Pooja Jadeja MPS[/caption]
To get through these tough tests, Ms Chhibber draws on her experience in the demanding world of dispensing medicines in a busy pharmacy. 
‘That's very similar to reading medicine labels, because there'll be some ingredients that we won't know or have never experienced. But then you consult formulary references or search for similar compounds, or a particular drug class or excipient,’ she said. ‘You rely back on the basics to get you through that particular challenge.’
‘That was one of the best things I've ever done which I would love to do again. I don’t think there was anyone who wasn’t paying attention or having a good time,’ she said. ‘It’s good to spice things up to keep it interesting.’
Now that Network 10 has just issued the casting call for the 
Jeremy Sparks, Pharmacist in Charge of 
Lachlan Menouhos, Pharmacist Manager of 
Mohamed Bassuny MPS, former Pharmacist Manager 
Following several incident reports, the Therapeutic Goods Administration (TGA) has issued new preoperative precautions linked to these popular therapies.
Last week, the TGA issued an alert over use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs) before procedures involving general anaesthesia or deep sedation.
This warning extends to all medicines in these classes approved for diabetes and/or chronic weight management, including:
- semaglutide (Ozempic, Wegovy)
- dulaglutide (Trulicity)
- liraglutide (Victoza, Saxenda)
- tirzepatide (Mounjaro).
What are the risks?
GLP-1 RAs and GIP/GLP-1 RAs are known to delay gastric emptying. So despite standard fasting periods ahead of surgeries or procedures, patients may have residual stomach contents that increase the risk of aspiration under general anaesthesia or deep sedation.
Last month, the TGA delved into the Database of Adverse Event Notification to track incidents linked to GLP-1 and dual GIP/GLP-1 receptor agonists – uncovering 11 reported adverse events.
These included:
- semaglutide: seven aspiration episodes and one aspiration-related pneumonia
- liraglutide: one aspiration and one pneumonia aspiration
- dulaglutide: one pneumonia aspiration case.
What advice should pharmacists provide?
Product Information for these medicines has been updated to include the following warning:
4.4 SPECIAL WARNINGS AND PRECAUTIONS FOR USE:
Aspiration in association with general anaesthesia or deep sedation
Cases of pulmonary aspiration have been reported in patients receiving GLP-1 RAs undergoing general anaesthesia (GA) or deep sedation despite reported adherence to preoperative fasting recommendations. Therefore, the increased risk of residual gastric content because of delayed gastric emptying should be considered prior to performing procedures with GA or deep sedation.
It’s integral that pharmacists adjust their counselling advice accordingly, said Pooja Jadeja MPS from PSA’s Pharmacist to Pharmacist Advice Line.
‘Now that the TGA has issued this warning, pharmacists should mention it every first dispensing of these medicines,’ she said.
‘If the patient has used it before but is new to the pharmacy, pharmacists should also mention this information – just like they would for any other medicine that shouldn’t be taken prior to surgery or should be taken with caution in the case of a dental procedure.’
Patients should be encouraged to mention their GLP-1 medicine to any healthcare professional including their GP, dentist, or specialist, as this could affect how they are managed before any sedation or surgery, said Bill Wallace MPS, PSA Pharmacist – Professional Support Adviser.
‘Some people may be hesitant to mention they’re using a GLP-1 medicine for weight management, so it’s important they know it should always be discussed – especially before procedures,’ he said.
