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
The Catamaran Preferred Drug List is a guide identifying preferred brand-name medicines within select therapeutic categories. The Preferred Drug List may not include all drugs covered by your prescription drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of p