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Liraglutide (Victoza) has what MOA?
- Human GLP-1 analogue similar to extenatide
- Incretin mimetic
- Stimulates the production of insulin in response to high glucose concentrations.
- Inhibition of the release of glucagon after meals.
- Slows the rate of gastric emptying.
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Liraglutide (Victoza) is the same as ____________ with an added C-16 fatty acid chain increases half-life
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How often is Liraglutide (Victoza) dosed?
once daily dosing
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What is the most common adverse effect of Liraglutide (Victoza)?
Nausea (10.5%-40%)
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What is the efficacy of Liraglutide (Victoza)?
Decreases A1C ~ 1.0% at 1.8 mg/day
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Why do you use dose escalation from 0.6 mg/day for one week, increased by 0.6 mg per week to a maximum of 1.8 mg/day when initiating Liraglutide (Victoza)?
Reduce GI effects
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Is Liraglutide (Victoza) used in renal failure?
No dosage adjustment for renal impairment
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How should you make up for missed doses of Liraglutide (Victoza)?
Do not make up for missed doses
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What are the AE for Liraglutide (Victoza)?
- Thyroid c-cell tumors and pancreatitis
- Patients with thyroid nodules or elevated serum calcitonin levels should be referred to an endocrinologist
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What should you monitor when a patient is taking Liraglutide (Victoza)?
S/S of pancreatitis at initiation and with dose increases
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Exenatide-ER (Bydureon) comes in what dosage form?
- Injectable suspension
- Available in a premixed pen
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How does Exenatide-ER (Bydureon) compare to Byetta and Victoza?
- More effective than Byetta (0.9% vs. 1.6% A1C); similar to liraglutide
- Less nausea (~15%) than either Byetta or liraglutide
- Less expensive than Liraglutide
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How is Exenatide-ER (Bydureon) dosed?
- Any time of the day
- 2 mg SQ once every 7 days without regard to food
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What are the SE/Precautions of Exenatide-ER (Bydureon)?
- Bumps at injection site; dissipates within weeks
- Caution with renal impairment
- Weight loss (same as for all incretins) 6-8 pounds over 6 months
- Pancreatitis
- Risk of thyroid c-cell tumors
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What is Exenatide-ER (Bydureon)CI in?
Personal or family history of medullary thyroid carcinoma
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What are the disadvantages of Exenatide-ER (Bydureon)?
Expensive
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What are the main advantages of Exenatide-ER (Bydureon)?
- Less expensive than Liraglutide
- May be:
- More effective than prandial insulin when combined with basal
- More effective than insulin glargine?
- May be a good alternative to basal insulin (A1C ≥ 8.5%) for those concerned with weight gain, risk of hypoglycemia, and QD injections
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What patient population may Exenatide-ER (Bydureon) be particularly useful in?
May be a good alternative to basal insulin (A1C ≥ 8.5%) for those concerned with weight gain, risk of hypoglycemia, and QD injections
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________________________ should be injected immediately after powder becomes suspended.
Exenatide-ER (Bydureon)
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What is the MOA of Exenatide-ER (Bydureon)?
- Incretin mimetic
- Stimulates glucagon-like peptide 1 receptor
- Stimulates the production of insulin in response to high glucose concentrations.
- Inhibition of the release of glucagon after meals.
- Slows the rate of gastric emptying.
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Albiglutide (Tanzeum) comes in what dosage form?
Injectable suspension in a pen similar to Bydureon
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What is a normal dose of Albiglutide (Tanzeum)?
- 30 mg SQ Q week (abdomen, thigh, upper arm)
- Administer same time each day without regard to meals
- May increase to 50 mg Q wk if inadequate response
- Day of weekly administration may be changed as long as last dose was 4 or more days before
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How should you make up for missed doses of Albiglutide (Tanzeum)?
- Administer ASAP within 3 days after the missed dose
- If more than 3 days after the missed dose, wait until next regularly scheduled weekly dose
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Should Albiglutide (Tanzeum) be used in renal failure?
No dosage adjustment for renal impairment
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What are the most common AE/precautions for Albiglutide (Tanzeum)?
- ≥ 10% URTI, diarrhea, nausea, injection site reaction
- Risk of thyroid c-cell tumors and pancreatitis
- (Patients with thyroid nodules or elevated serum calcitonin levels should be referred to an endocrinologist)
- Pancreatitis
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What should you monitor for with Albiglutide (Tanzeum)?
Monitor for S/S of pancreatitis at initiation and with dose increases
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What drugs should you monitor for S/S of pancreatitis at initiation and with dose increases?
Incretin mimetics, Exenatide, Liraglutide, Albigultide and Dulaglutide
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Dulaglutide (Trulicity) is administered in what way?
- Inject SQ Q week at any time of day
- Initiate at 0.75 mg Q week; can increase to 1.5 mg/week
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Can Dulaglutide (Trulicity) be given in renal impairment?
No dosage adjustment with renal dysfunction
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What is Dulaglutide (Trulicity) approved for?
- Monotherapy or in combination with metformin, sulfonylurea, TZD, and prandial insulin
- Not considered first-line therapy
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What are the Contraindications of Dulaglutide (Trulicity)?
- T1DM
- Ketoacidosis
- Severe GI disorders
- Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2
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What are the Warnings and Precautions for Dulaglutide (Trulicity)?
- Thyroid C-cell tumors in animals
- Pancreatitis
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Hypoglycemia - use lower dose when combined with insulin or insulin
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What should you monitor for with Dulaglutide (Trulicity)?
Renal function in patients with impairment; worsen GI effects
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What are the Side effects of Dulaglutide (Trulicity)?
Nausea, diarrhea, vomiting, abdominal pain, and decreased appetite
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