Dapagliflozin

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By: Daniel J. Crona, PharmD, PhD

  • Assistant Professor, Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy
  • Clinical Pharmacy Specialist (Genitourinary Malignancies), Department of Pharmacy, North Carolina Cancer Hospital, Chapel Hill, North Carolina

https://pharmacy.unc.edu/news/directory/crona/

Direct-reading colorimetric diffusion tubes requiring no pump are available for a small number of substances (Table 10 diabetic diet meal plans . Because of their simplicity diabetes type 2 kaneel , colour indicator tubes are widely used but their limitations must be appreciated; sources of inaccuracy are given in Table 10 diabete wikipedia . Portable or fixed multi-point colorimetric detectors are available which rely on paper tape impregnated with the reagent. A cassette of the treated paper is driven electrically at constant speed over a sampling orifice and the stain intensity measured by an internal reflectometer to provide direct read out of concentration of contaminant in sample. Such instruments are available for a range of chemicals including the selection given in Table 10. Flammable gases Flammable atmospheres can be assessed using portable gas chromatographs or, for selected compounds, by colour indicator tubes. The flammable gas is oxidized on the heated catalytic element, causing the electrical resistance to alter relative to the reference. Instruments are calibrated for specific compounds in terms of 0–100% of their lower flammable limit. Recalibration or application of correction factors is required for different gases. These types of sensor are subject to ‘poisoning’ by certain chemicals such as silicone, sulphur, and halogen compounds. Again, errors can arise if the instrument is used for gases other than those for which it is calibrated. These sensors offer a long life expectancy; they are not restricted to flammable substances. Many such particles are invisible to the naked eye under normal lighting but are rendered visible, by reflection, when illuminated with a strong beam of light. This is the ‘Tyndall effect’ and use of a dust lamp provides a simple technique for the rapid assessment of whether a dust is present, its flow pattern, leak sources, the effects of ventilation, etc. Whether personal, spot or static sampling is adopted will depend upon the nature of the information required. Air in the general atmosphere, or in the breathing zone of individuals, may be collected using a pump coupled to a means of isolating particulate matter for subsequent analysis or determination (Table 10. Since different organic vapours interact with the flame ionization detector (FlD) to varying extents, it is vital that the instrument user be aware of the magnitude of the variation in order to obtain the most accurate data. This is accomplished using the portable isothermal pack (PlP) kit which is supplied with three 8 in (203 mm) columns packed with B, G and T materials respectively. Isothermal control is accomplished non-electrically using an ice-water mixture for 0°C and a seeded eutectic mixture for 40°C. The data listed are for comparison purposes only since retention time for a compound can vary according to the condition of the column packing material, packing procedure and chemical interaction among the components of a vapour mix. T y y s C o m p o u n d A n a l y t i c a l P a t h l e n g t h m A b s o r b e n c e M i n i m u m D e t e c t a b l e W a v e l e n g t h m C o n c e n t r a t i o n ppm (m tr c e ll A c e t l h A c e tc c i A c e tc nh r A c e tone A c e toni trl A c e toph none A c e t l ne A c e t l ne c h lor s e e c h loroe th l ne A c e t l ne t tr b rom A c rol n A c r loni trl A ll l lc oh ol A ll lc h lor A ll lgl c i l th r 2 m noe th nol s e e th nol m ne A m m oni n m l c e t t A ni lne A rsi ne A r l m s e e rb r l B nz ne p nz oqu none s e e Q none B nz lc h lor B sph nol s e e gl c i l th r B s(c h lorom th l th r B oron trfl or B rom oform B t ne b t ne B t ne B t ne th ol s e e t lm rc a pt n 2 t none 2 tox th nol b t lc e llosol B t l c e t t n b t l c e t t se c t l c e t t t rt t l c e t t n t l lc oh ol se c t l lc oh ol t rt t l lc oh ol B t l m ne B t l th r B t lc a rb tol n t lgl c i l th r B t lm rc a pt n p t rt t ltol ne C rb on su lph C rb on ox C rb on m onox C rb on t tr c h lor C rb ony lsu lph C rb r C h lorna t c a m ph ne C h lorob nz ne m onoc h lorob nz ne C h lorob rom om th ne 2 h loro b t ne s e e h loropr ne C h lorod fl orom th ne r on 1 h loro pox propa ne s e e pi c h loroh rn 2 h loroe th nol s e e th l ne c h loroh rn C h loroe th l ne s e e ny lc h lor C h loroform trc h lorom th ne 1 h loro ni tropropa ne C h lorope nt fl oroe th ne ne tron C h loropi c rn trc h loroni trom th ne C h loropr ne c h loro b t ne C h lorotrfl oroe th l ne C r sol ll som rs) C rotona l h tr ns b t na l C m ne sopropy lb nz ne C noge n C c loh ne C c loh nol C c loh none C c loh ne D t r m ox D se c h lor os D c e tone lc oh ol h rox m th l pe nt none 1 m noe th ne s e e th l ne m ne D b or ne D b rom oc h loropropa ne 1 b rom ot tr fl oroe th ne o c h lorob nz ne p c h lorob nz ne D c h lorod fl orom th ne r on 1 c h loroe th ne 1 c h loroe th l ne T C o m p o u n d A n a l y t i c a l P a t h l e n g t h m A b s o r b e n c e M i n i m u m D e t e c t a b l e W a v e l e n g t h m C o n c e n t r a t i o n ppm (m tr c e ll D c h loroe th l th r D c h lorom th ne s e e th l ne c h lor D c h lorom onofl orom th ne r on 1 c h loro ni troe th ne 1 c h loropropa ne s e e ropy l ne c h lor D c h lorot tr fl oroe th ne r on D c h lor os D D th l m ne D th l m no th nol D th l th r s e e th l th r D th lke tone D th lm lona t D fl orod b rom om th ne D gl c i l th r D h rox b nz ne s e e roqu none D sob t lke tone D sopropy l m ne 1 m th ox th ne D m th ox m th ne s e e th l l N N m th l c e t m D m th l m ne D m th l m nob nz ne s e e l ne D m th l ni lne m th l ni lne D m th lb nz ne s e e l ne D m th lform m 2 m th lh pt none s e e sob t lke tone D m th lsu lph t D m th lsu lph ox D ox ne th l ne ox D ph ny lm th ne soc y na t s e e th l ne b sph ny l soc y na t l E nfl r ne E pi c h loroh rn 1 pox propa ne s e e ropy l ne ox 2 pox propa nol s e e l c i ol E th ne th ol s e e th lm rc a pt n E th ne E th nol m ne 2 th ox th nol c e llosol 2 th ox th l c e t t c e llosol c e t t E th l c e t t E th l c r l t E th l lc oh ol th nol E th l m ne E th lse c m lke tone m th l h pt none E th lb nz ne E th lb rom E th lb t lke tone h pt none E th lc h lor E th l th r E th lform t 2 th lh nol E th lm rc a pt n E th lsi lc a t E th l ne E th l ne c h loroh rn E th l ne m ne E th l ne b rom b rom oe th ne E th l ne c h lor c h loroe th ne E th l ne gl c olm onom th l th r c e t t s e e th lc e llosol c e t t E th l ne ox E th l ne c h lor s e e c h loroe th ne F l orob nz ne F l orotrc h lorom th ne r on F l rox ne F orm l h F orm c c i F rfu r l F rfu r l lc oh ol G l c i ol pox propa nol G l c olm onoe th l th r s e e th ox th nol G th on s e e nph osm th l H loth ne H pt ne n h pt ne 1 pt nol H c h loroe th ne H fl oroprope ne H ne n h ne 2 none H one m th l sob t lke tone se c l c e t t H r ne H roge n c h lor T C o m p o u n d A n a l y t i c a l P a t h l e n g t h m A b s o r b e n c e M i n i m u m D e t e c t a b l e W a v e l e n g t h m C o n c e n t r a t i o n ppm (m tr c e ll H roge n c y ni H roqu none I soa m l c e t t I soa m l lc oh ol I sob t l c e t t I sob t l lc oh ol I sod c a nol I sofl r ne I soph orone I sopr ne I sopropy l c e t t I sopropy l lc oh ol I sopropy l m ne I sopropy l th r L lqu fi pe trol m ga s) M si t lox M th ne M th ne th ol s e e th lm rc a pt n M th ox fl r ne 2 th ox th nol s e e th lc e llosol M th l c e t t M th l c e t l ne propy ne M th l c r l t M th l l m th ox m th ne M th l lc oh ol m th nol M th l m ne M th l m l lc oh ol s e e th l sob t lc a rb nol M th ln m lke tone h pt none M th lb rom M th lb t lke tone s e e none M th lc e llosol M th lc e llosol c e t t M th lc h lor M th lc h loroform M th lc y c loh ne M th lc y c loh nol o th lc y c loh none M th l ne b sph ny l soc y na t l M th l ne c h lor M th l th lke tone s e e t none N m th lform m M th lform t M th l od M th l soa m lke tone M th l sob t lc a rb nol M th l sob t lke tone s e e one M th l soc y na t M th l sopropy lke tone M th lm rc a pt n M th lm th c r l t M th lpropy lke tone s e e nt none fi th lst r ne M onom th l ni lne M orph olne N c ke lc a rb ony l N trc ox N trob nz ne N troe th ne N troge n ox N troge n trfl or N trom th ne N trotol ne N trotrc h lorom th ne s e e h loropi c rn N trou s ox O c t ne P nt ne 2 nt none P rc h loroe th l ne P trol m stll t s P h ny l th rb ph ny lm t r pou r P h ny l th l ne s e e t r ne P h ny lh r ne P h osge ne c a rb ony lc h lor P h osph ne P c rc c i P ropa ne n ropy l c e t t P ropy l lc oh ol n ropy lc h lor n ropy lni tr t P ropy l ne c h lor P ropy l ne ox P ropy ne s e e th l c e t l ne P r ne T C o m p o u n d A n a l y t i c a l P a t h l e n g t h m A b s o r b e n c e M i n i m u m D e t e c t a b l e W a v e l e n g t h m C o n c e n t r a t i o n ppm (m tr c e ll Q none S tod r sol nt S t r ne S lph r ox S lph rh fl or S lph r lfl or S stox s e e m ton 1 tr c h loro fl oroe th ne r on 1 tr c h loroe th ne 1 tr c h loroe th ne T tr c h loroe th l ne s e e rc h loroe th l ne T tr c h lorom th ne s e e rb on t tr c h lor T tr h rofu r n T tr l T ol ne o ol ne T ox ph ne s e e h lorna t c a m ph ne T rb t lph osph t 1 rc h loroe th ne s e e th lc h loroform 1 rc h loroe th ne T rc h loroe th l ne T rc h lorom th ne s e e h loroform 1 rc h loropropa ne 1 rc h loro rfl oroe th ne r on T rfl orom onob rom oe th ne r on 2 rni troph nol s e e c rc c i 2 rni troph ny lm th lni tr m ni ne s e e tr l T rpe ntne V ny lb nz ne s e e t r ne V ny l c e t t V ny lb rom V ny lc h lor V ny lc y ni s e e c r loni trl V ny l ne c h lor V ny ltol ne X l ne lol X l ne (h na l tc a l l ngth h s su ll b n c h ose n sth tof th stronge stb nd n th spe c tr m h c h sfr from nt rfe r nc e to tm osph rc t r nd C f m or th n one nfr r b sorb ng m t r l spr se nt n th r n si gni fi c a ntc onc e ntr ton, th se of noth r na l tc a l l ngth m b ne c e ssa r (th l ngth s r c h ose n to optm r ngs tth posu r lm ts. Insertion of the tube incorrectly into the pumphousing (the correct direction is indicated on the tube). Leaks in sample lines, or insufficient time allowed to lapse between pump strokes when extensions are used. Tubes should be stored under refrigerated conditions but allowed to warm to ambient temperature prior to use. Use of tubes under conditions of temperature, pressure or humidity outside the range of calibration. Unless pumps possess a limiting orifice they should be calibrated with the air indicator tube in position. Interference due to the presence of other contaminants capable of reacting with the tube reagent. Equipment for personal monitoring comprises a lapel-mounted filter holder connected to a portable pump with a flow rate of about 3 litres/min. In order to ensure uniformity of fractionation, smooth and constant flow rates are essential.

Physiological oedema of pregnancy diabetes mellitus gpc , as we Overt haematological abnormalities exist in only a minority know diabetes type 1 with ketoacidosis , is due to diabetes mellitus type 2 description increased intracapillary hydrostatic pres of patients with severe preeclampsia. In preeclampsia, an increased precapillary resistance mild thrombocytopenia, which affects 7–10% of the cases. Overt thrombocytopenia (platelet count, 100,000/µL) in Hence the pathological oedema of preeclampsia is caused dicates severe disease. In most cases, delivery is advisable not due to increased intracapillary pressure but due to as thrombocytopenia usually continues to fall and improves increased capillary permeability to plasma proteins and a after a day of delivery reaching normal levels after 3–5 days reduction in plasma colloid osmotic pressure. Lower the platelet count, higher is the oedema appears suddenly, more often facial and periorbital, maternal and fetal morbidity and mortality. The physiological expansion of plasma vol penia, coagulation aberrations are generally minimal and ume in normal pregnancy is about 40% and is highest at present only in association with abruption. Women with tory assessment of coagulation including prothrombin time, 204 Practical Guide to High-Risk Pregnancy and Delivery activated partial thromboplastin time, fbrinogen levels may the hallmark renal lesion in preeclampsia characterized be unnecessary except in patients suspected with placental by swollen intracapillary endothelial cells in the glomeruli has abruption. There is no change in haemolysis is semiquantifed by elevated serum lactate the epithelial cells or foot processes, no proliferation of inter dehydrogenase and by presence of schizocytosis, spherocy capillary cells and no alteration in the architecture of the renal tosis and reticulocytosis in peripheral blood. The nature of the osmiophilic deposits has been drome is a manifestation of microangiopathic haemolysis elucidated with the help of immunofourescent techniques. The increase in intravascular coagulation is secondary to endo excess sFlt-1 probably plays a major role in causation of glo thelial cell injury. Preeclampsia is associated with increased uric acid count less than 50,000/mm3 and lactate dehydrogenase concentration and diminished urinary calcium excretion. The characteristic lesion in severe preeclampsia/ this systematic review did not fnd an association between eclampsia are periportal haemorrhages in the liver periphery. However, women with thrombophilia had increased susceptible to injury resulting in subcapsular haemorrhages. It seems that women who develop larger and cause major subcapsular haematomas and liver severe preeclampsia before 32 weeks will beneft from a rupture. If the rupture or hae matoma is contained within the capsule, the patient will be Renal Changes haemodynamically stable with excruciating pain. In a normal pregnancy, renal perfusion and glomerular fl tration rate are increased. But with development of pre Brain eclampsia, there is about fvefold increased renal afferent In response to acute and severe hypertension, there is cere arteriolar resistance causing a reduction in renal blood fow brovascular overregulation leading to vasospasm, ischaemia, and diminished glomerular fltration. The motor Chapter | 13 Hypertensive Disorders in Pregnancy 205 cortex is susceptible to cellular injury with resultant convul efforts have been made to develop faster methods to deter sion. Hyperrefexia and clonus are hallmarks of severe pre mine the concentration of urinary protein. Eclamptic methods is the dipstick that has a good, although not seizures are grand mal in character with tonic/clonic phases. Urine dipsticks can be affected by variable excretion, manifestations: Vasospasm of frontal cortex causes frontal maternal dehydration and bacteriuria. The correlation of the headache unrelieved by analgesics and is described as throb dipstick with the 24 hours excretion of protein was studied bing headache. A protein/ tension-related maternal mortality is due to cerebrovascular creatinine ratio of 0. The almost always indicates absent or nonsignifcant protein diagnostic cut off values and the right technique for measur uria. Intermediate values have elevated percentages of false ing blood pressure were described in the beginning of the negative and false positive results. Unfortunately, mistakes are frequently made due to the defnitive test for diagnosing proteinuria is a lack of consistency in the measurement of the blood pres quantitative measurement of total protein excretion in sure. This causes abnormally line, if anautomated reagent-strip reading device is used high readings. Another common error is not using the same to detect proteinuria and a result of 11 or more is ob maternal position in repeated measurements. When an ab tained, a spot urinary protein:creatinine ratio or 24-hour normally high reading is obtained, it is common practice to urine collection to quantify proteinuria should be done. This is an inappropriate technique because in validated 24-hour urinecollection result shows greater the pregnant woman the lateral recumbent values are always than 300 mg protein.

Public committee diabetic diet meal , key informants and key informants and expert Health Nurse diabetes eye test wolverhampton , Early Years expert reviewers was critical to diabetes test zeist Professor, Department of reviewers in the development Health Program, City of Ottawa the development of this Best Family and Community of this manual: Medicine, Mount Sinai Hospital, Public Health Start resource, final decisions University of Toronto about content were made by the the Advisory Committee: • Dr. The information herein Babies (Canada Prenatal Education Program, Member of reflects the views of the authors the Professional Team of the and is not officially endorsed by Nutrition Program) Perinatal Partnership Program the Government of Ontario. This demographic change has important implications to women planning a pregnancy, their partners and families, their future chil dren, the service providers who work with pregnant women, and to the health care system. With advances in preconception and prenatal care, most women over the age of 35 can expect to have a healthy pregnancy and a healthy baby. However, there are some concerns in pregnancy that may increase the risk for this population. Many of these risks can be successfully managed through preconception and prenatal care. Focused care for women over age 35 plays a vital role in minimizing health risks, sensitively meeting their unique psychosocial needs, and maximizing health opportunities to achieve the best possible outcome, a healthy baby and a healthy mother. For simplicity, this manual uses “after age the term “advanced 35” and “over age 35” when discussing advanced maternal age. This older terminology is no longer considered by health care to be supportive or appropriate for this growing population. This manual is designed as a reference and does not duplicate best practice care guidelines. Women in their first pregnancies need different information and have different concerns. However, not all of the information found in the literature or from key informant interviews was specific to women having their first baby. Where possible, the information in this manual is separated for women having their first or subsequent babies after age 35. Reflecting on the Trend: Pregnancy After Age 35 3 Manual Development the information in this manual was obtained through a literature review in the fall of 2006. Also included in the review are reports from various Canadian organizations, some U. Journal articles prior to 1996 were used in the development of this manual if they were recently re-referenced. Keywords used in the search of these databases include: “delayed pregnancy”, “advanced maternal age”, “older mother”, “pregnancy”, “obstetrics”, “obstetrical outcomes”, “primip”, “elderly primip”, “elderly primagravid”, “older gravida”, “elderly gravida”, “maternal age”, “maternal health services”, “later pregnancy”, “maternal age, 35 and over”, “risks”, “pregnancy”, “pregnancy outcomes”, “risk factors”, “amniocentesis”, “interventions”, “genetic counselling”, “stillbirths”, “spontaneous abortion”, “ectopic”, “obstetric labour/labour complications”, “infant, mortality”, “down syndrome”, “genetic screening”, “screening”, “preconception care”, “preconception health”, “fetal death”, “ultrasound, neck”. In addition to the literature search, information was also obtained through interviews with Ontario service providers with expertise in providing prenatal services for women over age 35. Limitations the information in this manual has some limitations due to lack of research in some areas and lack of Ontario specific data. Some aspects of pregnancy over age 35 have not been studied, and more research is needed. While the main focus of this report is Ontario populations, in some areas the manual relies on data from other provinces, Canada, the United States and other countries, which may have limited relevance for Ontario. In addition, there were few opportunities to include the voices of pregnant women over age 35 in the development of this resource. However, age 35 is not an absolute number at which to expect risks for women in pregnancy and childbirth. Rather, age is service providers to merely one factor for service providers to consider in the context of look at advanced maternal prenatal care. Other factors include health status of the mother, age in a comprehensive nutrition, medical and family histories, and access to prenatal care. It is also important to recognize that while there are some manner, considering increased health risks associated with advanced maternal age, health risks and there are also psychosocial and health advantages. Most pregnant advantages, preconception women over age 35 would be considered “low risk” and would be able to choose among a variety of care providers and birth options. They, in turn, provide a range of antenatal services to pregnant women over age 35, including preconception and prenatal care, prenatal classes and drop-in programs for pregnant women. While some of the information and strategies in this manual are medical in nature, it is helpful if all service providers who work with women have a sense of the health risks, opportunities and recommended care for pregnant women who are over age 35. Service providers can refer women for more information, support or specific services, answer some questions and/or provide written information, even if they do not provide medical care. The information in this manual may help a wide range of providers to improve the services they offer to women over age 35, in a number of different ways.

. Gestational diabetes : Gestational diabetes and high blood sugar during pregnancy.