non-insulin treatments pg 17-28 Flashcards
kania pt 3
what is the brand name of tirzepatide?
mounjaro
what is the MOA of tirzepatide?
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
what is the efficacy profile of tirzepatide?
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
what are the AE of tirzepatide?
similar to GLP-1Ras (NVD)
warnings for pancreatitis, thyroid tumors, and gallbladder disease
tachycardia in 10-20% of patients
what is the dosing for tirzepatide?
2.5mg SQ weekly
adjust once a month up to 15mg
what is the brand name of Sitagliptin?
Januvia
what is the brand name of saxagliptin?
onglyza
what is the brand name of linagliptin?
tradjenta
what is the brand name of alogliptin?
nesina
what are some examples of DPP4-inhibitors?
sitagliptin
saxagliptin
linagliptin
alogliptin
what is MOA of DPP-4 inhibtors?
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)
what is the efficacy profile of DPP-4 inhibitors?
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
what are AE of DPP-4 inhibitors?
nasopharyngitis
upper respiratory tract infections
headache
some reports of pancreatitis
what is the FDA warnings for DPP-4 inhibitors?
join paint –> usually resolves within 1 month after D/C
heart failure risk –> specifically saxagliptin and alogliptin; use sitagliptin instead
what is SAVOR study?
determined increase risk of HF hospitalization in saxagliptin
what is the EXAMINE study?
determined increase HF hospitalization in alogliptin
what is the TECOS study?
saw no increased risk for CV events or HF hospitalization
what is the dosing for sitagliptin?
if CrCl > 50 –> 100 mg
if CrCl 30-50 –> 50 mg
if CrCl < 30 or ESRD –> 25 mg
what is the dosing for saxagliptin?
if normal CrCl –> 2.5-5mg
if CrCl < 50 –> 2.5mg
what is the dosing for linagliptin?
5mg
no renal adjustments
what is dosing alogliptin?
if normal CrCl –> 25 mg
if CrCl 30-60 –> 12.5 mg
if CrCl < 30 or ESRD on dialysis –> 6.25 mg
what is the MOA of sulfonylureas?
stimulate insulin release from pancreatic beta cells
may increase binding between insulin and receptors or increased number of receptors
what is the efficacy profile of sulfonylureas?
A1c –> decrease by 1-2%
FBG –> decrease by 60-70 mg/dL
what is the brand names of glyburide?
diabeta
micronase
glynase
what is the brand names of glipizide?
glucotrol
glucotrol xl
what sulfonylurea is preferred in renal disease?
glipizide –> metabolized without the formation of active metabolites
more effective when take 30 minutes before meal
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
what candidates are best for sulfonylureas?
no type 1 pts
short duration of diabetes
FBS < 250 mg/dL
high fasting C-peptide levels
is treatment failure common is sulfonylureas?
yes 25% will have primary failure
after 5 years, 50-75% may experience secondary failure
what is the brand name of pioglitazone?
actos
what is an example of a thiazolidinedione?
pioglitazone
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
what is the efficacy profile of TzDs?
A1c –> decreases by 0.5-1.5%
FBG –> decreases by 60-70 mg/dL
what is the AE of TzDs?
hepatoxicity
resumption of ovulation
exacerbations of HF
macular edema
increased fracture risk
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
what is the DREAM study?
no statistical significance with the usage of rosiglitazone and CV benefit
what is the ADOPT trial?
statistically significant excess of congestive HF episodes in rosiglitazone in comparison with glyburide
what is the RECORD trial?
showed no statistical significance in CV death when using rosiglitazone and metformin/sulfonylurea
what is PROactive study?
showed reduction in death, MI, and stroke in pioglitazone
what is the IRIS study?
CVA and MI benefits of pioglitazone
what is the TOSCA.it study?
showed no difference in CV outcomes in pioglitazone
what is the dosing for pioglitazone?
initial of 15-30mg
max of 30-40mg
titrate every 12 weeks
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)
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%)
when should dual therapy in T2DM be considered according to AACE guidelines?
if A1c is between 7.5-9% or greater
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)
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
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)
