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, (...
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...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
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)
For this evaluation of a clinical practice guideline I chose to evaluate a guideline that was published in 2012 and that addressed the use of oral medication in the treatment of Type 2 Diabetes (Appendix B). People who have received a diagnosis of Type 2 Diabetes Mellitus (T2DM) are facing a long term treatment plan. Diabetes mellitus is a chronic metabolic disorder that results from a problem with insulin in the body. T2DM is growing in prevalence and is a cause for concern. There are several co-morbidities that can be linked to poorly controlled blood sugar levels such as cardiovascular disease, peripheral vascular disease, renal failure, and a decrease in eyesight. If blood sugar levels can be maintained at a normal to near normal limits the patient has a decreased risk of experiencing these comorbidities. Because of this it is important for the healthcare practitioner to evaluate all treatment methods available and the evidence that supports the efficacy of recommending this treatment to our patients. I used the AGREE II tool in evaluation of this guideline (Appendix A).
Glipizide: Glipizide is an oral rapid acting antidiabetic drug from the class of sulfonylurea. It is a second generation of sulfonylurea that undergoes enterohepatic circulation. The efficacy of the glipizide can be observed by monitoring the glycemic control. However, it is important to observe the toxicity of glipizide as well. Sulfonylureas can decrease the serum glucagon and potentiate
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. American Diabetic Association. (2003). Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care, 26, 3160-3167. doi: 10.2337/diacare.26.11.3160
...t compliance, and medication adherence is highly correlated with positive health outcomes. Thus, a medicine that maximizes patient adherence, delivers the same efficacy as previously used drugs, and shows no additional adverse effects is exceedingly likely to become the drug of choice. Of particular interest to researchers currently are the medications glyburide and metformin. As more and more research continues, it is hypothesized that these drugs will become part of the pharmaceutical regime in the treatment of gestational diabetes mellitus. In fact, both glyburide and metformin have been successfully prescribed to treat GDM in other countries for several years. Glyburide, especially, is predicted to gain the approval by the FDA in the coming years as, at least, a second line medication since it has shown to only cross the placenta in insignificant quantities.
According to the CDC, diabetes is becoming more common and has more than tripled from 1980 through 2011, from 5.6 million to 20.9 million (Diabetes public health resource, 2013). Type two diabetes can be managed through diet and exercise. Type two diabetes is a condition formerly called ‘adult-onset’ or ‘non insulin-dependent’ where the body doesn’t
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...
Refer to your doctor or pharmacist for guidelines on dosage. Do not exceed what they
Bostock-Cox, B. (2015). Diabetes master class: Optimizing therapies for type 2 diabetes. Practice Nurse, 45(8), 12-17 6p.
Alternatively gentamicin 5 mg per kg IM or intravenously (IV) once daily, or a 2 mg per kg loading dose followed by 1.7 mg per kg every 8 hours; doxycycline 100 mg IV twice daily (or 200 mg once daily); chloramphenicol 25 mg per kg IV every 6 hours; or ciprofloxacin 400 mg IV or 500 mg oral twice daily.
Diabetes affects 18.2 million people in the United States. It is often referred to by doctors as diabetes mellitus and described as, “… a metabolic disease in which the person has high blood sugar …” (Collazo- Clavell et all. 2009), either because the insulin is inadequate or the body’s cells don’t respond well to the insulin. The health and economic consequences of diabetes are considerable. The majority of people that have diabetes live in low and middle income countries, where the prevalence of the disease is high. There are three types of diabetes that are called type 1, type 2, and gestational diabetes. Although diabetes is a disorder, it can lead to other diseases such as heart attack, kidney failure or death. A person that has diabetes has to maintain a healthy lifestyle, by eating the right diet, controlling their blood sugar level, and be optimistic.
• Certain medications such diuretics may not be suitable for those who’re suffering from diabetes. At times, it results to increased sugar levels.
Diabetes Mellitus is a chronic health condition in which the level of glucose in the blood is higher than usual. Type 1 diabetes occurs when the pancreas does not create enough insulin and type 2 diabetes occurs when insulin is produced, but is not adequate in lowering blood glucose levels or there is resistance to the insulin (Edwards, 2007, p. 9). Diabetes mellitus is the leading cause of end-stage kidney disease, foot and leg amputations, and new cases of blindness in the United States (Ignatavicius & Workman, 2010, p. 1465-66). People with type 1 diabetes are required to take insulin to manage their glucose levels. People with type 2 diabetes are usually prescribed oral medications such as sulfonylurea agents, meglitinide analogues, or biguanides to help control their glucose levels. Twenty to 30% of people with type 2 diabetes require insulin therapy as well (Ignatavicius & Workman, 2010, p. 1471). In addition to medication therapy, diet and weight control can help manage both type 1 and type 2 diabetes. Because diabetes mellitus can cause such severe complications, it is important that people with diabetes understand the importance of certain health and lifestyle choices, such as their diet and weight to manage their disease. Patients with diabetes mellitus should pay special attention to the amount of carbohydrates, protein, fat, and minerals that are included in their diet. Monitoring these components of their diet, along with weight management, can help control their diabetes mellitus.
Diabetes mellitus is a syndrome which causes relative or absolute insulin deficiency and characterized by hyperglycemia. The most common type is Type II Diabetes Mellitus. Metformin which is a biguanid group drug is the first line treatment for diabetes mellitus. Hypoglycemia does not usually occur with metformin and other advantages are the lower incidence of weight gain. It is mainly absorbed in intestine inhibits the hepetia gluconeogenesis and increases insulin sensitivity. Metformin is contraindicated in patients with hepatic, renal, heart and respiratory failure.