Exenatide

INTRODUCTION

Indications

Type 2 diabetes uncontrolled by metformin, a sulfonylurea, or a thiazolidinedione (or a combination of these agents).

Action

Mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose lowering. Therapeutic Effects: Improved control of blood glucose.

Adverse Reactions/Side Effects

CV: dizziness, headache, jitteriness, weakness. GI: PANCREATITIS, diarrhea, nausea, vomiting, dyspepsia, gastrointestinal reflux. Derm: hyperhydrosis. Metab: ↓ appetite, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of pancreatitis, including upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools. Report these signs immediately to the physician.

• Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular signs include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess blood pressure periodically (See Appendix F). A sudden or sustained increase in blood pressure (hypertension) may indicate problems in diabetes management and should be reported to the physician.

• Periodically assess body weight and report a substantial or sudden weight loss.

Interventions

• Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

Patient/Client-Related Instruction

• Encourage patient to monitor blood glucose before and after exercise, and to adjust food intake to maintain normal glycemic levels.

• Emphasize the importance of adhering to nutritional guidelines, and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) throughout the management of diabetes mellitus.

• Advise patient about symptoms of hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst). Drug dosages may need to be adjusted to prevent repeated episodes of hyperglycemia.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, jitteriness, weakness, increased sweating, or GI problems (nausea, vomiting, diarrhea, heartburn).

Pharmacokinetics

Absorption: Well absorbed following SC administration.

Distribution: Unknown.

Metabolism and Excretion: Excreted mostly by glomerular filtration followed by degradation.

Half-life: 2.4 hr.