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CC May 2016 SGLT-2 Inhibitors

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echoecho's version from 2016-08-02 02:46

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Question Answer
Type 2 DM is an epidemic with 350 million people affected, representing ____% of the world's adult population?6.5
List current mediation classes?1) analog insulins 2) DPP-4 (dipeptidyl peptidase-4) inhibitors 3) glucagon-like peptide-1 (GLP-1) receptor agonists 4) concentrated insulins 5) inhaled insulin
What is the newest class of drugs?sodium-glucose cotransporter-2 (SGLT-2) inhibitors
List the medications in the SGLT-2 inhibitor class?1) canagliflozin (Invokana) 2) dapagliflozin (Farxiga) 3) empaglifozin (Jardiance)
While ________ remains the preferred first-line agent and should be included as the backbone of any 2- or 3- drug combination therapy for T2DM, the latest position statement of the ADA includes options for all currently available classes of antihyperglycemic therapies, including the SGLT-2 inhibitors?Metformin
Choosing which drug to add after metformin should be determined based on patient specific information including?1) the extent of A1c lowering required to reach target 2) the level of concern for hypoglycemia 3) the preference for effect on weight 4) cost to the patient, after efficacy and safety are appropriately addressed
Equally important in selecting a second agent is consideration of sensible pharmacologic ________?combination
Combining agents that address the ______ pathophysiologic defects in T2DM is one strategy?multiple
Because of their role in glucose homeostatsis the kidneys have been a target for the development of diabetic drugs, true or false?true
The kidneys filter about _____ gms of glucose every day?180
Under normal circumstances, virtually all filtered glucose is reabsorbed in the _______ renal tubules via 2 _____ - ______ ___ - ___________?1) proximal 2) sodium-glucose co-transporters (SGLT-1 [low capacity and SGLT-2 [high capacity])
What happens to the SGLT-2 transporter in T2DM?expression of the SGLT-2 transporter is up-regulated so glucose excretion occurs at HIGHER than usual plasma concentrations leading to prolonged periods of hyperglycemia
What do SGLT-2 inhibitors do?they induce the excretion of glucose by LOWERING the threshold for such excretion, inhibiting the reabsorption of about 30-50% of filtered glucose
List the 5 advantages of the SGLT-2 inhibitor class?1) act independently of insulin 2) should NOT confer a risk for hypoglycemia 3) are effective any stage of T2DM disease / level of insulin resistance 4) facilitate weight loss through glucose excretion (calories) 5) lower BP at least in part due to the osmotic diuresis
Emerging evidence of their favorable _______ profile is encouraging?cardiovascular
Presently, how many SGLT-2 inhibitors are available in the US?3
All of these can be used as monotherapy although they are more commonly used in combination, particularly with _______?Metformin
Have adequate and well-controlled studies of these drugs been performed on pregnant women?no
SGLT-2 inhibitors have been shown ________ (inferior vs. non-inferior) to sulfonylureas and DPP4-inhibitors with respect to their degree of A1c lowering?non-inferior
*** SGLT-2 inhibitors can anticipate an A1c lowering of about _____% with monotherapy?0.8
True or false? The ADA describes SGLT-2 inhibitors as having intermediate efficacy?true
For individuals requiring greater lower of A1c (> _____%), a drug from one of the classes with high efficacy might be preferable?0.8
With SGLT-2 inhibitors, an average of ___ to ____ kg?2; 3
List the 3 SGLT-2 inhibitors that are available currently?1) Canagliflozin 2) Dapagliflozin 3) Empagliflozin
*** All 3 agents require normal or near normal renal function for effect, given their site of action in the _______tubule?proximal
The maximum dose of canagliflozin is ____ mg when the eGFR is ____ to _____ mL/min?10; 45; 60
Dapagliflozin should be avoided when the eGFR is < _____ mL/min?60
Empaglifozin should be avoided when the eGFR is < ______mL/min?45
The metabolic pathways of SGLT-2 inhibitors allow for a low risk of what?clinically significant drug interactions
Which of the 3 agents can INCREASE digoxin levels ?Canagliflozin
What 2 agents can cause relevant interactions with induces of uridine diphosphate-glucuronosyltransferase?1) Canaglifozin 2) Dapagliflozin
List inducers of uridine diphosphate-glucuronosyltransferace?1) refampin (Rifadin) 2) phenytoin (Dilantin) 3) phenobarbital 4) ritonavir (Norvir)
List the 2 common adverse drug reactions?1) genital mycotic infections 2) UTI
These common adverse drug reactions generally present w/in the first ____ weeks of therapy, are usually mild-to-moderate intensity and respond to standard treatment?24
Cases appear to be common in what 3 groups of patients?1) women 2) uncircumcised men with a hx of similar infections 3) high BMI
SGLT-2 inhibitors can lead to increased urination and thirst, so adequate _______ is encouraged?hydration
memorize
The patient's baseline BP should be adequate enough to manage the anticipated ___ to ___ mmHG lowering in systolic BP with initiation
Question Answer
Two recent warnings for the SGLT-2 inhibitors include what?1) decreased BMD 2) euglycemic diabetic ketoacidosis
A clinical trial evaluated BMD changes over 2 years in 714 older adults and showed that Canagliflozin caused a greater loss of BMD at the ____ and ____ _____ compared to placebo?1) hip 2) lower spine
memorize
Bone fractures, as early as ___ weeks after starting Canagliflozin have occurred
The etiology of euglycemic diabetic ketoacidosis is believed to be drug-induced glycosuria that "artificially" lowers ______ levels? What does this predispose certain patients to?: 1) glucose 2) increased ketogenesis (such as those with longer standing T2DM) and possibly those with insulin deficiency.
Question Answer
List the causes of euglycemic diabetic ketoacidosis in patients taking SGLT-2 inhibitors?1) major illness 2) reduced food and fluid intake 3) reduced insulin doses
Providers may wish to evaluate SGLT-2 inhibitor patients with nasuea/vomiting and malaise for what lab tests?urine and/or serum ketones
*** SUMMARY = List the advantages of the SGLT-2 inhibitor class?1) act independently of insulin 2) should NOT confer risk of hypoglycemia 3) are effective at any stage of T2DM disease / level of insulin resistance (4) facilitate weight loss through glucose excretion (calories) and (5) lower blodd pressure
*** SUMMARY = SGLT-2 inhibitors require near normal renal function for effect, given their site of action in the ______ tubule?proximal
*** SUMMARY = The FDA has issued warnings related to decreased ________ and risk for ________?1) bone mineral density 2) risk of euglycemic ketoacidosis
memorize