GLP-1 RA Flashcards
GLP-1 RA: MOA
- slow gastric emptying
- promotes beta cells proliferation
- increase insulin secretion/decrease glucagon secretion
Excenatide IR (Byetta): Dosing
- 5 mcg SQ BID, titrate to 20mcg BID after 1 month
- DO NOT USE CrCl < 30 mL/min
- should be taken 60 min prior to meals
Liraglutide (Victoza®): Dosing
- 0.6 mg SQ daily, then titrate to 1.2 mg SQ daily after 7 days; can further titrate to 1.8 mg SQ daily
Lixisenatide (Adylxin®): Dosing
- 10mcg SQ daily x 14d; then 20mcg SQ daily
- Should be taken within 60min of the first meal of the day
Semaglutide (Rybelsus®): Dosing
- 3mg PO daily x 30d; then 7mg daily; then 14mg daily
- take 30 min before first meal
Exenatide ER (Bydureon®): Dosing
- 2 mg once weekly
- DO NOT USE if CrCl < 30 mL/min
Dulaglutide (Trulicity®): Dosing
- Start: 0.75mg once weekly, ↑ to 1.5mg once weekly after 4 weeks; can ↑ to 3mg and 4.5mg q4wks
- no renal adjustment
Semaglutide (Ozempic®): Dosing
- 0.25mg weekly x 4wks, then 0.5mg x 2-4 wks, then up to 1mg weekly
- No renal adjustment
GLP-1 RA: Side effects
● Hypoglycemia
● Nausea/GERD/dyspepsia
● Vomiting
● Diarrhea
● Jitteriness
● Headache
● URI/cough
● Injection site reaction
● Pancreatitis
● Cholelithiasis
GLP-1 RA: Drug interactions
Cause HYPOglycemia:
• Androgens
• Insulins/SU
• Pegvisomant
Cause HYPERglycemia:
• Corticosteroids
• Danazol
• LHRH
• Somatropin
• Thiazide diuretics
GLP-1 RA: BBW
• Thyroid C-Cell Tumors
• Medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome
type 2 (MEN2)
EXCEPT LIXISENATIDE (ADLYXIN)
GLP-1 RA: Contraindications
• MTC
• MEN2
• Renal Impairment
• ESRD or CrCl < 30ml/min (exenatide IR and ER only)
GLP-1 RA: Precautions
• Severe GI disease (e.g., colitis,
Chron’s, obstruction, IBD, UC, Gastroparesis)
• Hypoglycemia
• Pancreatitis
GLP-1 RA: Counseling points
●May cause upset stomach; should decrease over time
● Don’t overeat
● Avoid large meals | eat smaller meals more frequently
●Prior to initial use, store in refrigerator
●After initial use, may be stored at room temperature
●Rybelsus only – take 30min before eating first meal
●Ask about: GI upset and timing of doses at every refill
EXENATIDE IR (BYETTA®): Counseling points
●Give BID; 30-60min b/f eating
●Need Rx for needles
●Requires titration
EXENATIDE ER (BYDUREON®):: Counseling points
EXENATIDE ER
(BYDUREON®):
●Must be reconstituted
immediately prior to use
●Given weekly; without regard to
EXENATIDE ER (BYDUREON® BCise): Counseling points
●Auto-injector
●Given weekly; without regard to meals
●Needle in device
LIXISENATIDE (ADLYXIN®): Counseling point
- given daily
LIRAGLUTIDE (VICTOZA®): Counseling points
● Given once daily; without regard to meals
● Need Rx for needle
● Requires titration
SEMAGLUTIDE (OZEMPIC®): Counseling Points
●Given once WEEKLY; without regard to meals
●Needle given with device
●Requires titration
DULAGLUTIDE (TRULICITY®): counseling points
● Given weekly; without regard to meals
● Needle is self-contained in device
● Requires titration
SEMAGLUTIDE (RYBELSUS®): counseling points
●Taken orally, once a day
●Take 30min before eating first meal
GLP-1 RA: Monitoring
●Renal function
● FBG
●PPG
●GI symptoms
● Patient use of device
● Time to peak effect: 6-8 weeks (depending on titration schedule)
GIP+GLP-1 RA: Available Agent
Tirzepatide (Mounjaro®)
GIP+GLP-1 RA : MOA
● Increases glucose dependent insulin
● Decreases inappropriate glucagon secretion
● Slows gastric emptying
GIP+GLP-1 RA : Indications
● As adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
GIP+GLP-1 RA : dosing
• Initial: 2.5mg once weekly x 4 weeks
• Then increase to 5mg once weekly x 4 weeks
• Continue to increase by 2.5mg increments every 4 weeks
• Maximum weekly dose: 15mg
GIP+GLP-1 RA : Side effects
● GI: decreased appetite, diarrhea, increased serum amylase & lipase, nausea
● Sinus tachycardia
● Injection site reaction
● Cholelithiasis
GIP+GLP-1 RA : Drug interactions
Cause HYPOglycemia:
• Androgens
• Beta-blockers (selective)
• Beta-blockers (nonselective)
• Insulins/SU
• Quinolones
Cause HYPERglycemia:
• Beta-blockers (nonselective)
• Quinolones
• Thiazide diuretics
GIP+GLP-1 RA: BBW
• Thyroid C-Cell Tumors
• Medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome
type 2 (MEN2)
GIP+GLP-1 RA: Contraindications
• MTC
• MEN2
GIP+GLP-1 RA: Precautions
• Severe GI disease (e.g., colitis, Chron’s, obstruction, IBD, UC, Gastroparesis)
• Hypoglycemia
• Pancreatitis
• Acute Kidney Injury
• Retinopathy
• Acute Gallbladder Disease
GIP+GLP-1 RA : Counseling points
●May cause upset stomach; should decrease over time
● Avoid large meals | eat smaller meals more frequently
●Prior to initial use, store in refrigerator
●After initial use, may be stored at room temperature
●Given weekly; without regard to meals
●Ask about: GI upset and timing of doses at every refill
GIP+GLP-1 RA: Monitoring
●Renal function
● FBG
●PPG
●GI symptoms
● Patient use of device
● Time to peak effect: 6-8 weeks (depending on titration schedule)
