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Injectable DM
Injectable DM Drugs GLP-1 and Pramlintide
| Question | Answer |
|---|---|
| What is the MOA of GLP-1 agonist? | - analogues of GLP-1 - increases the glucose dependent insulin secretion |
| Which GLP-1 agonist are NOT recommended in pt with CrCL < 30 or ESRD? | exenatide ( byetta) and Exenatide extended release ( bydureon) |
| Which GLP-1 agonist are dosed once every WEEK? | - Exenadtide extended release - Dulaglutide - Albiglutide |
| Which GLP-1 agonist DO NOT increases the risk of Thyroid C-Cell carcinomas? | - Byetta ( extentide) and Adlyxin ( Lixisenatide) |
| When GLP-1 agonist are considered C/I? | - ALL GLP-1 agonist increase the risk of Thyroid C cell carcinoma except Byetta and Adlyxin 1- Pt with h/o of medullary thyroid carcinoma 2- pt with endocrine neoplasia syndrome type II |
| When GLP-1 agonist is not recommended? | in pt with severe GI diseases |
| What are some of the GLP-1 agonist warnings? | - pancreatitis ( h/o pancreatitis, EtOH use, gallstones, increased TG) |
| Which GLP-1 agonist has increased risk of injection site reaction such as abscess, cellulitis and necrosis? | Bydureon -- Extenatide extended releases |
| Which GLP-1 agonist has increased risk of Cardiovascular effects such as tachycardia, 1st degree AV block and PR interval prolongation? | -Trulicity ( Dulaglutide) |
| What are some of GLP-1 agonist side effects? | - NAUSEA common effect - Wt LOSS - vomiting, D, constipation, hypoglycemia - injection site reaction |
| What are the common monitoring parameters while pt on GLP-1 agonist? | - Renal function - A1c and BG |
| Which GLP- 1 agonist should be taken within 60 min of meals? | - Byetta ( exenatide) and Adlxin ( lixisenatide) |
| What is the proposed MOA of DDI in pt taking GLP-1 agonist? | - GLP-1 can slow gastric emptying --> REDUCE extend/ rate of absorption - Caution if narrow therapeutic drugs are used ( as threshold conc of efficacy is required) |
| When should the patient on GLP-1 agonist be advised to take oral contraceptive? | - 1 hr before exenadtide and Adlyxin - 8 hr after Adlyxin |
| What are the main point to counsel pt using GLP-1? | - SC injection - Rotate sites - dispose needle, pen and syringes in sharp containers |
| what is the dosing of Byetta ( exenatide)? | - 2X/day - 60 min with in the meal time - NEVER Inject after a meal - GOOD for 30 days ONLY |
| What is the dosing of Bydureon ( extenatide extended release)? | - ONCE/week - single-dos vital/tray formula --> once mixed --> inject - pen formula --> refrigerator |
| What is the dosing of Tanzeum ( albiglutide)? | - pen formula --> powder + water --> needs mixing - needs refrigerator - after mixing the solution is clear and slightly yellow |
| What is the recommendations if pt misses a dose of the following medications: Bydureon, trulicity and tanzeum? | - these dosed once/week - missed dose take ASA you remember as long as the next dose is not < 3 days |
| What is the the dosing of Adlyxin ( Lixisenatide)? | - once/day within 60 min of the 1st meal ( similar to byetta) - it's 14 days supply - it comes as starter pack ( green / 10 mcg/dose) and continuous pack ( burgundy 20 mcg/dose) - |
| What is the MOA of Pramlintide? | - it's a synthetic analog of Amylin ( neuroendocrine hormone produced by beta cells) - targets PPBG - slows down the gastric emptying, suppress glucagon |
| When Pramlintide ( symlin) is C/I? | - in pt with gastroparesis - Unawarness hypoglycemia |
| Which class of drugs increases the risk of severe hypoglycemia in pt taking Pramlintide (symlin) and considered BBW as combination ? | - insulin within 3 hrs - severe hypoglycemia is BBW when used with insulin - consider 50% reduction of mealtime insulin when starting Pramlintide |
| What are some of the common side effects of pramlintide? | - GI : n/v/ anorexia/ wt loss - headache |
| What is the pramlintide ( symlin) dosing in type I and II DM pt? | - type I: symlin pen 60 mcg/dose - type II: symlin pen 120 mcg/dose ** NAUSEA: is the titration factor ** |
| What is the required major meal nutrients prior to SC administration of Pramlintide? | - SC in thigh or abdominal area prior to meal - >250 Kcal - > 30 grams carbs *** if the meal doesn't meet these requirements, skip the dose 2/2 to severe hypoglycemia side effect |
| What is the proposed MOA of DDI with pramlintide? | - slows gastric emptying --> reduces rate/extent of absorption - administer other drugs 1 hr before or 2 hr after |
Created by:
Smoham38
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