Drug Topics - November 19, 2007 - (Page 22)

22 DRUG TOPICS NOVEMBER 19, 2007 www.drugtopics.com CONTINUING EDUCATION An ongoing CE program of The University of Florida College of Pharmacy and DRUG TOPICS New insulins in the management of diabetes Brandon J. Sucher, Pharm.D., CDE, Associate Professor of Pharmacy Practice, and Allana J. Mehlhorn, Pharm.D., BCPS, Associate Professor of Pharmacy Practice, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Fla. CE The University of Florida College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE # 012-99907-222-H01-P F This lesson is no longer valid for CE credit after 11/30/09. To obtain immediate CE credit, take the test on-line at www.drugtopics.com. Just click on the “Continuing Education” box on the Drug Topics home page, which will take you to the CE site. Log in, find and click on this lesson, and follow the three simple steps. Test results will be displayed immediately and you can print the certificate showing your earned CE credits. or some patients with diabetes, lifestyle interventions and oral pharmacotherapeutic agents are insufficient to maintain adequate control of diabetes. In order to decrease the risk of complications associated with diabetes, these patients will need insulin pharmacotherapy. Over five million patients with diabetes in the United States are currently using insulin to help control their diabetes. Over the past three years, seven insulin formulations were removed from the market, and three new insulin formulations were approved. Insulin preparations derived from beef and pork sources were known to have a higher risk of allergic reactions in patients compared with human insulin and insulin analogs. The manufacturing of beef insulin was discontinued in 1998. Regular Iletin II Pork Insulin, NPH Iletin II Pork Insulin, Humulin L Lente, Humulin U Ultralente, Novolin L Lente, and Velosulin BR Human are no longer produced due to declining use of these products. Inhaled human insulin is a relatively new insulin formulation that will no longer be available to patients by February 2008. The manufacturing of inhaled human insulin was discontinued due to the lack of a significant number of patients using this product. Inhaled insulin was available in 1-mg and 3-mg blister packets. The 1-mg dose of inhaled insulin is equivalent to 3 units of subcutaneous regular insulin, and the 3-mg dose of inhaled insulin is equivalent to 8 units of subcutaneous regular insulin. Using this information, pharmacists can help physicians and patients with the conversion of inhaled human insulin to subcutaneous regular insulin. Insulin glulisine and insulin detemir are the most recently approved insulin formulations. Currently, only human insulin and insulin analogs are available to patients in the United States (see Table 1). When patients are switched from pork and beef insulins to human insulins, they may experience less pronounced, or different, symptoms of hypoglycemia compared with what they experienced with their previous insulin. Patients who still use pork or beef insulin may seek permission to import these insulin formulations using information found on www. fda.gov/cder/drug/beefandporkinsulin/. Insulin preparations have been classified using numerous terminologies. This article focuses on using time course of action to describe the appropriate use of insulin for patients. Insulin preparations are described as rapid-acting, short-acting, intermediate-acting, long-acting, and premixed insulins. This classification can be simplified for patients by describing insulins as mealtime insulins, maintenance insulins, and premixed insulins. Mealtime insulins include insulins used before meals, such as rapid-acting and short-acting insulins. Maintenance insulins include intermediate-acting and long-acting insulins. Premixed insulins contain a combination of a mealtime insulin and a maintenance insulin. This article provides For questions concerning PRINT CEs, call (352) 273-6275. For questions concerning ON-LINE CEs, call (866) 261-3558. Photo: Sandy Schultz http://www.drugtopics.com http://www.fda.gov/cder/drug/beefandporkinsulin/ http://www.drugtopics.com

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Drug Topics - November 19, 2007 Contents Latebreakers Letters Leukemia Patients Now Have More Options First-in-Class HIV Drug Boon to Patients at End of Tether 150 Years of American Pharmacy Pharmacy Schools Confront New Pressures From Pariah to Patient ACCP Releases Position Paper on Ethical Interactions New Injectable Antibiotic Welcomed with Open Arms NCCN Updates Head and Neck Cancer Guide Improved Phosphate Binder Approved for Dialysis Patients Considering Combination Concern Ensuring Seamless Care Bill Would Create Center for Comparative Effectiveness Hospital Improves Patient Safety with Automatic Drug Distribution System Infection Rates, Patient Stays Drop with New Drug Device How R.Ph.s Helped Three Hospitals Win Quality and Safety Awards A Pharmacist and Dog in Tow are Alzheimer’s Patients’ Best Friends More PBMs Agreeing to Pricing Transparency New Insulins in the Management of Diabetes New Products Advertisers Index Classified VIEWPOINT: Reflections on Pharmacy School After 30 Years

Drug Topics - November 19, 2007

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