o Nursing Management -Assess of current compliance to diabetes and weight management regimens. -Assess for pregnancy as this medication has not been approved by the FDA for use in pregnant or lactating patients. - Assess serum lab values prior to initiation of therapy to establish a baseline. o Patient Education -Have your bloodwork checked by your primary care provider before taking this medication. -This medication has been evident to cause thyroid cancer in some animals. Do not use this drug if you or your family have a history of thyroid cancer. -Wear disease medical alert ID for type 2 diabetes (such as bracelet, keychain, or necklace.) - This medication is not intended for use with type 1 diabetes. - rotate injection sites to prevent injury and skin breakdown and to promote full absorption of the medication. -Follow the diet and exercise plan you have discussed with your provider. -This medication has been shown to reduce the efficacy of oral contraceptives. o Considerations- Tell your doctor if… -Discuss with your doctor before drinking alcohol. - if you are experiencing difficulty swallowing, swelling in the neck and throat, voice changes, or trouble breathing that will not go away while taking Tirzepatide. - if you are experiencing abdominal pain that radiates to the back. Drugs like this have been known to cause pancreatitis. -Any known food or drug allergies. References: Chavda, V. P., Ajabiya, J., Teli, D. M., Bojarska, J., & Apostolopoulos, V. (2022). Tirzepatide, a New Era of DualTargeted Treatment for Diabetes and Obesity: A Mini-Review. Molecules, 27(13), 4315. https://doi.org/10.3390/molecules27134 315 Farzam, K., & Patel, P. (2022). Tirzepatide. In StatPearls - NCBI Bookshelf. StatPearls. https://www.ncbi.nlm.nih.gov/books/NB K585056/#:~:text=Tirzepatide%20is%2 0administered%20subcutaneously%20vi a,being%205%20mg%2F0.5%20mL. Memorial Sloan Kettering Cancer Center. (2022). Tirzepatide. MSKCC.org. https://www.mskcc.org/cancercare/patienteducation/medications/tirzepatide RX List. (2022). Mounjaro (Tirzepatide Injection): Uses, Dosage, Side Effects, Interactions, Warning. RxList.com. https://www.rxlist.com/mounjarodrug.htm#warnings Drug Class Tirzepatide is a synthetic peptide, a dual gastric inhibitory polypeptide (GIP), and glucagon-like peptide 1 (GLP-1) receptor agonist. Mechanism of Action Stimulates the pancreas to release insulin, as well as increasing the levels of adiponectin. The combination agonism ability substantially decreases the occurrence of hyperglycemia. How To Take This Medication Drug Interactions Dosages of sulfonylureas may need to be adjusted when taken with tirzepatide to reduce the risk of hypoglycemia. Tirzepatide may effect the absorption of oral medications, therefore should be discussed with a health care provider about when to take oral medications in relevance to administration of tirzepatide. Reduced efficacy of oral contraception has been shown when taken in combination with tirzepatide. Lab Value Considerations Tirzepatide is a subcutaneous injection. The initial dosage is typically 5 mg/0.5 ml to be administered once a week. Dosages may be adjusted with follow up visits according to effectiveness and efficacy. • -Administer on the same day each week. If a dose is missed, and it is within 4 days of the missed dose, administer the full dose and continue the next dose on schedule. If it is not within 4 days of the missed dose, skip the missed dose and continue with the administration of the next dose when it is due. Do not take extra doses or two doses simultaneously. • -Do not mix with other insulins. -Discard used syringe in sharps container. -Keep medication refrigerated. • Tirzepatide has been shown to increase amylase and lipase levels. The significance of this increase is unclear with absent symptoms of pancreatitis. Continuous monitoring of blood glucose levels is imperative to prevent instances of hypoglycemia and hyperglycemia. Monitor hbA1c levels to evaluate efficacy of regimen. Side Effects Some commonly reported side effects for tirzepatide include nausea, vomiting, abdominal cramping, constipation, decreased appetite and heartburn. Reports of hypoglycemia are not as common, but still occur. Adverse Effects Adverse effects that require immediate attention or health care provider notification include: -worsening symptoms of diabetic retinopathy. -signs and symptoms of cholelithiasis and cholecystitis. -cardiac dysrhythmias and significantly increased heart rate. -signs of renal injury such as increased urine production, urine retention, blood in the urine, pain or burning while urinating, or drastic weight gain in a short amount of time. -rash, hives, trouble breathing or swallowing, tightness in the chest, swelling in the mouth or throat as these are signs of an allergic reaction. - fainting or loss of consciousness. Special Considerations Tirzepatide is not intended for everyone. It is specific to patients with type 2 diabetes. People with the following conditions should not use Tirzepatide: -personal or family history of thyroid cancer -Type 1 diabetes -Kidney disease -Hepatic impairment -Pregnancy or people who may become pregnant.
