شو ماكو تفاعل🙄

Fludarabine (prodrug)➡️ remove of phosphate in the plasma ➡️ 2-F-araA (هذا الشكل النشط الاولي)➡️ again phosphorylated (deoxycytidine kinase)➡️ incorporated into both DNA and RNA

Fludarabine orally ➡️ fluoroadenine (toxic)✖️✖️
Fludarabine IV ☑️☑️





❇️Capecitabine (prodrug)➡️5-FU ➡️ by thymidine phosphorylase ➡️ inhibit thymidylate sythase
Thymidylate synthase= انزيم مهم للخلية السرطانية وهذا الدوه راح يثبطه

*cancer (antimetabolites)

#cancer

' Cancer chemotherapy '

Antimetabolites

Cell-cycle specific, active in the S-phase.

Bleomycin

Cell-cycle specific, active in the G₂-phase.

Vinca rosea derivatives

Cell-cycle specific, active in the M-phase.

Taxane derivatives

Cell-cycle specific, active in the G₂ / M-phase.

Platinum Coordination Complexes

Cell-cycle specific, active in the G₁ and S-phase.

Camptothecins

Cell-cycle specific, active in the S-phase.

Podophyllotoxins

Cell-cycle specific, active in the Late S to G₂-phase.

Proteosome Inhibitors

Cell-cycle specific

Anthracyclines

Cell-cycle non-specific.

Alkylating Agents

Cell-cycle non-specific.

Tyrosine Kinase Inhibitors

Cell-cycle non-specific.

#cancer

يجي سؤال بيشنت عنده renal dysfunction. شنو البديل بهالحالة ؟
ج/ Linagliptin لان ماينطرح من الكلى
#dm
👇

منو يسوي nasopharyngitis ؟
ج/ DPP-4 inhibitors

ومنو يسوي pancreatitis ؟
ج/ DPP-4 inhibitors و analogs of GLP-1


منو يسوي HF ؟

Thiazolidinediones و Alogliptin and saxagliptin

منو عنده active metabolite ؟
ج/ Saxagliptin

Glipizide or glimepiride +++

هسه منو يعتبر insulin sensitizers ؟

pioglitazone and rosiglitazone ، Metformin

منو first line ؟
ج/ Metformin

منو second- or third line ؟
ج/ pioglitazone

مهمممممم ‼️

منو يسوي bladder cancer. ؟
ج/ Pioglitazone

منو يسوي MI و angina ؟
ج/ rosiglitazone.

ملخص Insulin Adjuncts
#PharmacologyII

Oral Hypoglycemic Agents — Side Effects
#PharmacologyII

📄  مراجعة الشغلات المهمة ب DM واللي اجت بالوزاري ..

🔸Pramlintide / avoid patients with diabetic gastroparesis+creosol hypertensive or hypoglycaemic unawareness

🔸Liraglutide is approved to reduce the risk Cardio vascular event and cardio vascular mortality

🔸Exenatide /should be avoided in patients with sever renal impairment

🔸Glipizide /  or glimepiride / are safer option in renal dysfunction and elderly patients

🔸glybiride/ renal impairment is a particualr problem


🔸Repaglinide / used caution in
patients with hepatic imperment

🔸Metformin / contraindicated in renal dysfunction due to the risk of lactic acidosis

🔸Pioglitazone /ADA recommend a second or third for type 2

🔸Rosiglitazone /  less use because CV adverse MI and angina

🔸Pioglitazone  /is negligible and No dosage adjustment is required in renal impairment

🔸Pioglitazone /increase risk of bladder cancer+avoid patients HF

🔸Acarboes / miglitol / adverse effects inflammatory bowel disease , colonic ulceration

🔸All drugs SgLT should avoided renal function

🔸Empagliflozin  / indicated to reduce the risk of cardiovascular death in patients

🔸Canagliflozine / should taken befor the first meal of the day

🔸All Dpp-4 inhibitor except linagliptin require dosage adjustment in renal dysfunction

🔸Alogliptin &saxagliptin/ increase risk of heart failure hospitalisation and used caution in patients with risk HF
س / يكلك ادوية الميكانزم مالتها ماتتحارش ب الانسولين بس تسبب weight gain
-thiazolidinedion

س/ ادوية الميكانزم  مالتها يتشابه ومايصير ناخذهم سوة ؟
✨Glinides+sulfonylurea

⭕️الميكانزمات كلش مهمه

🔺Metformine

✨Reduction of hepatic gluconeogenesis

🔺a-Glucosidase
✨Break down carbohydrates into glucose

🔺Thiazolidinediones
✨Lower insulin resistant by PPAry

🔺SGLT2
Decrease reabsorption of glucose ,increase urinary glucose excretion and lower blood glucose

🔺Sulfonylurea+GLinides
Stimulate insulin release from the B-cell of the pancreas, glinides have rapid onset and short duration

🔺GLP1 receptor

improve glucose-dependent insulin secretion, slow gastric emptying,reducing food intak by enhancing satiety,decrease postprandial glucagon secretion

🔺Dpp-4
inactivation of incretin  hormones sush/ GLP-1

⭕️Typ1 هسه نجي لل

✨polydipsia,polyphagia,polyuria,and
weight loss

✨/ must rely on exogenous insulin to control hyperglycaemia,avoid ketoacidosis

✨/ usually during children or puberty+ 5-10%

✨Charachterized/ absolute deficiency of insulin due to destruction of B-cell

وهذن هم نسيتهم

a-cell   / produce glucagon
B-cell/produce insulin
Delta-cell/produce somatostatin
⭕️وهذول اخير شي اكيد حيجي واحد منهم
🔺Short acting /regular insulin/subcutaneously 30 befor meal/peak level 50/120 minutes /most common IV rout is needed

🔺Rapid acting/lispro,Aspart,glulisine,inhaled,/peak 30to90 /administration 15 minutes preceding a meal or 15to 20 after meal/inhaled peak to 45-60/

🔺Intermediate/NPH/basal fast control Typ1.typ2/ delayed absorption  and longer duration /should be given only subcutaneously never IV/should not use rapid glucose lower/formed by additional zinc,protamine

🔺Long acting /glargine,detemer,degludec

✨Glargine :isoelectric point lower than of human insulin

✨Detemir :fatty acid chain enhance  essociaation to albumin

✨Degludec : remains  in solution,slow release over axtend,has longer half lif

⭕️insulin combination
70%NPH+regular insulin 30 % or 50 of each thes
#dm

Anti diabetic drugs
هاي طرق لحل كيسات السكري في حاله اجت
موجود ضمن ملف
Drugs for diabetes

🔤🔤🔤🔤🔤🔤🔤🔤

💡Insulins

1️⃣Short acting

⏺️Regular insulin

2️⃣Rapid acting

⏺️Lispro
⏺️Aspart
⏺️Glulisine
قاعدة: تخيلهم لزكة بساع نخليها
l,as,g

3️⃣Intermediate acting insulin

⏺️Neutral prostamine Hagedorn (NPH)
قاعدة: بي N يعني Not speed,Not solw

4️⃣Long acting insulin

⏺️Detemir
⏺️Degludec
⏺️Glargine
قاعدة: تخيلهم determine او delayed يعني يطولون

5️⃣Insulin Combination

⏺️70% NPH ➕ 30% Regular
⏺️50% NPH ➕ 50% Regular
قاعدة : لازم NPH موجود

💡Synthetic amylin analog

⏺️Pramilintide
قاعدة: يحتوي على amilin يشبه amylin

💡GLP1 receptor agonist

⏺️Albiglutide
⏺️Dulaglutide
⏺️Exenatide
⏺️Liraglutide
⏺️Lixisenatide
⏺️Semaglutide
قاعدة: كلهم ينتهون بـ glutide عدا
لكزز lixis واستان extan
تخيلها هيچ
GLP1 = Glu-Tide

💡Oral hypoglycemic drugs

1⃣Sulfonylureas

🔘Glipizide
🔘Glyburide
🔘Glimepiride
قاعدة: كلهم ينتهون بـ ide
تذكر بأيدي اخلي بيها السلفون مال نركلية

2⃣Glinides

🔘Repaglinide
🔘Nateglinide
قاعدة: كلهم ينتهون بـ glinide
نفس العائلة

3⃣Biguanides

🔘Meformin
قاعدة: هو هذا وحده ويكون big العائلة

4⃣Thiazolidinediones

🔘Pioglitazone
🔘Rosiglitazone
قاعدة : كلهم ينتهون بـ glitazone
ويحتوون على azo يعني من عائلة Thiazo

5⃣Alpha -glucosidase inhibitors

🔘Acarbose
🔘Miglitol
قاعدة : تخليهم "كاربوهيدرات" فيشتغلون على انزيم الكلوكوسديز

6⃣DPP4 inhibitors

🔘Alogliptin
🔘Linagliptin
🔘Saxagliptin
🔘Sitaglitptin
قاعدة: كلهم ينتهون بـ gliptin
راح نسوي فديو glip للـ دبب DPP

7⃣SGLT2 inhibitors

🔘Canagliflozin
🔘Dapagliflozin
🔘Empagliflozin
🔘Ertugliflozin
قاعدة: كلهم ينتهون بـ gliflozin
بيهم flo يعني يطلعون السكر مع البول

8⃣Dopamine agonist 

🔘Bromocriptin
قاعدة: الدوبامين للدماغ
هسة مال كريب وفوكاه مبروش

9⃣Bile acid sequestrant

🔘Colesvelam
قاعدة: من إسمه cole يعني تخيله كولسترول فيرتبط بالقنوات الصفراوية

#dm

مهم ‼️
يادرك يقلل من cardiovascular events ؟
ج/ Liraglutide ليرررره

مهم ويامن انطيهم ؟
ج/ وي long-acting

ياما glargine plus lixisenatide
او degludec plus liraglutide.