Note s4
يجي سؤال بيشنت عنده renal dysfunction. شنو البديل بهالحالة ؟ ج/ Linagliptin لان ماينطرح من الكلى #dm 👇
منو عنده active metabolite ؟
ج/ Saxagliptin
ج/ Saxagliptin
Note s4
يجي سؤال بيشنت عنده renal dysfunction. شنو البديل بهالحالة ؟ ج/ Linagliptin لان ماينطرح من الكلى #dm 👇
Glipizide or glimepiride +++
Forwarded from مقبلات (Ha)
Pharmacology Ⅲ — DM - Insulin Adjuncts.pdf
181.7 KB
ملخص Insulin Adjuncts
#PharmacologyII
#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
🔸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
Forwarded from Your Pharmacy Guide (كرار صباح)
🔤🔤🔤🔤🔤🔤🔤🔤
💡Insulins
⏺️Regular insulin
⏺️Lispro
⏺️Aspart
⏺️Glulisine
قاعدة: تخيلهم لزكة بساع نخليها
l,as,g
⏺️Neutral prostamine Hagedorn (NPH)
قاعدة: بي N يعني Not speed,Not solw
⏺️Detemir
⏺️Degludec
⏺️Glargine
قاعدة: تخيلهم determine او delayed يعني يطولون
⏺️70% NPH ➕ 30% Regular
⏺️50% NPH ➕ 50% Regular
قاعدة : لازم NPH موجود
⏺️Pramilintide
قاعدة: يحتوي على amilin يشبه amylin
⏺️Albiglutide
⏺️Dulaglutide
⏺️Exenatide
⏺️Liraglutide
⏺️Lixisenatide
⏺️Semaglutide
قاعدة: كلهم ينتهون بـ glutide عدا
لكزز lixis واستان extan
تخيلها هيچ
GLP1 = Glu-Tide
💡Oral hypoglycemic drugs
🔘Glipizide
🔘Glyburide
🔘Glimepiride
قاعدة: كلهم ينتهون بـ ide
تذكر بأيدي اخلي بيها السلفون مال نركلية
🔘Repaglinide
🔘Nateglinide
قاعدة: كلهم ينتهون بـ glinide
نفس العائلة
🔘Meformin
قاعدة: هو هذا وحده ويكون big العائلة
🔘Pioglitazone
🔘Rosiglitazone
قاعدة : كلهم ينتهون بـ glitazone
ويحتوون على azo يعني من عائلة Thiazo
🔘Acarbose
🔘Miglitol
قاعدة : تخليهم "كاربوهيدرات" فيشتغلون على انزيم الكلوكوسديز
🔘Alogliptin
🔘Linagliptin
🔘Saxagliptin
🔘Sitaglitptin
قاعدة: كلهم ينتهون بـ gliptin
راح نسوي فديو glip للـ دبب DPP
🔘Canagliflozin
🔘Dapagliflozin
🔘Empagliflozin
🔘Ertugliflozin
قاعدة: كلهم ينتهون بـ gliflozin
بيهم flo يعني يطلعون السكر مع البول
🔘Bromocriptin
قاعدة: الدوبامين للدماغ
هسة مال كريب وفوكاه مبروش
🔘Colesvelam
قاعدة: من إسمه cole يعني تخيله كولسترول فيرتبط بالقنوات الصفراوية
#dm
💡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
🔹 شباب هاي كل الارقام اللي تخص جابتر مكسنك
▪️Propeller / three most common
▪️Turbines /90 degrees angle to
their shaft ,1000 time more viscous than fluid in propeller
▪️Paddles /operated at low speed of 50 rpm or less
▪️Vortexing / very high liquid viscoities >20,000
▪️Aviscosity of monophase system Approximately / 10 poise
▪️High viscosity for polyphase system / 2 surface in close proximity
▪️Roller mills / three -roller type are preferred
▪️Particle size / miling of components below approximately 30 um
▪️Twin - shell blender / approximately 45 -degree angle
#mixing
▪️Propeller / three most common
▪️Turbines /90 degrees angle to
their shaft ,1000 time more viscous than fluid in propeller
▪️Paddles /operated at low speed of 50 rpm or less
▪️Vortexing / very high liquid viscoities >20,000
▪️Aviscosity of monophase system Approximately / 10 poise
▪️High viscosity for polyphase system / 2 surface in close proximity
▪️Roller mills / three -roller type are preferred
▪️Particle size / miling of components below approximately 30 um
▪️Twin - shell blender / approximately 45 -degree angle
#mixing
🔹الأرقام اللي تخص جابتر الميلنك والدراينك
🔸Coarse / size large 20-mesh
🔸intermediate / 20-200mesh
(74-840) micron
🔸Fine for particles /smaller than 200 - mesh
🔸Hammer mill used for
granulation (16-mesh) ,miling crystalline (120-mesh)
🔸Cutter mill
Horizontal rotor with 2 to 12 knives
Turning from 200 to 900
🔸Roller mile / two to five smooth roller
Two cylindrical rolls mounted horizontally
🔸Hammer Miill / using high speed rotor(10.000 rpm )
Size reduction of 20-40
🔸Fluid energy mill
At pressure of 100 to 150 pound per square inch (psi)
🔸Moisture content/more than 5%water hinder comminution and produce a sticky mass
🔸Greater than 50% / slurry or
fluid suspension
🔹جابتر الدراينك
🔺Moving bed system / rotating slowly at ( 0.1 to 1.0 ) rpm
🔺Flash dryer / velocity 3000-6000 at temperature / 300-1300 air stream
🔺Pre - freezing below or at -20 C
#drying
#milling
🔸Coarse / size large 20-mesh
🔸intermediate / 20-200mesh
(74-840) micron
🔸Fine for particles /smaller than 200 - mesh
🔸Hammer mill used for
granulation (16-mesh) ,miling crystalline (120-mesh)
🔸Cutter mill
Horizontal rotor with 2 to 12 knives
Turning from 200 to 900
🔸Roller mile / two to five smooth roller
Two cylindrical rolls mounted horizontally
🔸Hammer Miill / using high speed rotor(10.000 rpm )
Size reduction of 20-40
🔸Fluid energy mill
At pressure of 100 to 150 pound per square inch (psi)
🔸Moisture content/more than 5%water hinder comminution and produce a sticky mass
🔸Greater than 50% / slurry or
fluid suspension
🔹جابتر الدراينك
🔺Moving bed system / rotating slowly at ( 0.1 to 1.0 ) rpm
🔺Flash dryer / velocity 3000-6000 at temperature / 300-1300 air stream
🔺Pre - freezing below or at -20 C
#drying
#milling