Incretinmimetics & Amylin analogs

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jdonaldson
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102380
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Incretinmimetics & Amylin analogs
Updated:
2011-09-18 12:34:14
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james James donaldson Donaldson usp USP diabetes Diabetes
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  1. (GIP/GLP) secretion is impaired in diabetics. It causes:
    1. (faster/slower) gastric emptying
    2. (induces/inhibits) satiety
    3. (induces/inhibits) glucagon secretion
    4. (stimulates/inhibits) insulin secretion
    • GLP-1
    • 1. slower
    • 2. induces
    • 3. inhibits
    • 4. stimulates
  2. What medications are classified as incretinmimetics?
    • 1. exenatide (Byetta)
    • 2. liraglutide (Victoza)
  3. What are the adverse drug effects associated with incretinmimetics?
    • - High rates of nausea
    • - vomiting
    • - diarrhea
  4. What are the contraindications to incretinmimetics?
    Liraglutide: Hx or family hx of medullary thyroid carcinoma, or pts with endocrine neoplasia syndrome type 2
  5. 1. Incretinmimetics may be combined with ______ or ______ for synergistic effects.
    2. Incretinmimetics should not be combined with ______ or ______, or hypoglycemia will result.
    • 1. metformin or TZDs
    • 2. insulin or SUs
  6. What considerations must be made when taking pain medications or antibiotics with incretinmimetics?
    Incretinmimetics delay gastric emptying. Pain meds or antibiotics should be taken 1 hour before or 3 hours after an incretinmimetic.
  7. Dosing for exenatide (Byetta) -
    • Initiate SubQ 5 mcg BID within 60 minutes prior to a meal.
    • Titrate to 10 mcg BID in roughly 1 month if tolerated.
  8. Dosing for liraglutide (Victoza) -
    • Initiate at 0.6 mg SubQ inj. into abdomen or upper arm once daily for one week --> 1.2 mg SubQ once daily
    • *If inadequate, increase to 1.8 mg SubQ once daily
    • **No timing with meals required (unlike exenatide)
  9. True or False?
    Incretinmimetics are associated with weight gain.
    • False.
    • Incretinmimetics are associated with weight loss (not due to N&V but to decreased caloric intake).
  10. Things to monitor while a pt is on an incretinmimetic -
    • 1. Weight
    • 2. Renal function
    • 3. Hypoglycemia (when added to other agents)
    • 4. SMBG (at least once daily on initiation)
  11. With incretinmimetics, N&V may be worse with ______________. How can this be fixed?
    • 1. Overconsumption of meals
    • 2. Instruct pts to eat slow and to stop when full
  12. What degree of A1C lowering effect do incretinmimetics have?
    0.8 - 1.0 % reduction
  13. True or False?
    Exenatide is associated with reduction in CV risk factors (as it lower TG and SBP).
    • True.
    • Could be due to weight loss caused by drug.
  14. Incretinmimetics are often combined with _______, though this combination is not FDA approved.
    Insulin
  15. True or False?
    DPP-IV inhibitors, TZDs, and incretinmimetics may preserve beta cell function.
    True.
  16. Who should receive amylin analogs?
    Patients already on insulin.
  17. What medications are classified as amylin analogs?
    1. pramlintide (Symlin)
  18. True or False?
    Pramlintide (Symlin) works mostly to lower fasting BG levels.
    • False.
    • Pramlintide (Symlin) works mostly to lower wide swings in post-prandial BG levels.
  19. What are common adverse effects with pramlintide (Symlin)?
    • Nausea, vomiting or anorexia
    • Hypoglycemia when combined with insulin (risk is doubled in DMI).
  20. True or False?
    Amylin analogs (working like amylin), have similar effects as incretins/incretinmimetics.
    • True.
    • They slow the rate of gastric emptying, increase feelings of satiety, and decrease post-meal glucagon secretion.
  21. True or False?
    Pramlintide (Symlin) is only indicated for use in DMI.
    False.
  22. What are the contraindications to pramlintide (Symlin)?
    • - Gastroparesis
    • - Hypoglycemia unawareness
  23. What considerations must be made when taking pain medications or antibiotics with pramlintide (Symlin)?
    Pramlintide slows gastric emptying, therefore pain medications and antibiotics (and other meds that require precise absorption) should be taken 1 hour before or 3 hours after pramlintide.
  24. Pramlintide (Symlin) dosing in DMI -
    • 15 mcg SubQ ac meals
    • * Increase dose at 15 mcg increments when pt has been nausea free for 3 days on a given dose, to a max of 60 mcg
    • ** Reduce mealtime insulin dose by 50 %
    • *** D/C if pt unable to tolerate 30 mcg dose
  25. When taking pramlintide (Symlin), insulin dose should be reduced by ____ %.
    50 %
  26. Pramlintide (Symlin) dosing for DMII -
    • 60 mcg SubQ ac meals
    • * Increase dose to 120 mcg if pt is nausea-free for 3-7 days (and decrease back down if severe N&V occurs at 120 mcg)
    • ** Reduce meal-time insulin by 50 %
  27. Administration of pramlintide (Symlin):
    1. site -
    2. mixing technique with insulin -
    3. avoiding injection site reactions -
    4. timing
    • 1. SubQ in thigh or abdomen (not arm - variable absorption), 2 inches from insulin injection site.
    • 2. can NOT be mixed with insulin
    • 3. bring to room temp. before injecting
    • 4. administer prior to major meals (≥ 250 kcal or ≥ 30 gm carbs)
  28. How to monitor a pt on pramlintide (Symlin) -
    • 1. SMBG: pre- and post-prandial BG levels --> ensure no hypoglycemia
    • 2. Weight - monitor at each office visit.
  29. Pramlintide (Symlin):
    1. Lowers A1C levels by about _______ %
    2. Mostly lowers (basal/post-prandial) BG levels
    3. Is a good option for pts who __________...
    4. T/F causes weight gain
    5. Should not be used in pts with A1C > _____ %
    • 1. 0.5 - 0.6 %
    • 2. post-prandial
    • 3. have large fluctuations in daily BG levels
    • 4. False, mostly weight neutral (lose 3-6 lbs)
    • 5. > 9% (also should not be used in pts with poor adherence to insulin therapy or SMBG)

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