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In order to better understand the role of each drug class in the treatment of diabetes, it is important to have a basic understanding of the pathogenesis of diabetes Fig. 1 ; and the interplay between insulin and glucose at different sites. Postprandial elevations in serum glucose levels stimulate insulin synthesis and release from pancreatic cells. Insulin secreted into the systemic circulation binds to receptors in target organs skeletal muscle, adipose tissue, liver ; . Insulin binding initiates a cascade of intracellular signal transduction pathways that inhibits glucose production in the liver, suppresses lipolysis in adipose tissue and stimulates glucose uptake into target cells muscle and fat ; by mechanisms such as the translocation of vesicles that contain glucose transporters to the plasma membrane. Type 2 diabetes is a metabolic disorder that results from complex interactions of multiple factors and is characterized by 2 major defects: decreased secretion of insulin by the pancreas and resistance to the action of insulin in various tissues muscle, liver and adipose ; , which results in impaired glucose uptake. The precise molecular mechanism of insulin resistance is not clearly understood, but deficits in the postinsulin receptor intracellular signalling. Nonoxynol 9 NORCO NORDETTE-28 NORDITROPIN Noreth A-Et Estra Fe Fuma Norethindrone Norethindrone A-E Estradi Norethindrone-Ethinyl Est Norethindrone-Mestranol NORFLEX Norfloxacin NORGESIC NORGESIC FORTE Norgestimate-Ethinyl Estr Norgestrel-Ethinyl Estrad Normal Saline NOROXIN NORPACE NORPACE CR NORPRAMIN NOR-Q-D Nortriptyline HCL NORVASC NOVAHISTINE DH NOVANTRONE NOVASTART NOVOLIN 70 30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG MIX 70 30 NOVOPEN 3 NOVOPEN JR. NU-GAUZE NUMONYL NUMONYL PEDIATRIC NUTR-E-SOL NUTROPIN NUTROPIN AQ NUVARING NVP Nystatin Nystatin Triamcin and viramune. Or immune-mediated deficiencies of a metalloprotease that cleaves these ultra-large multimers may cause TTP. However, little information exists concerning the behavior of this protease in other physiological and pathological conditions. Levels of this protease have now been measured in healthy individuals of different ages, full-term newborns, pregnant women and a patients with variety of pathologic conditions, and these data will be reviewed herein. Heparin-induced thrombocytopenia thrombosis HIT T ; remains the most common antibodymediated, drug-induced thrombocytopenic disorder, and a leading cause of morbidity and mortality. Based on clinical correlations and murine models, there is increasing evidence that antibodies to complexes between platelet factor 4 PF4 ; and heparin cause HIT T, and the molecular composition of the relevant antigen has also become better defined. However, the introduction of sensitive ELISAs to measure anti-PF4 heparin antibodies has complicated diagnosis in some settings in which the incidence of such antibodies in unaffected patients exceeds the incidence of the disease. In addition, the FDA approval of Lepirudin and Argatroban has expanded the repertoire of agents available for therapy of HIT T and may change the approach to management of asymptomatic patients with thrombocytopenia. However, the optimal use of these drugs in commonly encountered settings remains in evolution, and a need for alternative approaches to prevention and treatment is evident.

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Diagnostic imaging is important in identifying a disease state and in monitoring the outcome of therapy. A pharmacist wishing to provide pharmaceutical care to assure optimal therapeutic outcomes must understand the relevance of diagnostic imaging in medicine. The pharmacist must understand the diagnostic modalities, their strengths and limitations as well as their utilization in patient care and management. Decisions of significant economic importance are made based upon the outcome of diagnostic procedures prior to and during the course of therapy. With rare exception, each aspect of practice function listed in Background Paper II is relevant to pharmaceutical care in diagnostic imaging. Drugs are either employed directly or as adjuncts for almost every diagnostic modality. Drug product selection, drug use decision making, appropriate dose and dosage form, source of supply, economics, patient counseling, monitoring adverse drug reactions, drug interactions and therapeutic outcomes all relate to drugs used in diagnostic imaging. An entry level pharmacist may not be expected to be an expert in all aspects of pharmaceutical care relevant to diagnostic imaging. However, it is not proper to ignore this area because the generalist is not prepared nor directed to participate. Educators in schools of pharmacy can provide fundamentals through lectures and case studies. These can be reinforced in clerkship rotations as part of the knowledge of disease states, diagnostic procedure and tests relevant to disease states. An introductory course has been described in the Journal 14 ; . Nuclear pharmacy practitioners can be utilized as a source of information and or lectures if the faculty requires assistance for development of curricular material. At the 76th Annual Meeting of the American Association of Colleges of Pharmacy in 1974 two resolutions were adopted by the delegates: 1 ; all pharmacy students should be introduced to the basic aspects of radiopharmaceuticals and their application in nuclear medicine and 2 ; all schools and colleges of pharmacy that wish to offer specialized programs in nuclear pharmacy radiopharmacy provide programs that would prepare students with certain specified competencies, and that an academic educational program for pharmacists wishing to specialize in nuclear pharmacy radiopharmacy should include a period of supervised clinical experience in the practice of nuclear pharmacy radiopharmacy. In retrospect, the first resolution should have been broader and included all areas of diagnostic imaging. In defense of the resolution, many diagnostic modalities and procedures taken for granted today did not exist at that time. However, the intent of the resolution remains relevant for pharmacist today and in the future. The terminology has changed while, in fact, the importance of the resolution has increased. Preparation of students for pharmaceutical care and diagnostic imaging should be a part of the educational process in all schools of pharmacy, for example, pregnancy.

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