Note s4

Forwarded from مقبلات (Ha)

Oral Hypoglycemic Agents — Side Effects
#PharmacologyII

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📄 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

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