Microsoft powerpoint - oral and injectable medication options for diabetes treatment(daphne).ppt

„ Identify the various classifications of oral and injectable medication currently used in the treatment of diabetes mellitus pharmacokinetics, dosing, adverse effects and drug interactions of each class of diabetes medications Metabolic disorder characterized by hyperglycemia ¾Impaired pancreatic insulin secretion¾Increased hepatic glucose production¾Decreased peripheral glucose uptake Glucagon
Islet-cell
(alpha cell)
dysfunction
Pancreas
resistance
Glucose uptake
Hyperglycemia
Adapted with permission from Kahn CR, Saltiel AR. Joslin’s Diabetes Mellitus. 14th ed.
Lippincott Williams & Wilkins; 2005:145–168.
1. Del Prato S, Marchetti P. Horm Metab Res. 2004;36:775–781. 2. Porte D Jr, Kahn SE. Clin Invest Med. 1995;18:247–254.
Sulfonylureas
Mechanism of Action (MOA): Stimulate insulin
secretion from pancreatic beta cells, reduces glucose output from liver, improves insulin sensitivity in periphery Second Generation Sulfonylureas
¾ Glyburide Micronized (Glynase PresTab) ¾ Allergic skin reactions¾ Disulfiram-type Drug Interactions
Drug Interactions
Precautions
Caution in elderly
Severe allergy to sulfonamides
Administration
Once daily-Twice daily dosing
Meglitinides
Biguanide-Drug of choice for Type 2
diabetes
‰ Decreases intestinal absorption of glucose ‰ Increases peripheral glucose uptake and Products:
Adverse effects:
Kinetics:
Dosage: Once daily-
Drug Interactions: (Increased effects)
¾ Cationic drugs (e.g. Digoxin, Amiloride, Contraindications:
¾ Renal disease (Cr >1.5 mg/dl Men, >1.4 Thiazolidinediones
Products:Rosiglitazone (Avandia)Pioglitazone (Actos) Precautions:
CARDIAC: Black box warning
for increase in myocardial
ischemic events
Hepatotoxicity:
Kinetics:
Side Effects:
Drug Interactions
Lab disturbance:
Propranolol and Ranitidine concentrations Contraindications
¾ Inflammatory Bowel Disease
Monitoring: LFTs every 3 months (Acarbose) Dosing: Three times daily with first bite of Available in combination with metformin (Janumet) „ Very Rapid Acting
(Analogs)
„ 70% NPH/ 30% Regular (Humulin 70/30, „ 75% Lispro protamine/ 25% Lispro (Humalog „ 70% Aspart protamine/ 30% Aspart (Novolog
„ 50% NPH/ 50% Regular (Humulin 50/50 insulin) „ 50% Lispro protamine/50% Lispro (Humalog Available as prefilled pen for 5 mcg or 10 mcg dose „ Indicated for type 1
diabetes and type 2
diabetes on insulin
Insulin dose is reduced
by 50% to avoid
hypoglycemia when
initiating pramlintide

Source: http://www.chtc.org/dl/handouts/20080108/Handout%202.pdf