Diabetic drugs is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
A short lecture highlighting the most important aspects of pharmacological management of DM in general. It discusses the use of insulin in type I diabetes mellitus and the approach with hypoglycemic agents in type II.
A short lecture highlighting the most important aspects of pharmacological management of DM in general. It discusses the use of insulin in type I diabetes mellitus and the approach with hypoglycemic agents in type II.
In this PPTs you will get in depth information about insulin and the first class of oral hypoglycemic agents , Sulfonylurea.
useful for GPAT and Third Year B.Pharm students.
SGLT2 Inhibitors (Gliflozins): A New Class of Drugs to treat Type 2 Diabetes:Naina Mohamed, PhD
Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).
social milestones a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
In this PPTs you will get in depth information about insulin and the first class of oral hypoglycemic agents , Sulfonylurea.
useful for GPAT and Third Year B.Pharm students.
SGLT2 Inhibitors (Gliflozins): A New Class of Drugs to treat Type 2 Diabetes:Naina Mohamed, PhD
Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors such as Dapagliflozin (Farxiga), Canagliflozin (Invokana) and Empagliflozin (Jardiance) are a new class of oral drugs available to treat type 2 diabetes mellitus (Type 2 DM).
social milestones a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Pharmacophore modeling: A continuously evolving tool for computational drug d...Simone Brogi
In the latest two or three years progressive
applications of pharmacophore modeling continue to appear in literature. Pharmacophore based parallel screening, for instance, has been introduced in 2006. Moreover, in 2008, a survey discussing the prospective impact of virtual screening techniques in the
discovery of bioactive natural products has been published.
neurosurgery is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Lizzy Schmidt, Director of the Woman's Program at Philadelphia FIGHT's Jonathan Lax Center, presented on HIV Treatment and PrEP at the June 2015 Ryan White Part A Planning Council meeting.
La GPC DM2 ayudará a los profesionales de la salud en la toma de decisiones clínicas basadas en la mejor evidencia científica disponible para el manejo de ésta enfermedad crónica no transmisible.
lecture about diabetes mellitus for undergraduated student, master student
its include definition of diabetes, type 1 diabetes, type2, gestational, diagnosis criteria, complication, world day
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
Exercise Testing in Cardiology : Dr. Akif Baigakifab93
The testing modality and protocol should be selected in accordance with the patient’s estimated functional capacity based on age, estimated physical fitness from the patient’s history, and underlying disease
Several exercise test protocols are available for both treadmill and stationary cycle ergometers
Patients who have low estimated fitness levels or are deemed to be at higher risk because of underlying disease (e.g., recent MI, heart failure) should be tested with a less aggressive exercise protocol
Treadmill and cycle ergometers may use stepped or continuous ramp protocols
Work rate increments (stages) during stepped protocols can vary from 1 to 2.5 METs
Ramp protocols are designed with stages that are no longer than 1 minute and for the patient to attain peak effort within 8 to 12 minutes
The natriuretic peptide system works antagonistically to the RAAS and has favorable effects on the pathogenesis of heart failure
Natriuretic peptides are broken down by an enzyme called neprilysin
Neprilysin is also responsible for the breakdown of other substances, including bradykinin and angiotensin II
Sacubitril/valsartan is a combination product
Sacubitril is a pro-drug that, upon activation, acts as a neprilysin inhibitor
It works by blocking the action of neprilysin, thus preventing the breakdown of natriuretic peptides
This leads to a prolonged duration of the favorable effects of these peptides
Coronary heart disease (CHD) remains a leading cause of death worldwide, accounting for 16% of total deaths globally .
Atherosclerosis plays a central role, with early fatty streaks progressing to late complex atheromas
Vascular calcification, the pathogenic and process of ectopic bone production, specifically was shown to strongly correlate with degree of atherosclerosis (both calcified and noncalcified)
Vascular calcification was shown independently to predict cardiovascular morbidity and mortality
These associations, combined with the radio-opaque appearance of calcium hydroxyappatite on CT images, have led to extensive investigation of the quantification, or scoring, of coronary artery calcium (CAC).
CAC scoring has emerged as a widely available and powerful tool for stratifying cardiovascular risk, predicting patient outcomes, and guiding preventive therapy
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
Left ventricular (LV) dysfunction remains one of the
best prognostic determinants of survival in patients
with coronary artery disease (CAD)
⚫ It was originally thought that dysfunctional
myocardium after an infarction was irreversibly
damaged
⚫ However, it was later recognized that some of the
involved tissue remained viable and contractility may
be restored with revascularization
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Ventricular septal defects occur either as an isolated defect or as a component of a more complex lesion
It occurs in 50 percent of all children with CHD and in 20 to 30 percent as an isolated lesion
Most common congenital cardiac anomaly in children
Second most common congenital abnormality in adults, second only to bicuspid aortic valves
They are more common in premature infants and those born with low weight
VSDs are slightly more common in females (56%)
Patients with peripheral artery disease who have undergone lower-extremity revascularization are at high risk for major adverse limb and cardiovascular events
The efficacy and safety of rivaroxaban in this context are uncertain
Most common cyanotic heart defect seen in children beyond infancy, accounting for a third of all congenital heart disease (CHD) in this age group
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Bentracimab (also known as PB2452) is a neutralizing recombinant human immunoglobulin G1 monoclonal antibody antigen-binding fragment that binds ticagrelor and its major active circulating metabolite with high affinity and specificity
Chlorthalidone for hypertension in advanced ckdakifab93
Chlorthalidone, a thiazide-like diuretic, reduces cardiovascular morbidity, such as the incidence of stroke and heart failure, and cardiovascular mortality
However, its efficacy and safety among patients with advanced chronic kidney disease remain poorly understood
An acute illness caused by an autoimmune response to infection with group A Streptococcus, leading to a range of possible symptoms and signs affecting any or all of heart, joints, brain, skin and subcutaneous tissues
Amyloidosis is a group of protein-folding disorders in which >1 organ is infiltrated by proteinaceous deposits known as amyloid. Amyloid involvement of the heart (cardiac amyloidosis) carries the worst prognosis of any involved organ, and light-chain (AL) amyloidosis is the most serious form of the disease
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
3. Starch/Saccharides
In diet
Decreases gastric
emptying
Alpha glucosidase
Release of Insulin
Increases Ca entry
Depolarisation
ATP formed from
glucose inhibits
ATP-K+ channels
Stimulates GLUT-2 receptors
On Beta islet cells
Glucose enters
circulation
Releases Insulin
& amylin
Stimulates Pancreas
Increases release of
Incretin or GLP-1
Enters intestinal
epithelial cells
Glucose
Increases GLUT-4 on
surface of cells
Metabolised by DPP-4
Enzyme
-
Gliptins
-Acarbose
voglibose
+
Exenatide
Liraglutide -
Meglitinides
Sulfonylureas
Amylin analogue: Pramlinitide
4. -This drugs inhibits conversion of starch into glucose
accumulation of starch
S/E:Flatulence>Diarrhoea Prevents rise in glucose levels
During both prandial and post-
Prandial levels (But not pre-
Prandial)
Acarbose reduces fibrinogen levels but also several other markers
of inflammation are reduced.
9. Smooth and peakless effect is caused by : Glargine & Detemir
Insulin increases K+ and Glucose uptake by cells and thus leads
To Hypokalemia
10.
11. Glargine has a acidic pH. So not mixed with other insulins
Other all Insulins are Neutral Insulins.
12.
13.
14.
15.
16. 1st Generation 2nd Generation
Chlorpropamide Glybenclamide
Tolbutamide Gliclizide
Acetohexamide Glyburide
Causes Hepatotoxicity ( Mnemonic; T for tolbutamide and there are
3Ts in hepatotoxicity)
Causes SIADH and Disulfiram like reaction
18. -Insulin Secretagogues i.e they stimulate Insulin Release.
-Max. potency among sulfonylureas = Glyburide
-C.I. in = Liver disease
Renal Disease
Pregnancy/Lactation
-S/E: Hypoglycemia
Weight Gain
-Causes maximum decrease in HbA1C levels ( 2nd : Biguanides) and increases
C-peptide values
-Long acting(Max.; Chlorpropamide) and hence increases insulin for long time
whereas meglitinides are short acting.
19. -Short acting Insulin secretagogues.
-Hence used for Post-prandial Hyperglucemia
-Metabolised in liver and excreted in Kidney. Hence, dose to be reduced
in both liver and renal failure.
-Rapeglinide
-Nateglinide
27. Stimulates PPAR-@
Increase transcription factors for GLUT-4 Production
Increase GLUT-4 receptors on tissue cells
But still requires Insulin to bring glucose to cells so that glucose can be taken
up by cells.
- They decreases Insulin Resistance
-Metabolised in Liver
-Safe in Renal Failure
28.
29. 1) Weight gain
2) Sodium and water retention
3) Macular edema
4) Increase risk of bone fracture in childrens.
35. Group Main Side Effect
Alpha glucosidase
Inhibitor
Flatulence/Dyspepsia
SGLT-2 Inhibitors UTI & Vaginal infections
Gliptins Steven Johnson Sx
Thiazolidinediones Water retention/Macular
edema
Insulin Hypoglycemia/
Lipodystrophy
Chlorpropamide SIADH/Disulfiram like
reaction
Tolbutamide Hepatotoxicity
Metformin Vit. B12 deficiency
Phenformin Lactic acidosis
Meglitinides Hypoglycemia
36. 1)Q. A 45-year-old woman presents to your office with a serum glucose
of 250 mg/dL and you diagnose diabetes mellitus type II. You intend to
prescribe the patient metformin, but you decide to order laboratory
tests before proceeding. Which of the following basic metabolic panel
values would serve as a contraindication to the use of metformin?
A. K+ > 4.0
B. Na+ > 140
C. HCO3- > 30
D. Creatinine > 2.0
37. Metformin is absolutely contraindicated in patients with renal failure
due to the risk of lactic acidosis.
An elevated serum creatinine suggests a decrease in GFR and the presence
of renal failure.
Metformin is a drug in the biguanide class used to treat diabetes mellitus
type II.
Metformin treats hyperglycemia by inhibiting gluconeogenesis.
Metformin carries no risk of hypoglycemia, but is known to occasionally
cause lactic acidosis in patients with renal failure, liver dysfunction, CHF,
alcoholism, and sepsis.
D. Creatinine > 2.0
38. 2.Q.A 45-year-old African-American male presents to the family medicine
physician to assess the status of his diabetes. After reviewing the laboratory
tests, the physician decides to write the patient a prescription for miglitol and
states that it must be taken with the first bite of the meal.
Which of the following bonds will be most likely affected by taking miglitol?
1. Phosphodiester bonds
2. Glycosidic bonds
3. Peptide bonds
4. Cystine bonds
5. Hydrogen bonds
39. The bonds that will be most likely affected by taking miglitol are
glycosidic bonds.
Miglitol is an alpha-glucosidase inhibitor that prevents the breakdown
of disaccharides/polysaccharides into monomers by alpha-glucosidases
located along the intestinal brush border.
Miglitol prevents these bonds from being hydrolyzed.
This delays sugar hydrolysis, resulting in a delayed glucose absorption.
This is advantageous for patients with type II diabetes mellitus as it
decreases postprandial hyperglycemia, thereby reducing insulin demand.
Common side effects of these inhibitors are upset stomach, diarrhea, and
flatulence.
2. Glycosidic bonds
40. 3.Q. A 60-year-old African-American female presents to your office
complaining of dysuria, paresthesias, and blurry vision. Her body mass
index is 37.2 kg/m2. Which of the following drugs would most
significantly increase the levels of C-peptide in the blood when
administered to this patient?
1. Metformin
2. Insulin
3. Glipizide
4. Acarbose
41. Glipizide is a second generation sulfonylurea that triggers release of insulin
from pancreatic beta cells. Increased release of endogenous insulin results in
elevated levels of C-peptide in the blood.
This patient's presentation is consistent with type II diabetes mellitus.
Dysuria due to a urinary tract infection (the presence of glucosuria creates a
good growth media for bacteria with subsequent increased risk of UTI),
paresthesia due to diabetic neuropathy, blurry vision due to osmotic damage
of the lens of the eye, and obesity are all associated with diabetes.
Glipizide is used in the treatment of diabetes type II only.
3. Glipizide
42. 4.Q. A patient presents to the emergency room in an obtunded state.
The patient is a known nurse within the hospital system and has no
history of any medical problems. A finger stick blood glucose is drawn
showing a blood glucose of 25 mg/dL.
The patient's daughter immediately arrives at the hospital stating that her
mother has been depressed recently and that she found empty syringes
in the bathroom at the mother's home. Which of the following is the test
that will likely reveal the diagnosis?
A. C-peptide level
B. 24 hr cortisol
C. Fasting blood glucose
D. Urine metanephrines
43. This patient is presenting with severe hypoglycemia likely secondary to
exogenous administration of insulin.
C-peptide is the portion of pro-insulin that is cleaved away within the
pancreatic beta cell.
In normal physiology, c-peptide is present within the circulation in equimolar
concentrations with insulin.
With the exogenous use of insulin, additional c-peptide is not present within
the circulation.
This scenario of hypoglycemia often occurs in individuals failing to
administer insulin correctly or in healthcare workers wishing to harm
themselves.
An insulin producing tumor should also be on the differential diagnosis for
these patients.
A. C-peptide level
44. 5.Q. A simple experiment is performed to measure the breakdown of sucrose
into glucose and fructose by a gut enzyme that catalyzes this reaction.
A glucose meter is used to follow the breakdown of sucrose into glucose.
When no enzyme is added to the sucrose solution, the glucose meter will
have a reading of 0 mg/dL; but when the enzyme is added, the glucose
meter will start to show readings indicative of glucose being formed.
Which of the following diabetic pharmacological agents, when added
before the addition of the gut enzyme to the sucrose solution, will maintain
a reading of 0 mg/dL?
1. Insulin
2. Glyburide
3. Metformin
4. Acarbose
45. The gut enzyme that is added to the solution is most likely alpha-glucosidase.
The only agent that will inhibit the enzyme from breaking down sucrose
into glucose and fructose thus showing a 0 mg/dL reading on the glucose
meter is acarbose.
Acarbose and miglitol are alpha-glucosidase inhibitors that prevent the
breakdown of disaccharides and polysaccharides into monomers by
alpha-glucosidase located along the intestinal brush border.
This delays sugar hydrolysis resulting in a delayed glucose absorption.
This is advantageous for patients with type II diabetes mellitus as it
decreases postprandial hyperglycemia, thereby reducing insulin demand.
Common side effects of these inhibitors are upset stomach, diarrhea, and
flatulence.
4. Acarbose
46. 6.Q. A 55-year-old male is hospitalized for acute heart failure. The patient
has a 20-year history of alcoholism and was diagnosed with diabetes mellitus
type 2 (DM2) 5 years ago. Physical examination reveals ascites and engorged
paraumbilical veins as well as 3+ pitting edema around both ankles.
Liver function tests show elevations in gamma glutamyl transferase and
aspartate transaminase (AST). Of the following medication, which most likely
contributed to this patient's presentation?
1. Glargine
2. Glipizide
3. Metformin
4. Pioglitazone
5. Pramlintide
47. Weight gain, edema (fluid retention), hepatotoxicity, and heart failure are
toxicities associated with pioglitazone. The drug should not be
administered to patients with heart failure or liver disease.
Pioglitazone and rosiglitazone are thiazolidinedione derivatives that
reduce insulin resistance in patients with DM2. They are occasionally used
as monotherapy for DM2 but are most often combined with other
hypoglycemics. The drugs are also used to treat polycystic ovarian
syndrome.
4. Pioglitazone
48. 7.Q. A 53-year-old male presents to your office for a regularly scheduled
check-up. The patient was diagnosed with type II diabetes mellitus two years
ago. To date, diet, exercise, and metformin have failed to control his elevated
blood glucose. Past medical history is also significant for hypertension.
The patient does not smoke or use cigarettes. Laboratory values show a
hemoglobin A1c (HbA1c) of 8.5%. You decide to add sitagliptin to the
patient’s medication regimen. Which of the following is the mechanism of
action of sitagliptin?
1. Inhibits degradation of endogenous incretins
2. Inhibits alpha-glucosidases at the intestinal brush border
3. Activates transcription of PPARs to increase peripheral sensitivity to insulin
4. Depolarizes potassium channels in pancreatic beta cells
5. Increases secretion of insulin in response to oral glucose loads and delays
gastric emptying
49. Sitagliptin is a dipeptidyl peptidase 4 (DPP-4) inhibitor. This class of
drugs acts to inhibit degradation of the endogenous incretins GLP-1 and
GIP.
Incretins are a group of gastrointestinal hormones that increase the
amount of insulin released from the beta cells of the islets of Langerhans
after eating.
They begin to act before blood glucose levels become elevated.
Incretins also inhibit glucagon release from alpha cells of the islets of
Langerhans.
DPP-4 inhibitors block degradation of incretins and promote enhanced
insulin secretion.
1. Inhibits degradation of endogenous
incretins