Canagliflozin (Invokana®)
Canagliflozin (Invokana®) is a new antihyperglycemic agent approved in March 2013 for the treatment of type 2 diabetes. Canagliflozin was the first sodium-glucose co-transporter 2 (SGLT2) inhibitor to be approved by the FDA.1 Based on the 2014 ADA guideline Metformin is the preferred initial therapy (if tolerated and not contraindicated), and insulin therapy with or without other agents should be considered in newly diagnosed patients with markedly symptomatic and/or elevated blood glucose levels or A1C. If noninsulin monotherapy at maximal tolerated dose does not achieve or maintain A1C target over 3 month, a 2nd oral agent (Sulfonylurea, TZDs, and DPP-4), GLP-1 receptor agonist, or insulin should be added.2
Pharmacology:2 By inhibiting SGLT2, canagliflozin reduces the renal threshold for glucose and increases urinary glucose excretion by interfering with the reabsorption of glucose across the proximal renal tubules.
Pharmacokinetics:2 oral bioavailability of canagliflozin is approximately 65. Reach Tmax after 1 to 2 hours, reaches steady state in 4 to 5 hrs. Canagliflozin is 99% protein bound. Eliminated trough renal route 33% (primarily metabolites) and fecal (41.5%).
Dose: 2 Starting dose of canagliflozin is 100 mg PO once daily before the first meal of the day. If patient tolerates 100mg daily and has an eGFR of 60 mL/min/1.73 m2 or greater, the dose can be titrated to 300mg daily.
Dose adjustment (renal impairment): In patients with an eGFR of 45 to 60 mL/min/1.73 m2, the dose of canagliflozin is limited to 100 mg once daily, Canagliflozin should not be used in patients with an eGFR less than 45 mL/min/1.73 m2.
Contraindications: 2 hypersensitivity to canagliflozin. Sever renal impairment, (...
... middle of paper ...
...5. Stenlöf, K., Cefalu, W. T., Kim, K. A., Alba, M., Usiskin, K., Tong, C., ... & Meininger, G. (2013). Efficacy and safety of canagliflozin monotherapy in subjects with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes, Obesity and Metabolism.
6. Cefalu, W. T., Leiter, L. A., Yoon, K. H., Arias, P., Niskanen, L., Xie, J., ... & Meininger, G. (2013). Efficacy and safety of canagliflozin versus glimepiride in patients with type 2 diabetes inadequately controlled with metformin (CANTATA-SU): 52 week results from a randomised, double-blind, phase 3 non-inferiority trial. The Lancet, 382(9896), 941-950.
7. Schernthaner G, Gross JL, Rosenstock J, et al. Canagliflozin compared with sitagliptin for patients with type 2 diabetes who do not have adequate glycaemic control with metformin plus a sulfonylurea. Diabetes Care. 2013. doi
Scheen AJ. Antidiabetic agents in subjects with mild dysglycaemia: Prevention or early treatment of type 2 diabetes. Diabetes and Metabolism. 2007;33:3-12.
Flonase 50 mcg spray OTC - instruct patient to use to use one spray per nostril daily and increase to two sprays per nostril daily if no improvement. Instructed patient on proper use of the nasal spray and to avoid spraying medication directly into nostril.
Labels on tryptophan supplements recommended a dosage of 500 to 1500 mg once or twice a day.
Coumadin most commonly comes in round and scored tablets of many different strengths and colors, although different manufactures may produce the medication in an oval shape. Scored tablets are meant to be easily broken in half to adjust your dose as your doctor may instruct you to do. The dose of medication usually ranges from 1 mg to 10 mg to be taken once daily. The different colors of each tablet represent a different strength that is measured in milligrams.
The pathophysiology of diabetes mellitus in is related to the insulin hormone. Insulin is secreted by cells in the pancreas and is responsible for regulating the level of glucose in the bloodstream. It also aids the body in breaking down the glucose to be used as energy. When someone suffers from diabetes, however, the body does not break down the glucose in the blood as a result of abnormal insulin metabolism. When there are elevated levels of glucose in the blood, it is known as hyperglycemia. If the levels continue to remain high over an extended period of time, damage can be done to the kidneys, cardiovascular systems; you can get eye disorders, or even cause nerve damage. When the glucose levels are low in one’s body, it is called hypoglycemia. A person begins to feel very jittery, and possibly dizzy. If that occurs over a period of time, the person can possibly faint. Diabetes mellitus occurs in three different forms - type 1, type 2, and gestational.
Metformin is prescribed for long-term treatment of Type II Diabetes Mellitus. It can be used alone or in combination with other drugs for diabetes management as part of a health plan that includes proper diet and exercise. Metformin, which has a low affinity for plasma protein binding, limits glucose production in the hepatic system, lowers absorption of glucose in the intestines and improves insulin sensitivity by enhancing uptake and utilization of glucose (FDA, 2008). This drug does not cause an increase in insulin, making it less likely to cause a patient to become hypoglycemic compared with other common antihyperglycemic medications.
Sethi, J. K., Vidal-Puig, A. J., (2007). Targeting fat to prevent diabetes. Cell Metab. . 5 (5), 357-70.
Lipid altering drugs include several classes of medications each of which have their own mechanism of action. Statins inhibit HMG CoA reductase (hydroxymethylglutaryl CoA reductase), which is the rate-limiting enzyme for the production of cholesterol in the liver. Statins competitively inhibit this enzyme and induce an increased expression of LDL receptors in the liver. Which in turn increases the uptake catabolism of serum LDL into the liver resulting in decreased serum cholesterol level. This reduction in serum LDL and cholesterol levels has resulted in reduction of 10-year CHD and stroke risk. Pitavastatin was approved in Japan since 2003 and was granted FDA approval in 2009 and is marketed under the name of Livalo. Several phase III and IV trials have shown that Pitavastatin is both safe and efficacious in lowering both serum LDL and Triglycerides (TG) by 29.1% and 22.7% respectively from baseline levels which was significant. These studies showed that only 10% of Pitavastatin treated patients had adverse events (AE) in which 84% of these events were mild and about 1% were serious adverse events (SAE)6, 12, 14, 16-26, 28-31. Atorvastatin is the most commonly used statin in clinical practice; the F...
Lasix is known as the “water pill” it’s a diuretic administrated orally.(1) The active ingredient of Lasix is furosemide, but also includes a number of inactive ingredients including lactose monohydrate NF, magnesium stearate NF, starch NF, talc USP, and colloidal silicon dioxide NF. (1) The peak effects of furosemide are typically seen within the first hour of two after a dose of the medication. (1). Lasix is prescribed for individuals to treat edema that may arise from congestive heart failure, liver cirrhosis or renal disease. (1) In adults, furosemide may also be taken to treat hypertension itself.(1) Furosemide comes in 20, 40, and 80mg tablets as well as oral suspensions.(2) Furosemide is absorbed rapidly from oral suspension at 50 minutes, and from tablets at 87 minutes.(2) Food may slow down the absorption of the drug and alter the bioavalibitly.(1) Furosemide binds to plasma proteins, albumin being the main plasma protein that furosemide binds to, at 91-99%, and peak plasma concentrations increase with the increase of a single dose.(2) Furosemide is excreted through the urine and the remainder is excreted in the feces. (2) The half-life for furosemide is approximately 2 hours but the diuretic effects last 6-8 hours. (2)
Type 2 DM is considered non-insulin-dependent and contains the vast majority of all diabetics, approximately 90 – 95%, wit...
...lized. The microorganisms that can be sensitive to trimethoprim-sulfamethoxazole are gram negative and gram positive bacteria. Treatment dosage for trimethoprim-sulfamethoxazole is one double strength tablet or two single strength tablets every 12 hours.
Diabetes has been around for 2000 years. Over the years there has been a vast improvement in treatments which are still ongoing to this day. In the 17th century, diagnoses were done through urine tests and one was diagnosed if one’s urine was sweet. In the 20th century, doctors would advise patients to go on radical diets of less than 450 calories per day. In 1921 insulin was finally discovered.
Some of the symptoms associated with type II diabetes include polyuria, polyphagia, and polydipsia. At diagnosis, 33 percent of patients have ketonuria, and 5 to 25 percent have ketoacidosis, both of which can be tested for by simple urinalysis (American Diabetes Assoc. 2000). Most patients of T2DM are obese with little to no weight loss, which allows doctors to distinguish them from type I diabetics. The total lack of insulin among type I diabetics, or insulin dependent diabetics, will result in problems in the storage of fat and mu...
Diabetes is becoming an increasing problem in the United States, with half of all Americans becoming either diabetic or pre-diabetic. Treatments for Type-1 diabetes include taking insulin to help increase your glucose levels (blood sugar), eating healthy, maintaining healthy weight, and monitoring your daily levels. Type-2 treatments include most of Type-1’s treatments (excluding the taking of insulin) and in some cases a special diabetes medication or insulin therapy (Type-2).... ... middle of paper ...
According to Krisha McCoy on her article: The history of Diabetes; “In 150 AD, the Greek physician Arateus described what we now call diabetes as "the melting down of flesh and limbs into urine." From then on, physicians began to gain a better understanding about diabetes. Centuries later, people known as "water tasters" diagnosed diabetes by tasting the urine of people suspected to have it. If urine tasted sweet, diabetes was diagnosed. To acknowledge this feature, in 1675 the word "mellitus," meaning honey, was added to the name "diabetes," meaning siphon. It wasn't until the 1800s that scientists developed chemical tests to detect the presence of sugar in the urine”.