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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 (48 cards)

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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?

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A

5mg
no renal adjustments

21
Q

what is dosing alogliptin?

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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?

Study These Flashcards
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?

Study These Flashcards
A

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

24
Q

what is the brand names of glyburide?

Study These Flashcards
A

diabeta
micronase
glynase

25
what is the brand names of glipizide?
glucotrol glucotrol xl
26
what sulfonylurea is preferred in renal disease?
glipizide --> metabolized without the formation of active metabolites more effective when take 30 minutes before meal
27
what are the AE of sulfonylureas?
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
what candidates are best for sulfonylureas?
no type 1 pts short duration of diabetes FBS < 250 mg/dL high fasting C-peptide levels
29
is treatment failure common is sulfonylureas?
yes 25% will have primary failure after 5 years, 50-75% may experience secondary failure
30
what is the brand name of pioglitazone?
actos
31
what is an example of a thiazolidinedione?
pioglitazone
32
what is the MOA of TzDs?
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
what is the efficacy profile of TzDs?
A1c --> decreases by 0.5-1.5% FBG --> decreases by 60-70 mg/dL
34
what is the AE of TzDs?
hepatoxicity resumption of ovulation exacerbations of HF macular edema increased fracture risk
35
how does hepatotoxicity effect TzDs?
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
what is the DREAM study?
no statistical significance with the usage of rosiglitazone and CV benefit
37
what is the ADOPT trial?
statistically significant excess of congestive HF episodes in rosiglitazone in comparison with glyburide
38
what is the RECORD trial?
showed no statistical significance in CV death when using rosiglitazone and metformin/sulfonylurea
39
what is PROactive study?
showed reduction in death, MI, and stroke in pioglitazone
40
what is the IRIS study?
CVA and MI benefits of pioglitazone
41
what is the TOSCA.it study?
showed no difference in CV outcomes in pioglitazone
42
what is the dosing for pioglitazone?
initial of 15-30mg max of 30-40mg titrate every 12 weeks
43
what should be considered if a T2DM pt has established/high risk of atherosclerotic CVD, HF, and/or CKD?
SGLT2 inhibitors and GLP1RAs (independent of A1c, be consideration of person-specific factors)
44
when should dual therapy in T2DM be considered according to ADA guidelines?
if A1c is greater than 1.5-2% above goal (usually 8.5%)
45
when should dual therapy in T2DM be considered according to AACE guidelines?
if A1c is between 7.5-9% or greater
46
is a GLP-1 RA or insulin preferred in pts with T2DM?
GLP-1RA but they would have to be on it for life (consider pt factors)
47
when should insulin be used in T2DM?
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
when should additional therapy be taken in T2DM?
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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