Question

Robert is a 62 year old male who recently retired from an aircraft manufacturing company. He is at the health care provider's (HCP) clinic for a follow-up visit. He has a history of diabetes mellitus type 2, hypertension (high blood pressure) and chronic obstructive pulmonary disease (COPD). He stopped smoking 5 years ago, but had smoked a pack a day for 35 years.

He has been taking metformin (Glucophage) orally twice a day at the maximum dose and long acting insulin glargine (Lantus) injection at night for the past year for diabetes. His previous Hbg A1c lab values have been high. He also takes metoprolol orally once daily for hypertension and fluticasone/salmeterol (Advair) discus inhaler for COPD. He has used his albuterol metered-dose inhaler (MDI) for rescue several times a week for the past month.

After some discussion with Robert, the health care provider (HCP) is going to continue the metoprolol for high blood pressure. The HCP is going to change the antidiabetic medication to increase control of the diabetes with SOLIQUA™ 100/33 ; and keep the COPD medication.

1. Appropriate drug-drug, drug - OTC, drug-herbal and drug-food information is presented based on the patient in the case study with SOLIQUA™ 100/33.
2. List common adverse effects and appropriate patient education based on the patient in the case study with SOLIQUA™ 100/33
3. Lists serious adverse effects and what to do if they happen in language appropriate for the patient in the case study with SOLIQUA™ 100/33

Answer 1

SOLIQUA 100/33 (insulin glargine and lixisenatide injection), for subcutaneous use, is a combination of a long-acting basal insulin analog, insulin glargine, and a GLP-1 receptor agonist, lixisenatide.It works 5 ways in your body to help deliver blood sugar control and lower your A1c.

List common adverse effects and appropriate patient education

• ow blood sugar (hypoglycemia),
• allergic reactions,
• nausea,
• runny or stuffy nose,
• diarrhea,
• upper respiratory tract infection,
• headache,
• injection site reactions (swelling, redness, itching, pain, skin discoloration, warmth, and a hard lump),
• swelling of the extremities,
• weight gain
• vomiting,
• constipation,
• indigestion,
• upset stomach,
• abdominal pain,
• gas,
• gastroesophageal reflux disease (GERD),
• bloating, and
• decreased appetite.

Patient education on hypoglycemia awareness, how to preveny low blood sugar , instruct to  carry glucose tablets, hard candy, or other sources of fast-acting carbohydrate.Avoid alcohol, smoking and other soft drinks. Weight maintenanace by diet and execise,need for routine medical care, and follow up.

Lists serious adverse effects

1. Anaphylaxis: Closely monitor patients for signs of anaphylaxis like

• skin reactions such as hives, flushed skin, or paleness.
• suddenly feeling too warm.
• feeling like you have a lump in your throat or difficulty swallowing.
• nausea, vomiting, or diarrhea.
• abdominal pain.
• a weak and rapid pulse.
• runny nose and sneezing.
• swollen tongue or lips.

If it occurs

the patient should discontinue SOLIQUA 100/33 and promptly seek medical attention.

2. Pancreatitis:observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting). If pancreatitis is suspected, promptly discontinue SOLIQUA 100/33 and initiate appropriate management.

3. Hypogycemia:Severe hypoglycemia can cause seizures, may be life-threatening or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery).

4. Acute kidney injury:Acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis,Advise patients of the potential risk of dehydration due to gastrointestinal adverse reactions and take precautions to avoid fluid depletion. SOLIQUA 100/33 is not recommended in patients with end-stage renal disease

5. Hypokalemia:All insulin-containing products, including SOLIQUA 100/33, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Teach the patient about warning signs of hypokalemia as

8 Signs and Symptoms of Potassium Deficiency (Hypokalemia)

• Weakness and Fatigue. Share on Pinterest. ...
• Muscle Cramps and Spasms. Muscle cramps are sudden, uncontrolled contractions of the muscles. ...
• Digestive Problems. ...
• Heart Palpitations. ...
• Muscle Aches and Stiffness. ...
• Tingling and Numbness. ...
• Breathing Difficulties. ...
• Mood Changes.

Discontinue the medication if anything occurs.