves peripheral glucose ___ and improves insulin resistence.

Answer 3

metformin is a biguanide class OHA that reduces HEPATIC GLUCOSE OUTPUT, improves peripheral GLUCOSE UPTAKE, and improves insulin resistence.

• FIRST CHOICE DRUG IN TYPE 2 DIABETES

Question 4

adverse affects of metformin– who should you not give it to?

Answer 4

Contraindicated in renal disease, liver disease, congestive heart failure

Question 5

Clinical Considerations to select next agent as T2DM management

Answer 5

Question 6

SGLT2 inhibitor MOA

Answer 6

normally; SGLT2 is a glucose transporter that works on the PCT of the kidney. it is involved in renal glucose reabsorption.

-SGLT2 inhibitors block this, thus more glucose is excreted

Question 7

T/G SGLT2 inhibitors are cardioprotective

Answer 7

true. primary outcome of CHF was reduced

Question 8

side effects of SGLT2 inhibitors

Answer 8

• primary one is UTIs and yeast infections, can also cause DKA. If someone is always dry and doesn’t drink a lot of water, don’t put them on SGLT2 inhibtiros.

Question 9

2 main classes of incretins used in OHA

Answer 9

1. GLP1 agonists
2. DPP4 inhibitors

Question 10

Role of GLP1 in glucose metabolism. ( 6 ways it helps with diabetes type II)

Answer 10

GLP1 is a peptide in the gut that promotes insulin release in the gut.

1. delayed gastric emptying
2. insulin secretion
3. glucagon suppressioin
4. decrease in glycogenolysis in liver
5. increase glucose uptake
6. no kidney effect, but they modulate the GI and liver aspect of glucose regulation

Question 11

side effects of incretins

Answer 11

nausea and vomiting– usually because of delayed gastric emptying. pancreatitis too.

Question 12

protective benefits of GLP 1. Do they have the same benefits and DPP4?

Answer 12

GLP1; profound weightlotss, CV benefit,

for DPP4, weight and CV neutral.

Question 13

T/F you can combine GLP1 and DPP4 classes

Answer 13

no

Question 14

compare and contrast the MOA of sulphonylureas and meglitinides. What drug class are they from?

Answer 14

insulin secretagogues. Megs are shorter acting, usually used each meal, whereas sulphonylureas are dosed once or twice daily

Question 15

Alpha glucosadase inhibitors MOA, Cons and Pros

Answer 15

MOA: prevents sugar from cleaving in the GI. delays absorption of sugar.

Cons: GI and Flatulance

Pros: weight neutral, CV neutral, good for post prandial hyperglycemia

Efficacy
– Reduces post-prandial blood glucose by 30-50%
– Reduces HgA1c by 0.5 to 0.75 % • Adverse effects

Question 17

3 TYPE II meds that are CVD protective

Answer 17

GLP1 agonists

AGLT2 inhibitos

metformin