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Glucagon-like peptide-1 (GLP-1) receptor agonists are non-insulin injectable medications that mimic the effect of endogenous incretin hormones to lower blood sugar. They are helpful to include in treatment regimens for clients who are overweight, have a risk for hypoglycemia, or have severe hypergly...

Glucagon-like peptide-1 (GLP-1) receptor agonists are non-insulin injectable medications that mimic the effect of endogenous incretin hormones to lower blood sugar. They are helpful to include in treatment regimens for clients who are overweight, have a risk for hypoglycemia, or have severe hyperglycemia. **rototype: exenatide (Byetta)**  - **Category:** Glucagon-like Peptide-1 (GLP-1) Receptor Agonists, Incretin Mimetic (Non-insulin Injectable)  - **Primary Function**: GLP-1 receptor agonists, also known as incretin mimetics, replicate the effects of the incretin hormone GLP-1, released from the gastrointestinal tract cells after a meal to help control blood glucose levels. They can be used alone or in combination with other medications for diabetes.  - **Unique Features**: GLP-1 receptor agonists are non-insulin injectable medications injected subcutaneously. They have also recently been studied and prescribed for weight management in clients without diabetes due to their ability to decrease food consumption, appetite, and hinger, while increasing sensations of fullness and satiety.  Mechanism of Action - Exenatide is an incretin mimetic that acts by activating GLP-1 receptors like endogenous incretin hormones, leading to slowed gastric emptying and insulin release, inhibited postprandial glucagon release, and suppressed appetite. These actions collectively improve glucose control and can induce weight loss.  Indications and Therapeutic Uses - **Diabetes**: GLP-1 receptor agonists are utilized to enhance glycemic control in clients with type 2 diabetes as an adjunct to diet and exercise, either alone or in combination with other medications. - **Weight Management**: Some GLP-1 receptor agonists are also approved for weight management in clients without diabetes.  Side Effects and Adverse Reactions **Side Effect** **Description** ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ GI Issues Nausea, vomiting, and diarrhea are common. Hypoglycemia Dose-related side effects, especially when combined with other medications for diabetes, such as sulfonylureas. Pancreatitis Symptoms include abdominal pain and vomiting, with severe cases leading to pancreatic necrosis. Renal Impairment Some clients can experience this side effect, which can require hemodialysis or a kidney transplant. Since this drug is excreted unchanged in the urine, clients with severe kidney disease should not use it since it can further impair kidney function. Precautions and Contraindications **Precautions** - Previously classified as a Pregnancy Risk Category C agent: Providers should weigh the risks and benefits.  - Use caution in clients with renal impairment.  **Contraindications** - Contraindicated in clients with severe renal impairment.  Drug Interactions - GLP-1 receptor agonists can delay gastric emptying, potentially affecting the absorption and efficacy of oral medications that require timely absorption, such as **\[oral contraceptives and antibiotics\]**. To minimize the potential for altered absorption, other oral medications should be given at least **\[one hour\]** before GLP-1 receptor agonists.  Dosing, Administration, & Client Teaching **Dosing** - Dosing varies based on the condition, severity, and client response.  - Check drug dosing guidelines for individualized dosing.  - GLP-1 receptor agonists are administered via subcutaneous injection with dosing frequency varying based on the specific drug.   - Monitor renal function and consider adjusting dosing for renal impairment.  - Consider adding to the treatment regimen for clients who are overweight, have a risk for hypoglycemia, or have severe hyperglycemia.  - These medications can also be used in clients who also have a history of ASCVD, stroke, TIA, or CKD.  **Administration** - Subcutaneous administration.  **Client Teaching** - Clients should regularly monitor their blood glucose levels to avoid hypoglycemia.  - Clients should be educated on recognizing the signs and symptoms of hypoglycemia and how to manage it should it occur.  - Educate clients about the correct way to administer subcutaneous injections.  - Educate clients about injection timing in relation to food and oral medications.  Labs to Monitor **Basic Metabolic Panel (BMP)** - Regular monitoring of kidney function and blood glucose levels is recommended to adjust dosing accordingly.  **Hemoglobin A1c** - Monitoring hemoglobin A1c will provide information on the effectiveness of the treatment regimen.