DM Pharmacology

Question 1

Incretin mimetic GLP-1-R agonist examples

Answer 1

“-glutide”

Lixisenatide

Question 2

Incretin mimetic GLP-1-R agonist MOA

Answer 2

Activates GLP-1 -R (Gs coupled)

Question 3

Incretin mimetic GLP-1-R agonist action on Beta cell

Answer 3

Inc glucose mediated insulin secretion

May also inc beta cell death

Question 4

Incretin mimetic GLP-1-R agonist action on Delta cells

Answer 4

Inc SST –> dec glucagon from alpha cells

Question 5

Incretin mimetic GLP-1-R agonist action on CNS

Answer 5

Inc satiety, dec gastric emptying –> slow glucose absorption

Question 6

Liraglutide - special notes

Answer 6

Approved for obesity

redux in CV mortality in T2Dm pts w estb CVD

Question 7

Incretin Mimetic GLP-1-R agonist AE

Answer 7

• NVD
• Risk of thryoid c-cell tumor/cancer
• Risk of pancreatitis

Question 8

Incretin Mimetic GLP-1-R agonist considerations

Answer 8

1. Administer SQ

2. Off-label use in T1DM

Question 9

Incretin Mimetic GLP-1-R agonist CI

Answer 9

medullary
thyroid cancer (MTC)

multiple endocrine
neoplasia 2A or 2B

Question 10

Incretin Mimetic DPP4-Inhib examples

Answer 10

“gliptin”

Question 11

Incretin Mimetic DPP4-Inhib MOA

Answer 11

Inhib DPP4 enzyme on the surface of capillary endothelium of most cells –> –> inc endogenous efects of GLP-1 but not exactly the same as GLP-1 agonists

Question 12

Incretin Mimetic DPP4-Inhib action on beta cell

Answer 12

Inc cAMP –> –> inc “glucose mediated” insulin secretion

Question 13

Incretin Mimetic DPP4-Inhib AE

Answer 13

1. Inc risk of upper respiratory infection
2. Rash
3. Angioedema
4. Joint pain (arthralgias)

Saxagliptin - CHF

Generally well tolerated

Question 14

Incretin Mimetic DPP4-Inhib Considerations

Answer 14

Use caution in patients w history of or risk factors for HF –> Inc hospitalization for HF

Question 15

SGLT-2 Inhib examples

Answer 15

“gliflozin”

Question 16

SGLT-2 Inhib MOA

Answer 16

Inhib SGLT-2 in proximal tubule –> Inc UglucoseV

Also inhib SGLT-2 on pancreatic alpha cells –> inc glucagon

Question 17

SGLT-2 Inhib Special Therapeutic effects

Answer 17

Dec BP

Dec CV risk

Question 18

Empaglifozin special note

Answer 18

approved for redux of CV mortality in T2DM w estb CVD

Question 19

SGLT-2 Inhib AE

Answer 19

Genitourinary/yeast infections
HoTN
AKI 
Euglycemic DKA 
Inc risk of lower limb amputations (canagliflozin)

Question 20

SGLT-2 Inhib Considerations

Answer 20

Off label for T1DM
Drink plenty of fluid
Caution w NSAIDs, ARBs, ACEIs
Baseline renal fx/monitor
Euglycemic DKA risk factors
Caution in neuropathy, foot deformities, PAD

Question 21

SGLT-2 Inhib CI

Answer 21

Severe renal impairment (eGFR < 45-60 ml/min)

Question 22

Alpha Glucosidase Inhibitor examples

Answer 22

Acarbose

Miglitol

Question 23

Alpha glucosidase MOA

Answer 23

Delayed glucose hydrolysis & absorption –> dec postprandial glucose

Question 24

Alpha glucosidase Inhib AE

Answer 24

AGIs reversibly inhibit intestinal brush border:

• GI upset
• Slower glucose absorption

Question 25

Pt ed for SGLT-2-I

Answer 25

Dehydration Dizziness (esp elderly) Yeast infection UTI

Question 26

CI for SGLT-2-I

Answer 26

NSAIDs

Question 27

What should be monitored for GLP-1 -R ag

Answer 27

Pancreatitis | Self monitoring blood glucose

Question 28

Sitagliptin excretion

Answer 28

79% unchanged in urine

Question 29

Saxagliptin excretion

Answer 29

Parent & active metabolite

Question 30

Linagliptin

Answer 30

90% unchanged enterohepatic

Question 31

Synthetic Amylin Analog example

Answer 31

Pramlintide

Question 32

Synthetic Amylin Analog MOA

Answer 32

Reduce post prandial glucagon secretion | Slows gastric emptying

Question 33

Synthetic Amylin Analog need to monitor ____

Answer 33

BG, esp before driving

Question 34

Synthetic Amylin Analog AE

Answer 34

Hypoglycemia (BBW) | NV