Anti diabetic medications
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Anti diabetic medications Patients who are intolerant of metformin are unlikely to be successful with a third trial of that agent. Empagliflozin, an SGLT2 inhibitor, is considered a second-line choice for patients who are intolerant of metformin. Both sitagliptin, a DPP-4 inhibitor, and liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution in patients with a history of pancreatitis -Linagliptin is not cleared by the kidney second choice if GFR<35(Stop Metformin) only liraglutide has been shown to lower the risk of recurrent cardiovascular events and has received FDA approval for this indication Empagliflozin, an SGLT2 inhibitor, has also been associated with secondary prevention of cardiovascular disease. Fasting C-peptide levels are markedly elevated in patients with T2DM, but in people with T1DM, C-peptide levels should be low . TZDs tend to cause fluid retention and should not be used in patients with congestive heart failure References ADA Step up to medicine Toronto notes UpToDate ABFM
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antidiabetic medications
This document summarizes different types of medications used to treat diabetes. It discusses mechanisms of action, side effects, and important details about popular classes of antidiabetic medications including biguanides (e.g. metformin), sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, meglitinides, GLP-1 receptor agonists, and various types of insulin. The types of insulin are categorized based on their onset, peak effects, duration of action and administration details. The document provides a comprehensive overview of common antidiabetic drugs.
Oral antidiabetic drugs (for primary care physician
This document summarizes different classes of oral antidiabetic drugs for primary care physicians. It describes biguanides like metformin, sulfonylureas like glibenclamide, alpha-glucosidase inhibitors like acarbose, and thiazolidinediones like pioglitazone. For each class, it provides information on indications, dosing, contraindications, and other details relevant to prescribing the drugs for treatment of type 2 diabetes. The document also lists additional resources on oral antidiabetics.
Diabetes
Type 1 diabetes results from beta cell destruction and insulin deficiency. It typically develops in younger people and requires lifelong insulin treatment. Type 2 diabetes involves insulin resistance where cells do not respond properly to insulin. It usually develops in older, overweight individuals and can sometimes be managed with lifestyle changes and oral medications instead of insulin. Diabetes can also be caused by excess hormones from conditions like Cushing's syndrome. Management involves lifestyle modifications, glucose monitoring, medications, and treatment of complications by a multidisciplinary team.
Drugs used in diabetes- Mr. panneh
This document discusses drugs used to treat diabetes. There are two major types of diabetes: type 1 characterized by pancreatic beta cell destruction, and type 2 characterized by insulin resistance and impaired insulin secretion. Common antidiabetic drugs include antiglycemics like metformin and sulfonylureas which lower blood glucose levels by different mechanisms of action. Insulin therapy is also discussed including rapid, short, intermediate, and long acting insulins. Side effects of the various drug classes are mentioned. The document provides an overview of common drug treatments for diabetes.
Oral hypoglycaemic agents
This document provides a summary of oral hypoglycemic agents (OHAs) used to treat type 2 diabetes. It classifies OHAs based on their mechanisms of action, which include enhancing insulin secretion, overcoming insulin resistance, and other miscellaneous mechanisms. For each class, it briefly describes prominent examples, their mechanisms of action, pharmacokinetics, adverse effects, and indications. The major classes discussed are sulfonylureas, meglitinide analogues, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, biguanides, and thiazolidinediones.
Oral Hypoglycemic Drugs - Sulphonylureas
1) Oral hypoglycemic drugs are classified into several categories including sulphonylureas, biguanides, meglitinides, thiazolidinediones, and alpha glucosidase inhibitors.
2) Sulphonylureas work by binding to receptors on pancreatic beta cells, reducing potassium channel conductance, enhancing calcium influx, and stimulating insulin secretion.
3) Potential drug interactions with sulphonylureas include those that increase their effects through plasma protein displacement or decreased metabolism, and those that decrease their effects through increased metabolism or antagonistic action.
DM Drugs
- Insulin is used to treat diabetes by replicating the body's natural insulin secretion. Various insulin preparations have different onset and duration of action. Oral antidiabetic drugs include sulfonylureas, meglitinides, biguanides, thiazolidinediones, DPP-4 inhibitors, GLP-1 analogs, and alpha-glucosidase inhibitors which lower blood glucose through different mechanisms such as stimulating insulin secretion or increasing insulin sensitivity. Choice of treatment depends on the type of diabetes, severity of hyperglycemia, and individual patient factors. All drugs have potential adverse effects like hypoglycemia that require monitoring.
Oral antidiabetics
This document provides information on the classification and mechanisms of action of various oral anti-diabetic drugs. It discusses drugs that enhance insulin secretion like sulfonylureas and meglitinides, drugs that overcome insulin resistance like metformin and thiazolidinediones, and other drugs like alpha-glucosidase inhibitors. For each class, it describes the specific drugs, their mechanisms of action involving pathways and targets like K+ channels, AMPK activation and PPARγ agonism, pharmacokinetics, indications, and adverse effects.
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antidiabetic medications
This document summarizes different types of medications used to treat diabetes. It discusses mechanisms of action, side effects, and important details about popular classes of antidiabetic medications including biguanides (e.g. metformin), sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, meglitinides, GLP-1 receptor agonists, and various types of insulin. The types of insulin are categorized based on their onset, peak effects, duration of action and administration details. The document provides a comprehensive overview of common antidiabetic drugs.
Oral antidiabetic drugs (for primary care physician
This document summarizes different classes of oral antidiabetic drugs for primary care physicians. It describes biguanides like metformin, sulfonylureas like glibenclamide, alpha-glucosidase inhibitors like acarbose, and thiazolidinediones like pioglitazone. For each class, it provides information on indications, dosing, contraindications, and other details relevant to prescribing the drugs for treatment of type 2 diabetes. The document also lists additional resources on oral antidiabetics.
Diabetes
Type 1 diabetes results from beta cell destruction and insulin deficiency. It typically develops in younger people and requires lifelong insulin treatment. Type 2 diabetes involves insulin resistance where cells do not respond properly to insulin. It usually develops in older, overweight individuals and can sometimes be managed with lifestyle changes and oral medications instead of insulin. Diabetes can also be caused by excess hormones from conditions like Cushing's syndrome. Management involves lifestyle modifications, glucose monitoring, medications, and treatment of complications by a multidisciplinary team.
Drugs used in diabetes- Mr. panneh
This document discusses drugs used to treat diabetes. There are two major types of diabetes: type 1 characterized by pancreatic beta cell destruction, and type 2 characterized by insulin resistance and impaired insulin secretion. Common antidiabetic drugs include antiglycemics like metformin and sulfonylureas which lower blood glucose levels by different mechanisms of action. Insulin therapy is also discussed including rapid, short, intermediate, and long acting insulins. Side effects of the various drug classes are mentioned. The document provides an overview of common drug treatments for diabetes.
Oral hypoglycaemic agents
This document provides a summary of oral hypoglycemic agents (OHAs) used to treat type 2 diabetes. It classifies OHAs based on their mechanisms of action, which include enhancing insulin secretion, overcoming insulin resistance, and other miscellaneous mechanisms. For each class, it briefly describes prominent examples, their mechanisms of action, pharmacokinetics, adverse effects, and indications. The major classes discussed are sulfonylureas, meglitinide analogues, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, biguanides, and thiazolidinediones.
Oral Hypoglycemic Drugs - Sulphonylureas
1) Oral hypoglycemic drugs are classified into several categories including sulphonylureas, biguanides, meglitinides, thiazolidinediones, and alpha glucosidase inhibitors.
2) Sulphonylureas work by binding to receptors on pancreatic beta cells, reducing potassium channel conductance, enhancing calcium influx, and stimulating insulin secretion.
3) Potential drug interactions with sulphonylureas include those that increase their effects through plasma protein displacement or decreased metabolism, and those that decrease their effects through increased metabolism or antagonistic action.
DM Drugs
- Insulin is used to treat diabetes by replicating the body's natural insulin secretion. Various insulin preparations have different onset and duration of action. Oral antidiabetic drugs include sulfonylureas, meglitinides, biguanides, thiazolidinediones, DPP-4 inhibitors, GLP-1 analogs, and alpha-glucosidase inhibitors which lower blood glucose through different mechanisms such as stimulating insulin secretion or increasing insulin sensitivity. Choice of treatment depends on the type of diabetes, severity of hyperglycemia, and individual patient factors. All drugs have potential adverse effects like hypoglycemia that require monitoring.
Oral antidiabetics
This document provides information on the classification and mechanisms of action of various oral anti-diabetic drugs. It discusses drugs that enhance insulin secretion like sulfonylureas and meglitinides, drugs that overcome insulin resistance like metformin and thiazolidinediones, and other drugs like alpha-glucosidase inhibitors. For each class, it describes the specific drugs, their mechanisms of action involving pathways and targets like K+ channels, AMPK activation and PPARγ agonism, pharmacokinetics, indications, and adverse effects.
Fun Pharmacy
A presentation on glucagon "The blood Glucose raising Hormone". Glucagon increases the blood glucose level in the blood stream and helps to provide the required energy source whenever recruited.
Hypoglycemic agents
This document discusses different classes of hypoglycemic agents used to treat type 2 diabetes. It describes 5 classes: sulfonyl ureas, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, and meglitinides/phenylalanine analogues. Sulfonyl ureas work by stimulating insulin secretion from pancreatic beta cells. Biguanides like metformin increase insulin sensitivity. Thiazolidinediones are insulin sensitizers that enhance insulin action in target tissues like liver and muscle. Alpha-glucosidase inhibitors prevent glucose absorption from the gut. Meglitinides stimulate acute insulin release. The document provides examples of drugs in each class and briefly summarizes their mechanisms of action and
Oral hypoglycemic agents
This document discusses the management of type 2 diabetes. It outlines lifestyle modifications like diet, exercise and weight loss that can help control blood glucose levels. It also discusses various classes of diabetic medications, including their mechanisms of action, indications, side effects and examples of drugs in each class. The goal of treatment is to achieve adequate glycemic control while preventing complications through a stepped care approach involving lifestyle changes and gradual escalation of medications if needed.
Antidiabetic agent
This document provides an overview of antidiabetic agents including insulin and oral medications used to treat type 2 diabetes. It discusses the aims of diabetes management including achieving near-normal glycemia to prevent short and long-term complications. It then describes the types of insulin including rapid, short, intermediate and long-acting varieties. The document also summarizes the classes of oral medications including their mechanisms of action, efficacy, side effects and examples of drugs from each class. Combination therapy approaches are briefly outlined.
oral hypoglycemic drugs
This document discusses various classes of oral hypoglycemic drugs used to treat type 2 diabetes mellitus. It describes sulfonylureas, the first class developed which work by stimulating insulin release from the pancreas. First and second generation sulfonylureas are outlined, noting their mechanisms, effects, and interactions. Meglitinides are discussed as having a similar insulin-releasing action to sulfonylureas but with a more rapid onset and shorter duration. Biguanides like metformin are covered, explaining how they lower blood glucose through decreasing hepatic glucose production and increasing glucose uptake in tissues. Thiazolidinediones are also mentioned as sensitizing tissues to insulin.
Oral hypoglycemic agents
introduction to oral hypoglycemic agents with description about sulphonylurea and glinides along with their MOA, indication, side effects and brand name
Diabetes mellitus
This document discusses diabetes mellitus, including its increasing prevalence worldwide driven by obesity and reduced activity. It covers the classification, pathogenesis, symptoms, diagnosis and management of both type 1 and type 2 diabetes. Key points include the roles of insulin and insulin resistance in the different types of diabetes, long-term complications involving microvascular and macrovascular damage, and treatment involving lifestyle modifications and medications like metformin, insulin, and other anti-diabetic drugs. Hypoglycemia, ketoacidosis, and other acute complications are also summarized.
Oral hypoglycaemic drugs
Oral hypoglycemic drugs are used to treat type 2 diabetes and work by lowering blood glucose levels. There are 5 classes of oral hypoglycemic drugs currently used: sulfonylureas, biguanides, meglitinides, thiazolidinediones, and alpha-glucosidase inhibitors. Sulfonylureas like glipizide stimulate insulin secretion from the pancreas. Biguanides like metformin reduce glucose production and absorption. Meglitinides and sulfonylureas both stimulate insulin secretion but meglitinides have a faster onset and shorter duration. Thiazolidinediones like pioglitazone increase insulin sensitivity. Alpha-glucosidase inhibitors
Voglibose
Voglibose is an alpha-glucosidase inhibitor used to lower post-meal blood glucose levels in people with diabetes by delaying the absorption of glucose in the intestine. It was developed by Takeda Pharma and works by inhibiting the enzymes that break down carbohydrates, which prevents sudden spikes in blood glucose after eating. Potential side effects include flatulence, abdominal pain, and diarrhea. It is contraindicated in people with inflammatory bowel disease or those predisposed to intestinal obstruction.
GPAT INSULIN,ORAL HYPOGLYCEMIC AGENTS
The document discusses various drugs used to treat diabetes, including their mechanisms of action, side effects, and classifications. It notes that lactic acidosis is common with phenformin, rosiglitazone acts as a PPAR gamma agonist but not by increasing insulin secretion, hypokalemia can occur if insulin is given rapidly for diabetic ketoacidosis, and metformin can cause vitamin B12 deficiency. Common side effects of thiazolidinadiones include water retention and weight gain.
Hypoglycemic agents
The document discusses hypoglycemic agents, which are drugs used to lower blood sugar levels and treat diabetes mellitus. It defines diabetes as a condition characterized by hyperglycemia and glucosuria due to abnormal carbohydrate, fat, and protein metabolism. The main types of hypoglycemic agents discussed are insulin, sulfonylureas like chlorpropamide and tolbutamide, biguanides like phenformin, and their mechanisms of action, formulations, and uses in treating diabetes.
Diabetic and antidiabetic drugs
Diabetic and Antidiabetic Drugs
By
Dr. Yousuf Ali Sarker
Dept. of Pharmacology
Bangladesh Agricultural University
Oral hypoglycaemic agents dr jayesh vaghela
1) Oral hypoglycemic agents work by enhancing insulin secretion, increasing insulin sensitivity, or reducing glucose absorption. The main classes include sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, amylin analogues, SGLT-2 inhibitors, and dopamine D2 receptor agonists.
2) Sulfonylureas work by blocking ATP-sensitive potassium channels, stimulating insulin secretion. Common side effects include hypoglycemia and weight gain.
3) Biguanides like metformin increase insulin sensitivity by decreasing hepatic glucose output and intestinal glucose absorption
Anti diabetic drugs
This document discusses different classes of antidiabetic drugs used to treat diabetes mellitus. It describes how these drugs work to lower blood glucose levels by different mechanisms such as increasing insulin secretion from the pancreas, increasing insulin sensitivity, or decreasing glucose absorption. The main classes covered are sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, and SGLT-2 inhibitors. Specific drugs discussed in more detail include tolbutamide, metformin, and glipizide.
Oral hypoglycemics
This document classifies and describes the mechanisms of various oral and parenteral antihyperglycemic agents. It discusses sulfonylureas, meglitinide analogues, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, incretin mimetics, DPP-4 inhibitors, and amylin mimetics. For each class, it covers mechanisms of action, pharmacokinetics, adverse effects, and examples of commonly used drugs. The document provides a comprehensive overview of different classes of antihyperglycemic medications used to treat diabetes.
Diabetes mellitus amol
This document discusses the drug management of diabetes mellitus. It begins by classifying the different types of diabetes and criteria for diagnosis. It then discusses the therapeutic aims of glycemic control and treatment of associated conditions. The main therapeutic strategies discussed are medical nutrition therapy, exercise, and pharmacologic therapy including insulin for type 1 diabetes and oral glucose lowering agents or insulin for type 2 diabetes. Finally, it summarizes the mechanisms and examples of common classes of oral glucose lowering drugs including sulfonylureas, meglitinides, biguanides, and alpha-glucosidase inhibitors.
Newer antidiabetic agents
This document summarizes newer antidiabetic agents, including their mechanisms of action, clinical trials, and side effects. It discusses newer insulins like detemir and degludec, as well as incretin-based therapies like GLP-1 agonists exenatide and liraglutide and DPP-4 inhibitors sitagliptin and saxagliptin. It also reviews amylin mimetic pramlintide, dual PPAR agonists saroglitazar, SGLT2 inhibitors dapagliflozin and empagliflozin, and other agents like bromocriptine and colesevelam. Emerging targets discussed include PTP-
Diabetes Mellitus definition,type,cause,symptom,treatment,complication
Diabetes mellitus is a clinical syndrome characterized by high blood glucose levels. Symptoms include increased thirst, urination, fatigue, and changes in weight or vision. It is diagnosed through blood tests showing elevated glucose levels. The main types are type 1 and type 2 diabetes. Treatment involves diet, exercise, medication like insulin or other drugs, and managing complications affecting the eyes, kidneys, nerves, and blood vessels.
Antidiabetic Drugs
This document summarizes different types of drugs used to treat diabetes mellitus. It discusses insulin, the main types of which include rapid-acting, short-acting, intermediate-acting, and long-acting insulins. It also discusses oral hypoglycemic drugs that help control blood sugar levels, including sulfonylureas that stimulate insulin secretion, biguanides that overcome insulin resistance, and others such as alpha-glucosidase inhibitors. New drug classes are also mentioned, like GLP-1 receptor agonists and DPP-4 inhibitors that enhance the body's own insulin response after meals. The document provides details on the mechanisms and examples of specific drugs within each class.
Liver Paracetamol Poisoning
The document discusses drug metabolism and liver toxicity. It describes 3 phases of drug metabolism: phase 1 alters the parent molecule through reactions like oxidation; phase 2 conjugates the drug or metabolite making it more water soluble; and phase 3 involves energy-dependent excretion from the body. The liver plays a key role through enzymes like cytochrome P450 and is susceptible to toxicity from drugs like paracetamol which can deplete glutathione stores and cause liver damage. Treatment depends on the toxin but may include decontamination, antidotes, and supportive care.
Anti diabetics
1) Diabetes mellitus affects approximately 5-8% of the population and is a leading cause of death, blindness, and renal failure. There are two main types: type 1 usually develops before age 30 and requires insulin therapy, while type 2 usually develops after age 40 and may be managed with diet and oral medications.
2) Insulin regulates carbohydrate, fat, and protein metabolism. In diabetes, insulin deficiency leads to hyperglycemia, glucosuria, dehydration, and ketosis. Various insulin preparations including short-acting, intermediate-acting, and long-acting types are used to treat diabetes.
3) Oral medications for type 2 diabetes include sulfonylureas, metformin
5 - PN Final PPP June 23rd 2015 Liz Gregory.pptx
This document provides information about diabetes, including:
- Approximately 3.5 million people in the UK have diagnosed diabetes and 850,000 have undiagnosed diabetes.
- The main types of diabetes are type 1, type 2, and gestational diabetes. Type 2 accounts for 85-90% of diabetes cases.
- Diagnostic criteria for diabetes includes a fasting blood glucose of 7.0 mmol/l or higher, random blood glucose of 11.1 mmol/l or higher, or an A1C level of 6.5% or higher.
- People at increased risk of developing diabetes include those who are obese, older than 65, have a family history of diabetes, or
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Fun Pharmacy
A presentation on glucagon "The blood Glucose raising Hormone". Glucagon increases the blood glucose level in the blood stream and helps to provide the required energy source whenever recruited.
Hypoglycemic agents
This document discusses different classes of hypoglycemic agents used to treat type 2 diabetes. It describes 5 classes: sulfonyl ureas, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, and meglitinides/phenylalanine analogues. Sulfonyl ureas work by stimulating insulin secretion from pancreatic beta cells. Biguanides like metformin increase insulin sensitivity. Thiazolidinediones are insulin sensitizers that enhance insulin action in target tissues like liver and muscle. Alpha-glucosidase inhibitors prevent glucose absorption from the gut. Meglitinides stimulate acute insulin release. The document provides examples of drugs in each class and briefly summarizes their mechanisms of action and
Oral hypoglycemic agents
This document discusses the management of type 2 diabetes. It outlines lifestyle modifications like diet, exercise and weight loss that can help control blood glucose levels. It also discusses various classes of diabetic medications, including their mechanisms of action, indications, side effects and examples of drugs in each class. The goal of treatment is to achieve adequate glycemic control while preventing complications through a stepped care approach involving lifestyle changes and gradual escalation of medications if needed.
Antidiabetic agent
This document provides an overview of antidiabetic agents including insulin and oral medications used to treat type 2 diabetes. It discusses the aims of diabetes management including achieving near-normal glycemia to prevent short and long-term complications. It then describes the types of insulin including rapid, short, intermediate and long-acting varieties. The document also summarizes the classes of oral medications including their mechanisms of action, efficacy, side effects and examples of drugs from each class. Combination therapy approaches are briefly outlined.
oral hypoglycemic drugs
This document discusses various classes of oral hypoglycemic drugs used to treat type 2 diabetes mellitus. It describes sulfonylureas, the first class developed which work by stimulating insulin release from the pancreas. First and second generation sulfonylureas are outlined, noting their mechanisms, effects, and interactions. Meglitinides are discussed as having a similar insulin-releasing action to sulfonylureas but with a more rapid onset and shorter duration. Biguanides like metformin are covered, explaining how they lower blood glucose through decreasing hepatic glucose production and increasing glucose uptake in tissues. Thiazolidinediones are also mentioned as sensitizing tissues to insulin.
Oral hypoglycemic agents
introduction to oral hypoglycemic agents with description about sulphonylurea and glinides along with their MOA, indication, side effects and brand name
Diabetes mellitus
This document discusses diabetes mellitus, including its increasing prevalence worldwide driven by obesity and reduced activity. It covers the classification, pathogenesis, symptoms, diagnosis and management of both type 1 and type 2 diabetes. Key points include the roles of insulin and insulin resistance in the different types of diabetes, long-term complications involving microvascular and macrovascular damage, and treatment involving lifestyle modifications and medications like metformin, insulin, and other anti-diabetic drugs. Hypoglycemia, ketoacidosis, and other acute complications are also summarized.
Oral hypoglycaemic drugs
Oral hypoglycemic drugs are used to treat type 2 diabetes and work by lowering blood glucose levels. There are 5 classes of oral hypoglycemic drugs currently used: sulfonylureas, biguanides, meglitinides, thiazolidinediones, and alpha-glucosidase inhibitors. Sulfonylureas like glipizide stimulate insulin secretion from the pancreas. Biguanides like metformin reduce glucose production and absorption. Meglitinides and sulfonylureas both stimulate insulin secretion but meglitinides have a faster onset and shorter duration. Thiazolidinediones like pioglitazone increase insulin sensitivity. Alpha-glucosidase inhibitors
Voglibose
Voglibose is an alpha-glucosidase inhibitor used to lower post-meal blood glucose levels in people with diabetes by delaying the absorption of glucose in the intestine. It was developed by Takeda Pharma and works by inhibiting the enzymes that break down carbohydrates, which prevents sudden spikes in blood glucose after eating. Potential side effects include flatulence, abdominal pain, and diarrhea. It is contraindicated in people with inflammatory bowel disease or those predisposed to intestinal obstruction.
GPAT INSULIN,ORAL HYPOGLYCEMIC AGENTS
The document discusses various drugs used to treat diabetes, including their mechanisms of action, side effects, and classifications. It notes that lactic acidosis is common with phenformin, rosiglitazone acts as a PPAR gamma agonist but not by increasing insulin secretion, hypokalemia can occur if insulin is given rapidly for diabetic ketoacidosis, and metformin can cause vitamin B12 deficiency. Common side effects of thiazolidinadiones include water retention and weight gain.
Hypoglycemic agents
The document discusses hypoglycemic agents, which are drugs used to lower blood sugar levels and treat diabetes mellitus. It defines diabetes as a condition characterized by hyperglycemia and glucosuria due to abnormal carbohydrate, fat, and protein metabolism. The main types of hypoglycemic agents discussed are insulin, sulfonylureas like chlorpropamide and tolbutamide, biguanides like phenformin, and their mechanisms of action, formulations, and uses in treating diabetes.
Diabetic and antidiabetic drugs
Diabetic and Antidiabetic Drugs
By
Dr. Yousuf Ali Sarker
Dept. of Pharmacology
Bangladesh Agricultural University
Oral hypoglycaemic agents dr jayesh vaghela
1) Oral hypoglycemic agents work by enhancing insulin secretion, increasing insulin sensitivity, or reducing glucose absorption. The main classes include sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, amylin analogues, SGLT-2 inhibitors, and dopamine D2 receptor agonists.
2) Sulfonylureas work by blocking ATP-sensitive potassium channels, stimulating insulin secretion. Common side effects include hypoglycemia and weight gain.
3) Biguanides like metformin increase insulin sensitivity by decreasing hepatic glucose output and intestinal glucose absorption
Anti diabetic drugs
This document discusses different classes of antidiabetic drugs used to treat diabetes mellitus. It describes how these drugs work to lower blood glucose levels by different mechanisms such as increasing insulin secretion from the pancreas, increasing insulin sensitivity, or decreasing glucose absorption. The main classes covered are sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, and SGLT-2 inhibitors. Specific drugs discussed in more detail include tolbutamide, metformin, and glipizide.
Oral hypoglycemics
This document classifies and describes the mechanisms of various oral and parenteral antihyperglycemic agents. It discusses sulfonylureas, meglitinide analogues, biguanides, thiazolidinediones, alpha-glucosidase inhibitors, incretin mimetics, DPP-4 inhibitors, and amylin mimetics. For each class, it covers mechanisms of action, pharmacokinetics, adverse effects, and examples of commonly used drugs. The document provides a comprehensive overview of different classes of antihyperglycemic medications used to treat diabetes.
Diabetes mellitus amol
This document discusses the drug management of diabetes mellitus. It begins by classifying the different types of diabetes and criteria for diagnosis. It then discusses the therapeutic aims of glycemic control and treatment of associated conditions. The main therapeutic strategies discussed are medical nutrition therapy, exercise, and pharmacologic therapy including insulin for type 1 diabetes and oral glucose lowering agents or insulin for type 2 diabetes. Finally, it summarizes the mechanisms and examples of common classes of oral glucose lowering drugs including sulfonylureas, meglitinides, biguanides, and alpha-glucosidase inhibitors.
Newer antidiabetic agents
This document summarizes newer antidiabetic agents, including their mechanisms of action, clinical trials, and side effects. It discusses newer insulins like detemir and degludec, as well as incretin-based therapies like GLP-1 agonists exenatide and liraglutide and DPP-4 inhibitors sitagliptin and saxagliptin. It also reviews amylin mimetic pramlintide, dual PPAR agonists saroglitazar, SGLT2 inhibitors dapagliflozin and empagliflozin, and other agents like bromocriptine and colesevelam. Emerging targets discussed include PTP-
Diabetes Mellitus definition,type,cause,symptom,treatment,complication
Diabetes mellitus is a clinical syndrome characterized by high blood glucose levels. Symptoms include increased thirst, urination, fatigue, and changes in weight or vision. It is diagnosed through blood tests showing elevated glucose levels. The main types are type 1 and type 2 diabetes. Treatment involves diet, exercise, medication like insulin or other drugs, and managing complications affecting the eyes, kidneys, nerves, and blood vessels.
Antidiabetic Drugs
This document summarizes different types of drugs used to treat diabetes mellitus. It discusses insulin, the main types of which include rapid-acting, short-acting, intermediate-acting, and long-acting insulins. It also discusses oral hypoglycemic drugs that help control blood sugar levels, including sulfonylureas that stimulate insulin secretion, biguanides that overcome insulin resistance, and others such as alpha-glucosidase inhibitors. New drug classes are also mentioned, like GLP-1 receptor agonists and DPP-4 inhibitors that enhance the body's own insulin response after meals. The document provides details on the mechanisms and examples of specific drugs within each class.
Liver Paracetamol Poisoning
The document discusses drug metabolism and liver toxicity. It describes 3 phases of drug metabolism: phase 1 alters the parent molecule through reactions like oxidation; phase 2 conjugates the drug or metabolite making it more water soluble; and phase 3 involves energy-dependent excretion from the body. The liver plays a key role through enzymes like cytochrome P450 and is susceptible to toxicity from drugs like paracetamol which can deplete glutathione stores and cause liver damage. Treatment depends on the toxin but may include decontamination, antidotes, and supportive care.
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Diabetes Mellitus definition,type,cause,symptom,treatment,complication
Diabetes Mellitus definition,type,cause,symptom,treatment,complication
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Anti diabetics
1) Diabetes mellitus affects approximately 5-8% of the population and is a leading cause of death, blindness, and renal failure. There are two main types: type 1 usually develops before age 30 and requires insulin therapy, while type 2 usually develops after age 40 and may be managed with diet and oral medications.
2) Insulin regulates carbohydrate, fat, and protein metabolism. In diabetes, insulin deficiency leads to hyperglycemia, glucosuria, dehydration, and ketosis. Various insulin preparations including short-acting, intermediate-acting, and long-acting types are used to treat diabetes.
3) Oral medications for type 2 diabetes include sulfonylureas, metformin
5 - PN Final PPP June 23rd 2015 Liz Gregory.pptx
This document provides information about diabetes, including:
- Approximately 3.5 million people in the UK have diagnosed diabetes and 850,000 have undiagnosed diabetes.
- The main types of diabetes are type 1, type 2, and gestational diabetes. Type 2 accounts for 85-90% of diabetes cases.
- Diagnostic criteria for diabetes includes a fasting blood glucose of 7.0 mmol/l or higher, random blood glucose of 11.1 mmol/l or higher, or an A1C level of 6.5% or higher.
- People at increased risk of developing diabetes include those who are obese, older than 65, have a family history of diabetes, or
Ohd
This document provides information on different drug treatments for type 2 diabetes, including sulfonylureas, meglitinide, metformin, thiazolidinediones, alpha-glucosidase inhibitors, and combination therapies. Key details are provided on drug names, mechanisms of action, dosages, side effects and precautions for each class.
Type 2 diabetes
This document provides an overview of the pharmacotherapy of type 2 diabetes mellitus. It discusses the pathogenesis of type 2 diabetes and diagnostic criteria. It then describes the various classes of antidiabetic medications including sulfonylureas, biguanides, thiazolidinediones, alpha glucosidase inhibitors, incretin mimetics, DPP-4 inhibitors, amylin mimetics, and SGLT2 inhibitors. For each class, it provides examples of medications, mechanisms of action, dosing, and side effects. The document concludes with sections on insulin therapy and individualizing treatment based on patient factors.
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drugtherapyindiabetes-.ppt
This document discusses drug therapy and management of diabetes. It provides information on diagnosing diabetes based on fasting and oral glucose tolerance tests. The aims of management are to achieve near-normal glycemia to prevent short and long-term complications and improve quality of life. Treatment targets for non-pregnant patients include an HbA1c of 6.5-7.5%, blood pressure under 130/80, and LDL cholesterol under 2.6 mM. The document describes different types of insulin including short, intermediate, and long-acting varieties. It also summarizes oral medications for treating type 2 diabetes including thiazolidinediones, biguanides, sulfonylureas, meglitinides, and alpha-
Oral antidiabetics by Dr. Mushtaq Ahmed, Associate Professor, Pharmacology, P...
Oral antidiabetics by Dr. Mushtaq Ahmed, Associate Professor, Pharmacology, P...Dr Mushtaq Ahmad Hakim
This document discusses diabetes mellitus and its classification and management. It begins with an overview of diabetes, noting that it is a metabolic disorder resulting from defects in insulin secretion or action. It then discusses the classification of diabetes into type 1, type 2, gestational, and other specific types. Statistics on the prevalence of diabetes globally and in India are provided. The pathophysiology and progression of type 2 diabetes is examined. Oral hypoglycemic agents and their mechanisms of action are outlined, including sulphonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. The roles of exercise, diet, and weight control in diabetes management are also summarizedDiabetes mellitus pharma 3 fall 2018
Type 1 diabetes is characterized by a lack of insulin production and requires lifelong insulin treatment. Type 2 diabetes results from insulin resistance and relative lack of insulin and can often be managed through lifestyle changes and oral medications, though some people may eventually require insulin therapy. Gestational diabetes develops during pregnancy and usually resolves after giving birth but increases the risk of developing type 2 diabetes later in life. The main goals of diabetes treatment and management are to control blood glucose levels and minimize the risk of short and long-term complications.
Type 1 Diabetes Mellitus
Type 1 diabetes is characterized by an absolute deficiency of insulin due to the autoimmune destruction of pancreatic beta cells. It typically presents in childhood or early adulthood with symptoms of polyuria, polydipsia, and unexplained weight loss. Treatment involves lifelong insulin replacement therapy via injections to control blood glucose levels and minimize the risk of complications. Rapid-, short-, intermediate-, and long-acting insulin formulations have different onset and duration profiles suited to individual treatment regimens. Strict glycemic control is important to reduce microvascular and macrovascular risks.
Anti diabetics
This document discusses different types of drugs used to treat diabetes mellitus. It describes two major types of oral anti-diabetic drugs: insulin secretagogues like sulfonylureas that stimulate insulin release from the pancreas, and insulin sensitizers like biguanides and thiazolidinediones that improve insulin sensitivity. It provides details on mechanisms of action, pharmacokinetics, uses, and side effects of representative drugs in each class.
Drug therapy in diabetes
The document discusses drug therapy for diabetes, including types of insulin, oral medications to treat type 2 diabetes, and guidelines for treatment. It provides details on short acting, intermediate acting, and long acting insulins. It also describes classes of oral medications like thiazolidinediones, biguanides, sulfonylureas, meglitinides, and alpha-glucosidase inhibitors. The document outlines targets for managing diabetes and discusses combination therapy options.
Drug therapy in diabetes
The document discusses drug therapy for diabetes, including types of insulin, oral medications to treat type 2 diabetes, and guidelines for treatment. It provides details on short acting, intermediate acting, and long acting insulins. It also describes classes of oral medications like thiazolidinediones, biguanides, sulfonylureas, and alpha-glucosidase inhibitors. Guidelines for treatment of type 2 diabetes include lifestyle changes, monotherapy, and combination therapy using oral drugs or oral drugs with insulin.
Drug therapy in diabetes
The document discusses drug therapy for diabetes, including types of insulin, oral medications to treat type 2 diabetes, and guidelines for treatment. It provides details on short acting, intermediate acting, and long acting insulins. It also describes classes of oral medications like thiazolidinediones, biguanides, sulfonylureas, and alpha-glucosidase inhibitors. Guidelines for treatment of type 2 diabetes include lifestyle changes, monotherapy, and combination therapy using oral drugs or oral drugs with insulin.
Ranjna.ppt
The document provides information on the management of type 2 diabetes mellitus (T2DM), including pathophysiology, treatment approaches, medication options, and treatment targets. It discusses lifestyle modifications and progressive medication options starting with metformin and including DPP-4 inhibitors, SGLT-2 inhibitors, thiazolidinediones, GLP-1 receptor agonists, and insulin. It also presents a case study example and discusses treatment considerations and options based on the patient's profile and treatment goals.
INSULIN.pdf
Insulin and oral hypoglycemic drugs are used to treat diabetes mellitus. There are two main types of diabetes - type 1 caused by lack of insulin and type 2 caused by insulin resistance. Insulin is secreted by beta cells in the pancreas and helps regulate blood glucose levels. Oral hypoglycemic drugs include sulfonylureas, biguanides, and alpha-glucosidase inhibitors which help lower blood glucose through different mechanisms of action. The document provides details on the classification, clinical features, complications, and treatment of diabetes mellitus.
Diabetes Mellitus - Medicine - ATOT
This document provides an overview of diabetes mellitus (DM), including its definition, types, causes, clinical features, diagnosis, treatment, and complications. It discusses the two main types of DM - type 1 caused by autoimmune destruction of beta cells resulting in absolute insulin deficiency, and type 2 caused by multiple factors including genetics, lifestyle, and obesity resulting in insulin resistance. The document outlines the diagnostic criteria and tests for DM, as well as medical management including lifestyle changes, oral hypoglycemic drugs that work via different mechanisms of action, and insulin therapy when other options fail or for severe cases. It concludes by describing the acute and long-term complications of uncontrolled DM.
Recent advances in treatment of diabetes melltius
The document discusses recent advances in the treatment of diabetes mellitus. It describes newer rapid-acting and long-acting insulin formulations that have faster onset of action and longer duration compared to regular human insulin. It also summarizes several new classes of oral hypoglycemic agents in development, including SGLT2 inhibitors, dual PPAR agonists, glucokinase activators, and GIP antagonists, and discusses their mechanisms of action and potential benefits for treating diabetes.
The pancreas and glucose homeostasis l4
Diabetes mellitus is characterized by elevated blood sugar levels due to a lack of insulin. There are two main types: type 1 involves a failure of insulin production while type 2 involves a gradual deterioration of insulin production. Glycosylated hemoglobin (HbA1c) is used to monitor blood glucose levels over several weeks. Insulin regulates glucose homeostasis by promoting glucose uptake and inhibiting glucose production in the liver and breakdown of fats and proteins. Complications of long-term diabetes include damage to blood vessels leading to issues like retinopathy, nephropathy, and neuropathy. Oral anti-diabetic drugs work by various mechanisms like stimulating insulin release, reducing glucose production, or increasing insulin sensitivity.
Management Of Diabetes
This document summarizes the management and treatment of diabetes. It discusses:
1) The classification of type 1 and type 2 diabetes, their typical presentations, and diagnostic criteria.
2) Guidelines for initial treatment including lifestyle changes and metformin for type 2 diabetes. Adding sulfonylureas or insulin if glycemic goals are not met.
3) Treatment of type 1 diabetes focuses on intensive insulin therapy to control blood glucose and reduce complications.
4) Screening and treatment of complications like nephropathy, retinopathy, and neuropathy are also covered.
Diabetes treatment
Controlling blood sugar (glucose) levels is the major goal of diabetes treatment, in order to prevent complications of the disease.
Type 1 diabetes is managed with insulin as well as dietary changes and exercise.
Type 2 diabetes may be managed with non-insulin medications, insulin, weight reduction, or dietary changes.
Medications for type 2 diabetes are designed to
increase insulin output by the pancreas,
decrease the amount of glucose released from the liver,
increase the sensitivity (response) of cells to insulin,
decrease the absorption of carbohydrates from the intestine, and
slow emptying of the stomach, thereby delaying nutrient digestion and absorption in the small intestine.
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Ati flash cards 11, medications affecting the endocrine system
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Renal pathology iii
This document discusses tubulointerstitial disorders, which are diseases affecting the renal tubules and interstitium. Tubulointerstitial disorders are distinguished from glomerular diseases by the absence of nephritic or nephrotic syndrome and the presence of tubular dysfunction manifesting as defects in concentration ability, polyuria, nocturia, and metabolic acidosis. Common tubulointerstitial disorders discussed include acute tubular necrosis, tubulointerstitial nephritis, pyelonephritis, drug-induced tubulointerstitial nephritis, analgesic nephropathy, and diseases causing hypercalcemia and nephrocalcinosis.
Renal pathology iv
The key features in this case are:
- Age of 4 years old
- Abdominal mass
- Hematuria
- Hypertension
This combination of findings is classic for Wilms tumor (nephroblastoma), which is the most common renal tumor in children.
The diagnosis is Wilms tumor (D).
Renal pathology ii
Membranous GN
MOST COMMON cause is idiopathic (85%); peak age 30-50; male:female, 2:1
May be secondary to:
Drugs-captopril, penicillamine, gold, mercury, trimethadione, NSAIDS
Infections-malaria (P. malariae), leprosy, schistosomiasis, syphilis, hepatitis B and C, filariasis, hydatid disease and enterococcal endocarditis
Diseases-malignancy (Carcinoma of breast, lung, colon, stomach, and esophagus) melanoma, renal cell CA, SLE, sarcoidosis, diabetes, thyroiditis, sickle cell anemia, Crohn’s disease
Renal pathology i
Congenital
Malformations, ectopic, cysts, dysplasia.
Acquired
Glomerular diseases
Tubulointerstitial diseases,
Renal calculi.
Neoplasms – carcinoma
Cervical ca screening ..
1. Women aged 21-24 with ASC-US or LSIL should have repeat cytology in 1 year; if negative twice, return to routine screening, but AGC, HSIL or ASC-H requires colposcopy.
2. Women over 30 should have co-testing every 5 years; if HPV negative the risk is low, but a positive HPV requires repeat co-testing in 1 year or colposcopy if cytology is ASC-US or greater.
3. ASC-H in women over 25 requires colposcopy regardless of HPV results due to possibility of significant abnormality.
01 cardiac pathology
Normal Heart
Fist size muscular pump
Pumps 6000 lit of blood daily
Perfuses
tissues with nutrients and
Facilitates
removal of waste products.
Heart diseases
Have severe physiologic consequences
Are leading cause of morbidity and mortality in developed nations
750,000 deaths/ year (In US
05 cardiac pathology
This document describes various congenital heart diseases (CHD) including their embryology, classification, pathophysiology and clinical presentations. It discusses abnormalities causing left-to-right shunts such as ventricular septal defects, atrial septal defects and patent ductus arteriosus which can cause volume overload. It also describes right-to-left shunting defects like tetralogy of Fallot and transposition of the great arteries which result in cyanosis. Obstructive lesions including coarctation of the aorta are also summarized. Fetal circulation is compared to changes at birth.
04 cardiac pathology
Infective Endocarditis (IE)
Is due to bacterial or fungal infection of the heart valves (endocardium).
Characterized by:
Formation of bulky, friable,easily detached and infected vegetations.
Damage to heart Valves and Chorda tendinae
perforation, ulceration, destruction (causes valve dysfunction)
03 cardiac pathology
Acute rheumatic fever
Chronic Rheumatic heart disease
Mitral stenosis
Mitral regurgitation
Mitral valve prolapse
Aortic stenosis
Aortic regurgitation
02 cardiac pathology
Ischemic Heart Disease
IHD is caused by myocardial ischemia due to
Imbalance between the myocardial oxygen demand and supply from the coronary arteries.
Majority of cases due to
Reduction in coronary artery blood flow caused by
Obstructive atherosclerotic disease.
IHD is also known as Coronary artery disease
09 respiratory pleura
The document discusses several disorders of the pleura and lungs, including pleural effusions, pneumothorax, and mesothelioma. Pleural effusions can be transudative or exudative depending on disturbances to Starling forces or increased vessel permeability. Pneumothorax can be spontaneous due to bleb rupture or tension pneumothorax from a flap-like pleural tear. Mesothelioma is a malignant tumor of the pleura associated with asbestos exposure that encases the lung.
08 respiratory restrictive
Restrictive lung diseases (interstitial lung diseases)
Histological Structure of Alveoli
The wall of the alveoli is formed by a thin sheet of tissue separating two neighbouring alveoli.
This sheet is formed by epithelial cells and intervening connective tissue.
Collagenous , reticular and elastic fibres are present.
Between the connective tissue fibres we find a dense, anastomosing network of pulmonary capillaries. The wall of the capillaries are in direct contact with the epithelial lining of the alveoli.
Neighbouring alveoli may be connected to each other by small alveolar pores (pores of Kohn).
The epithelium of the alveoli is formed by two cell types:
Alveolar type I cells (small alveolar cells or type I pneumocytes) are extremely flattened and form the bulk (95%) of the surface of the alveolar walls.
Alveolar type II cells (large alveolar cells or type II pneumocytes) are irregularly (sometimes cuboidal) shaped.
They form small bulges on the alveolar walls.
Type II alveolar cells contain are large number of granules called cytosomes (or multilamellar bodies), which consist of precursors to pulmonary surfactant (the mixture of phospholipids which keep surface tension in the alveoli low) .
Cilia are absent from the alveolar epithelium and cannot help to remove particulate matter which continuously enters the alveoli with the inspired air. Alveolar macrophages take care of this job. They migrate freely over the alveolar epithelium and ingest particulate matter.
FUNCTIONS OF PULMONARY CELLS
Type I pneumocytes
Permeable to Oxygen and CO2, do not divide
Type II pneumocytes
Reserve cells
secrete pulmonary surfactant
Serve as repair cells
Alveolar macrophages
Phagocytosis
Pores of Kohn (allow passage of Macrophages)
07 respiratory obstructive2
Asthma
A chronic relapsing inflammatory disorder characterized by:
Hyper-reactivity of the respiratory tree to various stimuli leading to
Reversible airway obstruction
Obstruction produced by combination of :
Constriction of bronchial musculature (bronchospasm)
Mucosal inflammation (edema)
Excessive secretion of mucus.
Clinically Manifested by :
Difficulty in breathing (Dyspnea)
Wheeze (a soft whistling sound during expiration)
Difficulty in expiration.
Asthma is:
Episodic and reversible airway disease
Primarily targets the bronchi and terminal bronchioles
MC chronic respiratory disease in children
Two types:
Extrinsic asthma (allergic, atopic)
Intrinsic asthma (non-allergic asthma or idiosyncratic asthma)
06 respiratory obstructive1
Obstructive diseases : Chr.by
Obstruction to airflow out of the lungs
Due to partial or complete obstruction in airway.
Increase in lung compliance and
Decrease in lung elasticity.
Restrictive diseases : Chr by
reduced expansion of lung parenchyma with problems in getting air in the lungs.
Lung compliance is decreased
Elasticity is increased: once air is in the lungs it comes out rapidly on expiration.
05 respiratory tumors
Tumors of lung
Malignant tumors of lung
Primary
Metastatic
Metastatic lung cancer
More common* than primary lung cancer.
Breast cancer (MCC)
Renal Cell carcinoma
Choriocarcinomas
Colorectal carcinomas
Appear as: "Cannon Balls” On X rays
04 respiratory infection2
This document discusses several types of pneumonia including nosocomial, aspiration, and lung abscess pneumonia. It provides details on causative organisms, pathophysiology, clinical features, diagnosis and treatment. Key points include:
- Nosocomial pneumonia is associated with immunosuppression, antibiotics, and respirators. Common organisms are E. coli, Pseudomonas aeruginosa, and S. aureus.
- Aspiration pneumonia results from gastric content aspiration and is characterized by necrotizing inflammation. Causative organisms include a mixture of oral aerobes and anaerobes like Bacteroides and S. pneumoniae.
- Lung abscesses develop most commonly from aspiration or
03 Respiratory infection1
Pneumonia
Three Types of Classification of pneumonias
Clinical
Morphological (distribution of inflammatory foci)
Etiological
02 respiratory vascular
Chronic passive pulmonary congestion (CVC lung)
Pulmonary edema
Pulmonary thrombo-embolism and infarction
Pulmonary hypertension
Pulmonary hemorrhage*
01 respiratory RDS
1. Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by diffuse alveolar capillary damage and severe pulmonary edema, resulting in hypoxemia that is refractory to oxygen therapy.
2. ARDS is caused by direct or indirect injury to the lungs from sources such as sepsis, gastric aspiration, trauma, or smoke inhalation. This causes damage to the alveolar capillary endothelium and epithelium.
3. The damage leads to increased capillary permeability, leakage of fluid into the alveoli, and formation of hyaline membranes. This results in impaired gas exchange and respiratory failure.
Environmental diseases 2
Heavy Metal poisoning
Lead, Arsenic, and Mercury
Produce acute or chronic intoxications
Blood tests are most useful for screening for heavy metal poisoning
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Anti diabetic medications
- 1. Antidiabetic medications -Stop prior to IV contrast & 48 hours after angiography -CC < 30 mL/min - Do not use Category B in pregnancy -B12 deficiency Gi upset- -No hypoglycemia or weight gain -Improves CKD - lactic acidosis( Rare) in the liver: 1↓gluconeogenesis, 2-↓Glycogenolysis 3-↓Fatty acid oxidation in skeletal muscle 1-↑ glycogenesis 2-↓Fatty acid oxidation in intestine: 1-Anerobic glucose metabolism Biguanide Metformin (max 2550) ▼HbA1c by 1.to 2.0 % -Avoid Glimepiride , glibenclamide in elderly -Weight gain -hypoglycemia Cholestasis(Chlorpropamide)- -Retinopathy (Gliclizide) -Stimulate pancreatic beta cells to release insulin Sulfonylureas -Glipizide, -Glyburide (glibenclamide), Glimepiride- -Gliclazide (Diamicron) ▼HbA1c by 1 to 2% -Black Box warning for class III or IV HF Category C in pregancy- -Risk of bladder, prostate, edemapancreatic cancers , -Decrease bone density and increase fractures Weight gain- Increases ovulation- -Decreases insulin resistance at muscle and fat level Thiazolidinedion -Pioglitazone (Actos) Rosiglitazone (Avandia)- .-Do not use in MEN2 and CC below 30. Category C in pregnancy Weight loss- -Pancreatitis -Hypoglycemia with Sulfonylureas Thyroid C-cell T- 1- Potentiate insulin secretion 2- Suppress postprandial glucagon secretion 3- Slow gastric emptying 4- Promote satiety 5- Increases insulin response to postprandial rise in glucose GLP-1 Exenatide- -Liraglutide( Victoza ) Dose 0.6, 1.2, 1.8 mg daily Dulaglutide- 1-Linagliptin not renally excreted and good choice in elderly 2-Better insulin release and blood sugar control, particularly postprandial -URI, sore throat, diarrhea, pancreatitis- Joint pain- weight neutral- Decrease breakdown- of GLP-1 DPP-4 Inhibitors Linagliptin 5mg daily- Sitagliptin(Januvia)100mg daily- Saxagliptin ▼HbA1c by .5 to .7 %- Lower BB- -Improve renal F - Decrease risk of MI, stroke, CKD B12 deficiency- Weight loss- DKA- -Increase fractures and risk of foot amputation Fournier's gangrene- Increased UTIs- 1-Block reabsorption of glucose in the kidney 2- Increase urinary excretion of glucose SGLT2 Inhibitors Canagliflozin- Dapagliflozin- Empagliflozin ▼HbA1c by .5 to .8 %- Weight neutral- no hypoglycemia- Category B in pregnancy-Delay carbohydrate absorption in gut A-Glucosidase Inhibitors Acarbose- Miglitol- - May be used in elderly, renal failure, & cardiopulmonary disorders Rapid-acting-Meglitinides -Repaglinide -Nateglinide ++Side effectMechanism of actionMedication
- 2. Types of insulins: Side effect : Systemic : Hypoglycemia, Wight gain, Insulin resistance Local : Hypersensitivity Infection ,Lipodystrophy Long actingIntermediateShort actingRapid acting ,)Lantus(Glargine )Levemir(etemirD Neutral protamine Hagedorn (NPH) Regular(Humulin R),)NovoRapid(spartA glulisine )Humalog(),lisproApidra) Onset 30-60 min, Glargine No peak Detemir dose dependent , duration 16-24 hr Onset 1-2 H, peak 4-8 hr, duration 8-12 hr Onset 30 min, peak 1-3 hr, duration 4-8 hr Onset 15 min, peak 1-3 hr, duration 2-5 hr Administered once daily ● Route: SubQ injection ○ NOT for IV use ● Appearance: Clear- -Can NOT be mixed with other types of insulin Administered once or twice daily ● Route: SubQ injection NOT for emergency IV use ● Appearance: Cloudy Only :insulin that can be mixed with short-acting -Administered immediately before eating a meal ● Route: May be given IV ● Appearance: Clear Patients who are intolerant of metformin are unlikely to be successful with a third trial of that agent. Empagliflozin, an SGLT2 inhibitor, is considered a second-line choice for patients who are intolerant of metformin. Both sitagliptin, a DPP-4 inhibitor, and liraglutide, a GLP-1 receptor agonist, should be avoided or used with caution in patients with a history of pancreatitis -Linagliptin is not cleared by the kidney second choice if GFR<35(Stop Metformin) only liraglutide has been shown to lower the risk of recurrent cardiovascular events and has received FDA approval for this indication Empagliflozin, an SGLT2 inhibitor, has also been associated with secondary prevention of cardiovascular disease . Fasting C-peptide levels are markedly elevated in patients with T2DM, but in people with T1DM, C-peptide levels should be low
- 3. .TZDs tend to cause fluid retention and should not be used in patients with congestive heart failure References ADA Step up to medicine Toronto notes UpToDate ABFM