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INTRODUCTION

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HIGH ALERT

pramlintide (pram-lin-tide)

Symlin

Classification

Therapeutic: antidiabetics

Pharmacologic: hormones

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Indications
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Used with mealtime insulin in the management of diabetics whose blood sugar cannot be controlled by optimal insulin therapy; can be used with other agents (sulfonylureas, metformin).

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Action
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Acts as a synthetic analogue of amylin, an endogenous pancreatic hormone that helps to control postprandial hyperglycemia; effects include slowed gastric emptying, suppression of glucagon secretion, and regulation of food intake. Therapeutic Effects: Improved control of postprandial hyperglycemia.

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Adverse Reactions/Side Effects
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Noted for concurrent use with insulin

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CNS: dizziness, fatigue, headache. Resp: cough. GI: nausea, abdominal pain, anorexia, vomiting. Endo: HYPOGLYCEMIA. Derm: local allergy. MS: arthralgia. Misc: injection-site reactions, systemic allergic reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of hypoglycemia, especially during and after exercise. Common neuromuscular symptoms include anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; difficulty in concentration; drowsiness; excessive hunger; headache; irritability; nervousness; tremor; weakness; unsteady gait. Report repeated or severe hypoglycemic episodes to the physician.

  • Monitor signs of systemic allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • Assess any joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess injection site for redness, swelling, or local allergic reactions. Make sure patient understands the need to rotate injections sites to prevent local damage.

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Interventions
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  • Implement aerobic exercise and endurance training programs to maintain optimal body weight, improve insulin sensitivity, and reduce the risk of macrovascular disease (heart attack, stroke) and microvascular problems (reduced blood flow to tissues and organs that causes poor wound healing, neuropathy, retinopathy, and nephropathy).

  • Provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.) to treat mild hypoglycemia. Call for emergency assistance if symptoms persist or in cases of severe hypoglycemia. Emergency treatment typically consists of IV glucose, glucagon, or epinephrine.

  • Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage at or near the injection site; these interventions will alter drug absorption from subcutaneous tissues.

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Patient/Client-Related Instruction
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  • Encourage patient to monitor blood glucose before and after exercise, and to adjust medications accordingly based on exercise duration and intensity.

  • Emphasize the importance of adhering to nutritional guidelines, and the need for periodic assessment of glycemic control (serum glucose and glycosylated hemoglobin levels) ...

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