ANTIDIABETIC DRUGS: GLP-1 AGONISTS

Question 1

MOA

Answer 1

Binds to and activates GLP-1 receptors to increase insulin secretion
Suppress glucagon secretion
Slows gastric emptying
Prevents weight gain

Question 2

Examples

Answer 2

Exenatide
Albiglutide
Dulaglutide (trulicity)
Liraglutide (victoza)
Lixisenatide
Semaglutide (ozempic)

Question 3

Which GLP-1 agonist is long-acting and therefore how often are they taken?

Answer 3

1. Dulaglutide (trulicity)
2. Semaglutide (Ozempic)
   injections
3. Exenatide (modified-release)
   These are all taken WEEKLY

Question 4

Which GLP-1 agonists are taken daily?

Answer 4

1. Exenatide (immediate release preparation)
2. Liraglutide (victoza)
3. Lixisenatide
4. Semaglutide (Rybelsus)
   TABLETS

Question 5

Semaglutide injections

Answer 5

• Ozempic
• once weekly, dose 0.25mg-1mg - ozempic);
• s/c into abdomen, thigh or upper arm - any time of the day - with or without meals
• MISSED DOSE: avoid taking missed doses if more than five days late

Question 6

Semaglutide tablets

Answer 6

Rybelsus
 daily, dose 3mg-14mg
 empty stomach, sip of water, wait at leats 30mins before eating, drinking or taking other meds

Question 7

Liraglutide

Answer 7

Victoza
o once weekly, 0.6mg-1.8mg
o can be injected with or without meals

o (saxenda: for weight loss ONLY)

Question 8

Dulaglutide

Answer 8

Trulicity
o once weekly, 0.75mg-4.75mg
o MISSED DOSE: avoid taking missed dose if more than 3 days late

Question 9

Exenatide (BD, MR)

Answer 9

o brand: byetta, MR brand: Bydureon
o dose of S/R=5mcg to 10mcg, MR=2mg - weekly
o MISSED DOSE (MR): avoid taking missed dose if more than 3 days late

Question 10

lixisenatide

Answer 10

daily, 10mcg-20mcg
o within the hour prior to any meal of the day
o MISSED DOSE: inject within 1 hour before the next meal - AVOID INJECTING AFTER MEAL!

Question 11

MHRA:

Answer 11

Risk of diabetic ketoacidosis when concomitant insulin was rapidly reduced

Question 12

Side effects

Answer 12

DNV
Headaches
Pancreatitis
Decreases appetite
Dehydration

Question 13

Acute pancreatitis

Answer 13

patients warned of persistent, severe abdominal pain

Question 14

Dehydration

Answer 14

risk of dehydration due to gastro-intestinal side-effects and advised to take precautions to avoid fluid depletion

Question 15

Missed doses

Answer 15

Do not administer AFTER a meal
Inject within one hour of next meal (Lixisenatide)
Continue with next scheduled dose (Exenatide)
Inject within 3 days of next weekly dose (Dulaglutide, Albiglutide, Liraglutide)

Question 16

Pregnancy + Contraception

Answer 16

Use contraception up to 3 months after stopping

Question 17

Lixisenatide cautions

Answer 17

Should not be used with both basal insulin and a SU - increased risk of HYPO

Question 18

Exenatide cautions

Answer 18

S/c nodules can occur with MR exenatide(bydureon)
MR effects can persist up to 10 weeks after discontinuation

Question 19

With which GLP-1 agonists is contraception strongly advised with concurrent use?→

Answer 19

exenatide and lixisenatide - effective contraception is advised for women of child-bearing age during treatment with AND for 12 weeks after stopping treatment with: M/R EXENATIDE!

Question 20

Renal impairment

Answer 20

o Exenatidfe I/R: avoid if CrCl<30, caution if CrCl 30-50!

Question 21

Severe GI disease

Answer 21

o avoid exenatide, liuraglutide, lixisenatide and dulaglutide

Question 22

Ketoacidosis

Answer 22

o avoid GLP-1 agonists

Question 23

Severe heart failure (HF)

Answer 23

o avoid liraglutide and semaglutide caution!

Question 24

Elderly

Answer 24

o caution due to weight loss!