Home Drug Guide Exenatide

Drug Guide

Generic Name

Exenatide

Brand Names Byetta, Bydureon, Bydureon Pen, Bydureon Bcise

Classification

Therapeutic: Antidiabetic agent

Pharmacological: GLP-1 receptor agonist

FDA Approved Indications

  • Type 2 diabetes mellitus, as adjunct to diet and exercise

Mechanism of Action

Exenatide mimics incretin hormones, stimulating glucose-dependent insulin secretion, suppressing glucagon secretion, slowing gastric emptying, and reducing appetite, thereby improving glycemic control.

Dosage and Administration

Adult: Byetta: 5 mcg twice daily subcutaneously, may increase to 10 mcg twice daily. Bydureon: 2 mg once weekly subcutaneously. Bydureon Bcise: 2 mg once weekly subcutaneously, administered by healthcare provider.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution in elderly; standard doses as above.

Renal Impairment: Adjust dosing in severe renal impairment (CrCl <30 mL/min).

Hepatic Impairment: No specific dose adjustment required.

Pharmacokinetics

Absorption: Peak plasma concentrations in approximately 2 hours after injection.

Distribution: Vd not well established, predominantly remains in plasma and interstitial fluids.

Metabolism: Broken down by proteolytic cleavage and renal elimination, not metabolized by liver enzymes.

Excretion: Renal route mainly.

Half Life: Approximately 2.4 hours (exenatide).

Contraindications

  • History of medullary thyroid carcinoma.
  • Multiple endocrine neoplasia syndrome type 2.

Precautions

  • Use with caution in renal impairment, pancreatitis, and in patients with a history of gastroparesis.

Adverse Reactions - Common

  • Nausea (Frequent)
  • Vomiting (Occasional)
  • Diarrhea (Occasional)
  • Hypoglycemia (especially when used with insulin or sulfonylureas) (Common)

Adverse Reactions - Serious

  • Pancreatitis (Rare)
  • Medullary thyroid carcinoma (Rare)
  • Severe allergic reactions (Rare)

Drug-Drug Interactions

  • Insulin (increase risk of hypoglycemia)
  • Sulfonylureas (risk of hypoglycemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose levels regularly, assess for signs of pancreatitis and allergic reactions.

Diagnoses:

  • Risk for hypoglycemia
  • Impaired skin integrity at injection site

Implementation: Administer subcutaneously as prescribed, educate on proper injection technique.

Evaluation: Maintain blood glucose within target range, monitor for adverse reactions.

Patient/Family Teaching

  • Take medication as prescribed.
  • Report severe abdominal pain or symptoms of pancreatitis.
  • Notice injection site reactions.
  • Follow dietary and exercise recommendations.

Special Considerations

Black Box Warnings:

  • Thyroid C-cell tumors, including medullary thyroid carcinoma, have been observed in rodents; human risk unknown.

Genetic Factors: Patients with a history of medullary thyroid carcinoma or MEN 2 should not use.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Severe nausea, vomiting.

Treatment: Supportive care, symptomatic management, no specific antidote.

Storage and Handling

Storage: Store unopened pens refrigerated; discard after expiration date. Bydureon pens may be stored at room temperature for up to 4 weeks.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.