Diabetes INJECTABLE Drugs PKPD

Question 1

What effects do incretin hormones (GLP and GIP) have?

Answer 1

1. Decreased glucagon secretion
2. Slows gastric emptying
3. Reduces food intake
4. Increases insulin secretion (glucose dependent)

Question 2

What are the brand names of Exenatide?

Answer 2

-Byetta
-Bydureon
-Bydureon BCise

Question 3

What is the general dosing scheme of Byetta?

Answer 3

SQ BID, hence why we don’t really use this anymore since we have more efficient (QW) agents

Question 4

Which exenatide agent was discontinued?

Answer 4

Bydureon

Question 5

What are some important counseling points for Byetta?

Answer 5

-give 30-60 mins before eating
-need separate Rx for needles

Question 6

What are some important counseling points for Bydureon BCise?

Answer 6

-auto-injector
-given weekly with or w/o meals

Question 7

What to do in case of missed dose for injectable products?

Answer 7

-give within 72 hours
-if more than 3 weeks missed, will need to re-start dose titration

Question 8

What is the brand name of liraglutide?

Answer 8

Victoza

Question 9

What is the general dosing scheme for liraglutide?

Answer 9

-daily SQ injections
-pre-filled multi-dose pens

Question 10

What are some important counseling points for liraglutide?

Answer 10

-need Rx for needle
-requires titration
-reusuable pens
-give with or without food

Question 11

What is the brand name of Dulaglutide?

Answer 11

Trulicity

Question 12

What is the general dosing scheme for Trulicity?

Answer 12

-weekly SQ injections
-auto-injector

Question 13

What are some important counseling points for Trulicity?

Answer 13

-give with or without food
-discard pen after each use
-requires titration

Question 14

Which chemical moity was added onto Semaglutide structure to allow for enhanced absorption and therefore allows once-daily ORAL administration?

Answer 14

SNAC: small fatty acid derivative

Question 15

What is the name of oral semaglutide?

Answer 15

Rybelsus

Question 16

How should Rybelsus be taken?

Answer 16

-QD PO
-take with 4 oz of water 30 mins before meal

Question 17

Which GLP-1 drug has a contraindication for patients with CrCl <30?

Answer 17

all Exenatide products!!

Question 18

What are some ADE of GLP-1 RA?

Answer 18

-N/V/D
-depression
-suicidal dieation
-URI/cough
-injection site reaction
-pancreatitis
-gall bladder disease

Question 19

What are drugs that cause hyPOglycemia when used concomitantly with GLP-1 RA?

Answer 19

-androgens
-sulfonylureas/Insulin
-pegvisomant

Question 20

What are drugs that cause hyPERglycemia when used concomitantly with GLP-1RA?

Answer 20

-corticosteroids
-danazol
-LHRH
-somatropin
-thiazide diuretics

Question 21

What is the major BBW for GLP-1 RA?

Answer 21

-Throid C-Cell Tumors (MTC and MEN2)

Question 22

What are some CIs for GLP-1 RA?

Answer 22

-MTC
-MEN2
-Renal impairment

Question 23

What should be monitored while a patient is on GLP-1 RA?

Answer 23

-renal function
-FBP
-PPG
-ADE

Question 24

How long does it take for the peak effect of GLP-1 RA to be seen?

Answer 24

6-8 weeks

Question 25

What is the MOA of Tirzepatide?

Answer 25

-increases insulin (glucose dependent) -decreases glucagon secretion -slows gastric emptying

Question 26

What is the brand name for Tirzepatide (indicated for DM)?

Answer 26

Mounjaro

Question 27

What is the general dosing for Tirzepatide?

Answer 27

weekly SQ injections (pre-filled single use pens)

Question 28

What are some ADE of Tirzepatide?

Answer 28

-GI (N/V/D/C) -sinus tachycardia -injection site reaction -ALOPECIA -pancreatitis -gall bladder disease

Question 29

What are some drugs that cause hyPOglycemia when used concomitantly with Tirzepatide?

Answer 29

-androgens -betablockers -insulins/SU -quinolones

Question 30

What are some drugs that cause hypERglycemia when used concomitantly with Tirzepatide?

Answer 30

-non-selective beta blockers -quinolones -thiazide diuretics

Question 31

True or false: Tirzepatide may increase OC effectiveness.

Answer 31

False: it may DECREASE OC effectiveness.

Question 32

Which GLP-1 RA have indication for weight loss?

Answer 32

-Liraglutide (as Saxenda) -Semaglutide (as Wegovy) -Tirazepatide (as Zepbound)

Question 33

What is the MOA of Amylin?

Answer 33

-works with insulin to regulate post-prandial hyperglycemia -slows gastric emptying -suppresses glucagon secretion -modulates appetite

Question 34

Amylin production is ____ (absent/inadequate) in T1DM and _______(absent/inadequate) in T2DM/

Answer 34

Amylin production is ABSENT in T1DM and INADEQUATE in T2DM.

Question 35

True or false: amylin is indicated for both type 1 and type 2 diabetes patients

Answer 35

True

Question 36

Pramlintide is in what drug class?

Answer 36

it is a amylin analogue

Question 37

What are some ADE of Pramlintide?

Answer 37

-SEVERE HYPOGLYCEMIA -N/V -HA -fatigue

Question 38

What DDIs does pramlintide have?

Answer 38

-potassium salts: delays absorption of K -anticholinergics: additive effect

Question 39

What is the BBW for pramlintide?

Answer 39

-co-administration with insulin

Question 40

What are some CIs for pramlintide?

Answer 40

-hypoglycemia unawareness -gastroparesis -hypersensitivity

Question 41

What should be monitored when on Pramlintide?

Answer 41

-PPG -Injection technique -GI intolerance

Question 42

What are some important counseling points for Pramlintide?

Answer 42

-best if given immediately prior to eating -skip meal=skip dose -may upset stomach but will decrease over time -keep in fridge or room temp, discard after 28 days once open