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Therapeutics 2 - Exam 3 > non-insulin treatments pg 17-28 > Flashcards

non-insulin treatments pg 17-28 Flashcards

kania pt 3

1
Q

what is the brand name of tirzepatide?

A

mounjaro

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2
Q

what is the MOA of tirzepatide?

A

dual action as receptor agonist for GLP-1 and GIP
enhances first and second-phase inuslin secretion
reduces glucagon levels in a glucose dependent manner
delays gastric emptying
increases satiety
CV outcomes expected in 2025
marked especially for weight loss

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3
Q

what is the efficacy profile of tirzepatide?

A

A1c –> decrease by 1.5-2.3%
FBS –> decrease by 40-60 mg/dL
PPG –> decrease by 20-40 mg/dL
weight –> decrease by 6-11kg

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4
Q

what are the AE of tirzepatide?

A

similar to GLP-1Ras (NVD)
warnings for pancreatitis, thyroid tumors, and gallbladder disease
tachycardia in 10-20% of patients

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5
Q

what is the dosing for tirzepatide?

A

2.5mg SQ weekly
adjust once a month up to 15mg

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6
Q

what is the brand name of Sitagliptin?

A

Januvia

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7
Q

what is the brand name of saxagliptin?

A

onglyza

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8
Q

what is the brand name of linagliptin?

A

tradjenta

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9
Q

what is the brand name of alogliptin?

A

nesina

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10
Q

what are some examples of DPP4-inhibitors?

A

sitagliptin
saxagliptin
linagliptin
alogliptin

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11
Q

what is MOA of DPP-4 inhibtors?

A

prevent the breakdown of endogenous GLP-1 by inhibiting dipepitdyl peptidase-4
stimulates insulin response from beta cells in a glucose dependent manner (helps prevent hypoglycemia)

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12
Q

what is the efficacy profile of DPP-4 inhibitors?

A

A1c –> decrease by 0.5-1%
FBS –> decrease by 20 mg/dL
PPG –> decrease by 20-40 mg/dL
weight –> decrease by 0-0.5kg neutral

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13
Q

what are AE of DPP-4 inhibitors?

A

nasopharyngitis
upper respiratory tract infections
headache
some reports of pancreatitis

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14
Q

what is the FDA warnings for DPP-4 inhibitors?

A

join paint –> usually resolves within 1 month after D/C
heart failure risk –> specifically saxagliptin and alogliptin; use sitagliptin instead

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15
Q

what is SAVOR study?

A

determined increase risk of HF hospitalization in saxagliptin

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16
Q

what is the EXAMINE study?

A

determined increase HF hospitalization in alogliptin

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17
Q

what is the TECOS study?

A

saw no increased risk for CV events or HF hospitalization

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18
Q

what is the dosing for sitagliptin?

A

if CrCl > 50 –> 100 mg
if CrCl 30-50 –> 50 mg
if CrCl < 30 or ESRD –> 25 mg

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19
Q

what is the dosing for saxagliptin?

A

if normal CrCl –> 2.5-5mg
if CrCl < 50 –> 2.5mg

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20
Q

what is the dosing for linagliptin?

A

5mg
no renal adjustments

21
Q

what is dosing alogliptin?

A

if normal CrCl –> 25 mg
if CrCl 30-60 –> 12.5 mg
if CrCl < 30 or ESRD on dialysis –> 6.25 mg

22
Q

what is the MOA of sulfonylureas?

A

stimulate insulin release from pancreatic beta cells
may increase binding between insulin and receptors or increased number of receptors

23
Q

what is the efficacy profile of sulfonylureas?

A

A1c –> decrease by 1-2%
FBG –> decrease by 60-70 mg/dL

24
Q

what is the brand names of glyburide?

A

diabeta
micronase
glynase

25
Q

what is the brand names of glipizide?

A

glucotrol
glucotrol xl

26
Q

what sulfonylurea is preferred in renal disease?

A

glipizide –> metabolized without the formation of active metabolites
more effective when take 30 minutes before meal

27
Q

what are the AE of sulfonylureas?

A

hypoglycemia (especially in renal/hepatic insufficient pts, elderly/malnourished pts, or concurrent hypoglycemic drugs)
weight gain (up to 3 kg)
GI upset
hematologic –> leukopenia, thrombocytopenia, aplastic anemia
allergic skin reactions/photosensitivity

28
Q

what candidates are best for sulfonylureas?

A

no type 1 pts
short duration of diabetes
FBS < 250 mg/dL
high fasting C-peptide levels

29
Q

is treatment failure common is sulfonylureas?

A

yes 25% will have primary failure
after 5 years, 50-75% may experience secondary failure

30
Q

what is the brand name of pioglitazone?

A

actos

31
Q

what is an example of a thiazolidinedione?

A

pioglitazone

32
Q

what is the MOA of TzDs?

A

binds to PPAR-gamma on fat cells and vascular cells
improves cellular response to insulin w/o increasing pancreatic insulin secretion
decreases insulin resistance
decreases hepatic glucose production

33
Q

what is the efficacy profile of TzDs?

A

A1c –> decreases by 0.5-1.5%
FBG –> decreases by 60-70 mg/dL

34
Q

what is the AE of TzDs?

A

hepatoxicity
resumption of ovulation
exacerbations of HF
macular edema
increased fracture risk

35
Q

how does hepatotoxicity effect TzDs?

A

check baseline LFTs
if baseline over 2.5x normal then do not start therapy
check periodically if do start
d/c if LFTs reach 3x normal levels
see jaundice symptoms arise

36
Q

what is the DREAM study?

A

no statistical significance with the usage of rosiglitazone and CV benefit

37
Q

what is the ADOPT trial?

A

statistically significant excess of congestive HF episodes in rosiglitazone in comparison with glyburide

38
Q

what is the RECORD trial?

A

showed no statistical significance in CV death when using rosiglitazone and metformin/sulfonylurea

39
Q

what is PROactive study?

A

showed reduction in death, MI, and stroke in pioglitazone

40
Q

what is the IRIS study?

A

CVA and MI benefits of pioglitazone

41
Q

what is the TOSCA.it study?

A

showed no difference in CV outcomes in pioglitazone

42
Q

what is the dosing for pioglitazone?

A

initial of 15-30mg
max of 30-40mg
titrate every 12 weeks

43
Q

what should be considered if a T2DM pt has established/high risk of atherosclerotic CVD, HF, and/or CKD?

A

SGLT2 inhibitors and GLP1RAs (independent of A1c, be consideration of person-specific factors)

44
Q

when should dual therapy in T2DM be considered according to ADA guidelines?

A

if A1c is greater than 1.5-2% above goal (usually 8.5%)

45
Q

when should dual therapy in T2DM be considered according to AACE guidelines?

A

if A1c is between 7.5-9% or greater

46
Q

is a GLP-1 RA or insulin preferred in pts with T2DM?

A

GLP-1RA
but they would have to be on it for life (consider pt factors)

47
Q

when should insulin be used in T2DM?

A

when there is evidence of ongoing catabolism (weight loss), if s/s of hyperglycemia are present, if A1c > 10%, or if blood glucose readings are > 300 mg/dL

48
Q

when should additional therapy be taken in T2DM?

A

if goals are not achieved after 3 months (this is the point that A1c can be evaluated)

Therapeutics 2 - Exam 3 (10 decks)

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