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Pioglitazone heart failure — GPhC CRA MCQ

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HardEndocrine TherapeuticsPioglitazone heart failureGPhC CRA

A patient using weekly semaglutide obtained privately for weight loss is due to undergo deep sedation tomorrow. They followed the fasting instructions but did not disclose semaglutide at pre-assessment. They ask whether simply omitting the next dose resolves the risk. What is the best advice?

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Correct answer: D — Notify the anaesthetic team now for an individual aspiration-risk plan

GLP-1 receptor agonists delay gastric emptying, so residual gastric contents and aspiration may occur despite standard fasting. MHRA advises patients to tell the surgical, pre-assessment and anaesthetic teams, who then make an individual risk assessment. The pharmacist should not invent a universal withholding interval: omitting one dose cannot by itself guarantee an empty stomach, and substitution with insulin or permanent cessation is not an unsupervised pharmacy intervention.

Reference: MHRA: GLP-1 and dual GIP/GLP-1 receptor agonists and pulmonary aspiration. https://www.gov.uk/drug-safety-update/glp-1-and-dual-gip-slash-glp-1-receptor-agonists-potential-risk-of-pulmonary-aspiration-during-general-anaesthesia-or-deep-sedation