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1 REMS only); OB: Has caused fetal physical defects and neonatal death in animal studies;
Lactation: Excretion into breast milk unknown.
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exenatide (ex-en-a-tide) Use Cautiously in: History of pancreatitis; Moderate renal impairment (CCr 30
Bydureon, Byetta 50 mL/min); Concurrent use of insulin (extended-release only); Pedi: Safety not es-
tablished.
Classification
Therapeutic: antidiabetics Adverse Reactions/Side Effects
Pharmacologic: incretin mimetic agents CV: dizziness, headache, jitteriness, weakness. GI: PANCREATITIS, diarrhea, nausea,
Pregnancy Category C vomiting, dyspepsia, gastroinestinal reflux. Endo: THYROID T-CELL TUMORS (ex-
tended-release), hypoglycemia. GU: acute renal failure. Derm: hyperhydrosis. Me-
tab:pappetite, weight loss.
Indications
Management of type 2 diabetes as an adjunct to diet and exercise. Interactions
Action Drug-Drug: Concurrent use with sulfonylureas or insulin mayqrisk of hypo-
Mimics the action of incretin which promotes endogenous insulin secretion and pro- glycemia (pdose of sulfonylurea or insulin if hypoglycemia occurs); concomitant
motes other mechanisms of glucose-lowering. Therapeutic Effects: Improved use of insulin with extended-release exenatide not recommended. Concurrent use
control of blood glucose. with nateglinide or repaglinide mayqrisk of hypoglycemia. Due to slowed gastric
emptying, maypabsorption of orally administered medications, especially those
Pharmacokinetics requiring rapid GI absorption or require a specific level for efficacy; take oral anti-
Absorption: Well absorbed following subcutaneous administration. infectives and oral contraceptives at least 1 hr before injecting exenatide).
Distribution: Unknown.
Metabolism and Excretion: Excreted mostly by glomerular filtration followed Route/Dosage
by degradation. Immediate Release (Byetta)
Half-life: Immediate-release 2.4 hr. Subcut (Adults): 5 mcg within 60 min before morning and evening meal; after 1
TIME/ACTION PROFILE (effects on post-prandial blood glucose) mo, dose may beqto 10 mcg depending on response.
ROUTE ONSET PEAK DURATION Renal Impairment
subcut (immediate-re- within 30 min 2.1 hr 8 hr Subcut (Adults): CCr 30 50 mL/min Use caution whenqdose from 5 mcg to
lease) 10 mcg.
subcut (extended-re- unknown 9 wk unknown
lease) Extended Release (Bydureon)
Subcut (Adults): 2 mg every 7 days.
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Type 1 diabetes or diabetic ketoacidosis; NURSING IMPLICATIONS
Severe renal impairment or end-stage renal disease (CCr 30 mL/min); Severe gas- Assessment
trointestinal disease; Personal or family history of medullary thyroid carcinoma (ex- Observe for signs and symptoms of hypoglycemic reactions (abdominal pain,
tended-release only); Multiple Endocrine Neoplasia syndrome (extended-release sweating, hunger, weakness, dizziness, headache, drowsiness, tremor, tachycar-
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/exenatide 02/12/2014 02:31PM
2 the next dose at the prescribed time. Do not take an extra dose or increase the
dia, anxiety, confusion, irritability, jitteriness), especially when combined with
oral sulfonylureas.
Assess for signs and symptoms of pancreatitis (persistent severe abdom-
inal pain, sometimes radiating to the back, may or may not be accompa-
nied by vomiting) at beginning of therapy and with dose increases. If
suspected, promptly discontinue therapy and initiate appropriate man-
agement. If pancreatitis is confirmed, do not restart exenatide. Consider
other antidiabetic therapies in patients with a history of pancreatitis.
Lab Test Considerations: Monitor serum glucose and glycolysated hemoglo-
bin periodically during therapy to evaluate effectiveness of therapy.
Monitor renal function prior to and periodically during therapy. Renal dysfunction
may be reversed with discontinuation of therapy.
Potential Nursing Diagnoses
Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)
Implementation
Some medications may need to be taken 1 hr before exenatide.
Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma,
infection, or surgery may require administration of insulin.
Subcut: Immediate release: Follow directions for New Pen Setup in Informa-
tion for Patient prior to use of each new pen. Inject exenatide in thigh, abdomen,
or upper arm at any time within the 60 min period before the morning and eve-
ning meals. Do not administer after a meal. Do not mix with insulin. Solution
should be clear and colorless; do not administer solutions that are discolored or
contain particulate matter. Refrigerate; discard pen 30 days after 1st use, even if
some drug remains in pen. Do not freeze. Do not store pen with needle attached;
medication may leak from pen or air bubbles may form in the cartridge.
Subcut: Extended release: Dilute with diluent and needles included in tray. Sus-
pension should be white or off-white and cloudy. Administer without regard to
meals. Inject into upper arm, abdomen, or thigh; change site each week. Refriger-
ate; each tray can be kept at room temperature of not 77F for up to 4 wks. Do
not use beyond expiration date.
Patient/Family Teaching
Instruct patient to take exenatide immediate release as directed within 60 min
before a meal. Do not take after a meal. If a dose is missed, skip the dose and take
2015 F.A. Davis Company
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amount of the next dose to make up for missed dose. If a dose of exenatide ex-
tended releaseis missed, administer as soon as remembered as long as the next PDF Page #2
dose is due at least 3 days later; if 1 or 2 days later skip dose and administer next
dose as scheduled. The day of weekly administration can be changed as long as the
last dose was administered 3 or more days before.
Instruct patient in proper technique for administration, timing of dose and con-
current oral medications, storage of medication and disposal of used needles. Pa-
tients should read the Information for Patient insert prior to initiation of therapy
and with each Rx refill. Advise patient that New Pen Setup should be done only
with each new pen, not with each dose.
Inform patient that pen needles are not included with pen and must be purchased
separately. Advise patient which needle length and gauge should be used. Caution
patient not to share pen and needles.
Explain to patient that exenatide helps control hyperglycemia but does not cure di-
abetes. Therapy is usually long term.
Encourage patient to follow prescribed diet, medication, and exercise regimen to
prevent hyperglycemic or hypoglycemic episodes.
Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia oc-
curs, advise patient to take a glass of orange juice or 2 3 tsp of sugar, honey, or
corn syrup dissolved in water, and notify health care professional. Risk of hypogly-
cemia is increased if sulfonureas are taken concurrently with exenatide.
Advise patient to notify health care professional immediately if symp-
toms of pancreatitis (unexplained, persistent, severe abdominal pain
which may or may not be accompanied by vomiting) occur.
Inform patient that therapy may result in reduction of appetite, food intake, and/or
body weight. Dose modification is not necessary. Nausea is more common at initi-
ation of therapy and usually decreases over time.
Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and to consult health care professional be-
fore taking any other Rx, OTC, or herbal products. Exenatide delays stomach emp-
tying. Some medications (such as anti-infectives and oral contraceptives) may
need to be taken 1 hr before exenatide injection.
Instruct patient in proper testing of blood glucose and urine ketones. These tests
should be monitored closely during periods of stress or illness and health care
professional notified if significant changes occur.
Advise patient to inform health care professional of medication regimen before
treatment or surgery.
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exenatide
Advise patient to notify health care professional if pregnancy is suspected or
planned.
Advise patient to carry a form of sugar (sugar packets, candy) and identification
describing disease process and medication regimen at all times.
Emphasize the importance of routine follow-up exams and regular testing of blood
glucose and glycosylated hemoglobin.
Evaluation/Desired Outcomes
Control of blood glucose levels without the appearance of hypoglycemic or hyper-
glycemic episodes.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.