1. A 58-year-old patient with type 2 diabetes presents to your community pharmacy to pick up a new prescription for liraglutide 0.6 mg SC daily. His medication profile reveals that he also uses the following therapies: metformin 1000 mg twice daily, sitagliptin 100 mg once daily, glargine 20 units SC once daily, lisinopril 20 mg po daily, and atorvastatin 40 mg po daily.

Why should you advise him to discontinue sitagliptin when initiating the newly prescribed liraglutide?

2. A 67-year-old patient is initiating semaglutide 0.25 mg SC weekly in light of experiencing a stroke several months ago. He is also using the following therapies for managing his type 2 diabetes: metformin 1000 mg twice daily and glipizide 10 mg po qAM. His A1C in clinic today is 6.8%.

As semaglutide is initiated, what other medication adjustment should be considered at this time?

3. Three GLP-1 RAs currently have expanded cardiovascular FDA indications. Why are these indications directed to decrease the risk of major adverse cardiovascular events predominately in patients with atherosclerotic cardiovascular disease (ASCVD)?

Evaluation Questions

4. How confident are you in your management of the 58-year old patient in question 1 above?

5. How confident are you in your management for the 67-year old patient in question 2 above?

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