Flashcards in Pharm2 1 T2DM Agents pt4 Deck (18)
Canagliflozin (Cana) became the first SGLT2 inhibitor to be approved in the US in
Canagliflozin (Cana) should not be initiated in patients with an
eGFR <45 mL/min/1.73 m2 - Severe renal impairment
Cana efficacy of lowering HbA1C:
female genital mycotic infections, uncircumsized men are also at risk of these yeast infections
urinary tract infection
increased urination, dehydration
Dehydration makes them pee less, and this relates to the UTI’s (current understanding of this new drug)
When Cana was first marketed, who was it marketed to? .
Non-insulin SQ Agents
Incretin-mimetics (these are injectable agents)
How do Incretin-mimetics work?
What's their route of admin?
Enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying (feel full longer). Works only when glucose is in the gut (not in the serum)
The only SQ agent for T2DM that does not contain insulin
Ex of Incretin-mimetics.
Route of admin, how many times per day/where/when?
SQ into upper thigh, abdomen or arm within 60 minutes of AM and PM meals
Think of its name, it’s taken BID.
Diabetes mediations are titrated up slowly because:
Formulations that exist of Exenatide (Incretin-mimetic SQ)
There’s a 2x day, 1x day, and 1x week version. Soon there will be a 1x month, and in a few months there will also be a 1x year! The longer lasting formulations lower the A1C more than the shorter ones do.
The longer lasting formulations lower the A1C more than the shorter ones do.
How do they do this?
Their coating. Absorbable stitches in a microsphere, impregnate each one with the drug. You inject it, and it’s absorbed at the appropriate rate. Just caution patients that these long acting versions leave a little bump on their skin.
Exenatide: Cautions, Precautions, Pregnancy
Cautions: rare cases of acute pancreatitis reported (only b/c this is given to patients with higher TG in the first place, which puts them at higher risk of pancreatitis)
Precautions: severe stomach disorders
Pregnancy: switch to insulin
What lab values are most abnormal (besides sugars) in a DM patient?
High risk of pancreatitis with high trigs
Exenatide: Side effects, Efficacy lowering HbA1C in monotherapy
Side effects: GI disturbances (esp. nausea), GERD, decreased appetite
Average 8 pound weight loss
Efficacy: 0.8 – 0.9
Exenatide's weight loss pleateaus after ~____.
And this helps motivate patients.
Bad news is it doesn’t lower A1C very much. But if they continue weight loss, that continues to lower the A1C
Multiple combinations exist of these classes (must have diff mech of action). Name 4
TZD + SU
Biguanide + TZD
Biguanide + SU
Biguanide + DPP4-Inhibitor