pharmacology

1. Dr. Mustafe Hussein
Mbbs, MMED (Internist)

2.  The pancreas is a large gland lying across the
upper part of the posterior abdominal wall.
 The endocrine part of the pancreas is scattered
through out the organ in the form of small
collections of tissues known as the islets of
langerhans, these islets contain four types of
cells:

3.  The alpha cells: Glucagon
 The beta cells: Insulin
 The D cells: Somatastatin
 The F cells: pancreatic polypeptide

4.  Diabetes mellitus is an important and very
common disease involving a large percentage
of the population.
 Diabetes mellitus is categorized under two
important types:
1. Type one or insulin dependant diabetes
2. Type two or non-insulin dependant diabetes

5.  Juvenile diabetes
 Maturity onset diabetes
 Gestational diabetes

6.  In 1921 Banting & Best first isolated insulin in
the form of pancreatic extract.
 1922 extract was first used for a 14 years old
juvenile diabetic patient having 640mg/dl
blood sugar.
 Chemically it contains 51 amino acids arranged
in two chains joined by disulfide bridges.

7.  Carbohydrate metabolism. E.g it stimulates
glycogen synthesis, the action lead to lowering
of blood glucose levels.
 Lipid metabolism. E.g insulin inhibits lipolysis.
Insulin stimulates the enzyme lipoprotein
lipase.
 Protein metabolism. E.g insulin promotes
amino acids and protein synthesis.

8.  Insulin exerts it is action by binding to speacific
insulin receptors which are present on almost
all the cells in the body.

9.  Insulin is distributed only in extracellular.
 It cannot be given as is a peptide hormone
which in destroyed in G.I.T.
 It is metabolized in liver, muscle and some
times in kidney to its amino acids.
 It is excreted in the by the kidney.
 It is half life is 5-9 minutes.
 It is given by subcutaneous injection.

10.  Hypoglycemia
 Allergy
 Lipodystrophy: disturbance of fat metabolism.

11.  Beta-adrenergic drugs
 Contraceptives
 Corticosteroids
 Thiazides
 Theophylline
 Salicylates
 Salbutamol

12.  Diabetes mellitus
 Diabetes ketoacidosis
 Supportive therapy
 Myocardial infarction
 Schizophrenia
 Burns
 Hyperkalemia

13.  The purpose of therapy in diabetes mellitus is
to restore metabolism to normal, to avoid
symptoms due to hyperglycemia and to
prevent short term complications (infections,
ketoacidosis) and long term complications
(renal, cardiovascular, retinal and neurological
problems)

14.  Generally occurs in type 1 diabetes and is rare
in type 2 diabetes:
 Syndromes: vomiting, sweating, impairment of
consciousness, hyperventilation, hypotension,
shock and dehydration.
 Management: insulin, i.v fluids, KCL, sodium
bicarbonate (to treat acidosis)

15.  Oral hypoglycemic agents as they are
commonly called are given orally to reduce the
blood glucose level.
 In 1957 tolbutamide was developed and soon
many more drugs were developed, which are
highly potent orally acting agents.

16.  Sulfonylurea's
1. Tolbutamide
2. Chlorpropamide
3. Acetohexamide
4. Glibenelamide
5. Glipizide
6. Glimepiride

17.  Biguamides
1. Metformin
2. Pharformine
 Meglitinides
1. Repaglanide
2. Nateglanide

18.  Thiazolidindiones
1. Troglitazoe
2. Rosiglitazoe
3. Pioglitazoe
 Alpha glucosidase inhibitors
1. Acarbose
2. Miglitol

19.  It is a short acting drug and was used for many
years.
 It is comparatively safe in elderly patients.
 It is given 2-3 times a day.
 Available adult dose is 0.5-1.5 g/day.

20.  It is the commonly used drug in sulfonylurea.
 It is action lasts for hours, and it can be given
once daily.
 To avoid hypoglycemia, it is better to divide
the dose into two and give twice daily.
 Available 2.5 – 15mg/day.

21.  Warfarin
 NSAIDS
 Alcohol
 Cimetidine
 Chloramphenicol
 Oral contraceptives
 Thiazide diuretics

22.  Nausea
 Vomiting
 Constipation
 Headache
 Weight gain
 Hypersensitivity
 hypoglycemia

23.  Inhibit glucose absorption.
 Suppress gluconeogenesis in liver.
 Metformin is often given to patients having
insulin resistance and is given obese diabetics.
 Metformin doesn't produce hypoglycemia and
weight gain.

24.  Metformin is also given along with insulin and
other oral anti-diabetic drugs in patients with
type 2 diabetes whose blood glucose level is
not adequately control by oral monotherapy.
 It can also be given to prevent diabetes in
middle aged obese individuals which impaired
glucose tolerance.
 Adult dosage is 500mg 1-3 times a day.

25.  Nausea
 Vomiting
 Diarrhea
 Abdominal pain
 Vitamin B12 is impaired
 It is toxicity increases in renal failure, hepatic
diseases and alcoholic.

26.  Glucagon is another pancreatic hormone
secreted by the alpha cells.
 Glucagon has opposite effects in glucose.
 Glucagon is hyperglycemic agent.

27.  Hypoglycemia, 0.5- 1mg i.v
 Cardiogenic shock, to stimulate the heart
especially the over dosage of beta-blockers.
 diagnosis, 1mg of glucagon causes rise in B.P
to release catecholamine's.

28.  Compare the regulation of glucagon and
insulin secretion after a meal high in
carbohydrates, after a meal low in
carbohydrates but high in proteins, and during
physical exercise?

29.  In response to a meal high in carbohydrates,
insulin secretion is increased and glucagon
secretion is reduced.
 During periods of exercise, sympathetic
stimulation inhibits insulin secretion.
 As blood glucose levels decline, there is an
increase of glucagon secretion.

30.  ID/CC: A 17 year old white female student
who is learning how to inject herself with
insulin is found unconscious by her desk.
 HPI: The patient suffered from weight loss.
Polyuria, polydipsia and polyphagia for
several months and was recently diagnosed
with juvenile onset diabetes mellitus.
 She has been meticulous in self administering
insulin injections but often injects larger doses
of insulin than prescribed.

31.  PE: Tachycardia, no fever, hypotension, skin
cold and moist, responsive to only painful
stimuli.
 Labs: severe hypoglycemia, hypokalemia,
hypomagnesaemia, increased serum levels of
insulin with normal
 Imaging: CT head, no intracranial pathology.

32.  Treatment
1. Administer IV 50% glucose or IM glucagon
after drawing base line blood sample.
2. Monitor and treat electrolyte imbalance
3. Follow serum glucose levels
 Discussion: A severe hypoglycemic coma may
result from an insulin overdose, which can
produce permanent neurologic damage or
death.

33. THANK YOU…