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Tuesday, February 8, 2011

pramlintide acetate

Posted by Sampil 11:56 PM, under | 1 comment

pramlintide acetate
(pram' lin  tyde)
Symlin

Pregnancy Category C

Drug classes
Amylinomimetic
Antidiabetic

Therapeutic action
A synthetic analog of human amylin, a hormone produced by the beta cells in the pancreas that helps to control glucose levels in the postprandial period; modulates gastric emptying, causes a feeling of fullness or satiety, prevents the postprandial rise in serum glucagons levels all leading to lower serum glucose levels

Indications
·        Adjunct treatment in patients with type 1 diabetes who use mealtime insulin and who have failed to achieve desired glucose control despite optimal insulin therapy
·        Adjunct treatment in type 2 diabetes patients who use mealtime insulin and who have failed to achieve desired glucose control despite optimal insulin therapy with or without a concurrent sulfonylurea or metformin

Contraindications and cautions
·        Contraindicated with known hypersensitivity to pramlintide or any of its components; gastroparesis; hypoglycemia unawareness.
·        Use cautiously with pregnancy, lactation.

Available forms
Solution for injection—0.6 mg/mL

Dosages
ADULTS
·        Type 2 diabetics: Initially, 60 mcg by subcutaneous injection immediately prior to major meals. Dose may be increased to 120 mcg if needed and tolerated. Dosage of oral drugs and insulins will need to be reduced, usually by 50% based on patient response.
·        Type 1 diabetics: Initially 15 mcg by subcutaneous injection immediately before major meals, titrate at 15 mcg increments to a maintenance dose of 30 or 60 mcg as tolerated. Dosage of insulins and oral drugs will need to be reduced by 50% and the patient must be monitored closely to achieve optimal glucose control.

Pharmacokinetics
Route
Onset
Peak
SC
Rapid
21 min
Metabolism: Renal: T1/2: 48 min
Distribution: May cross placenta; may pass into breast milk
Excretion: Urine

Adverse effects
·        CNS: Dizziness, headache, fatigue
·        GI: Nausea, anorexia, vomiting, abdominal pain
·        Respiratory: Cough, pharyngitis
·        Other: Hypoglycemia, injection site reaction

Interactions
·        Risk of delayed absorption of oral medications because of effects on gastric emptying; if rapid effect is needed, take oral medication 1 hr prior to or 2 hr after pramlintide
·        Risk of combined effects on gastric emptying if combined with anticholinergic drugs or drugs that slow intestinal absorption of nutrients; avoid this combination.

Nursing considerations
Assessment
·        History: Hypersensitivity to pramlintide or any of its components; gastroparesis; hypoglycemia unawareness, pregnancy, lactation
·        Physical: Orientation, reflexes, affect; abdominal examination; injection site; blood glucose levels

Interventions
·        Inject subcutaneously before each major meal of the day; inject it into a site that is more than 2 inches away from the site of insulin injection.
·        Do not combine in syringe with insulin.
·        Maintain other antidiabetic drugs, diet and exercise regimen for control of diabetes.
·        Administer oral medications at least 1 hr before or 2 hr after administering pramlintide.
·        Monitor serum glucose levels and HbA1c levels frequently to evaluate effectiveness of drug on controlling glucose levels.
·        Arrange for thorough diabetic teaching program to include disease, dietary control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, avoidance of infection and hygiene.

Teaching points
·        This drug is given subcutaneously. Use sterile technique. Dispose of syringes appropriately.
·        Do not use any solution that appears cloudy; do not combine this drug in syringe with insulin.
·        Inject it into a site on your thigh, abdomen, or upper arm; rotate injection sites periodically; inject into a site that is at least 2 inches away from the site of your insulin injection.
·        Store unopened vials in the refrigerator. Opened bottles may be kept at room temperature. Throw away any out-of-date bottles.
·        Inject this drug before any major meal that you are eating; do not use if you are not going to be eating; if you forget a dose, do not inject after you have eaten.
·        Be aware that alcohol consumption can change your blood glucose levels and may alter your response to this drug.
·        Do not take this drug if you are not able to eat or if you plan to skip a meal or if your blood sugar is too low.
·        Do not change the dosage of this drug without consulting your health care provider.
·        It is not known how this drug affects a pregnancy. If you think you are pregnant or would like to become pregnant, consult your health care provider. 
·        It is not known how this drug could affect a nursing baby. If you are nursing a baby, consult your health care provider.
·        You will need to regularly monitor your blood glucose levels. Your health care provider may change the dose of pramlintide or your other antidiabetic drugs, based on your blood glucose response.
·        It is important that you follow the diet, exercise and drug guidelines related to your disease.
·        Review the signs and symptoms of hypoglycemia; be prepared to treat hypoglycemia with fast-acting sugar or glucagon.
·        Do not drive a car or operate potentially dangerous machinery until you are aware of how pramlintide will affect your blood sugar. Low blood sugar can cause dizziness and changes in thinking.
·        This drug affects how fast your stomach empties, this may affect other drugs you may be taking; consult your health care provider about the need to change the timing of drug administration.
·        You may experience these side effects: Injection site reactions (proper injection and rotation of injection sites should help; if problems occur, consult your health care provider); hypoglycemia (use fast acting sugars or glucagons if this occurs, proper use and eating of meals should prevent this effect); nausea (this usually passes after a few days).
·        Report hypoglycemic reactions; redness, pain or swelling at injection sites; stomach pain; vomiting.

Adverse effects in Italic are most common; those in Bold are life-threatening.

1 comments:

Pramlintide is an analogue of amylin, a small peptide hormone that is released into the bloodstream by the β-cells of the pancreas along with insulin, after a meal. Like insulin, amylin is completely absent in individuals with Type I diabetes.Pramlintide

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