Oral Anti-Diabetic Drugs

Oral Anti-Diabetic Drugs

• Sulfonylureas (Tolbutamide, Chlorpropamide, Glipizide, Glyburide, Glimepiride) stimulate insulin release, reduce liver glucose output, and increase insulin sensitivity
  • Hypoglycemia, hyperinsulinemia, and weight gain are adverse effects
• Meglitinides (Nateglinide, Repaglinide) stimulate insulin secretion after meals
  • Rare hypoglycemia is an adverse effect
• Biguanides (Metformin) inhibits liver glucose production and improves peripheral glucose uptake
  • GI disturbances and decreased B12 absorption are adverse effects
• Thiazolidinediones (Pioglitazone, Rosiglitazone) increase insulin sensitivity in muscle, fat, and liver
  • Anemia, weight gain, and heart failure are adverse effects
• α-Glucosidase Inhibitors (Acarbose, Miglitol) inhibit carbohydrate breakdown in intestines
  • This results in GI disturbances
• DPP-IV Inhibitors (Sitagliptin) inhibit incretin breakdown, increasing insulin secretion
  • This may result in upper respiratory tract infections and headache

Adverse Effects of Metformin

• Common adverse effects include GI disturbances like diarrhea and nausea
• Long-term use can decrease Vitamin B12 absorption
• It is contraindicated in patients with kidney/liver disease, cardiac/respiratory problems, pregnancy, and alcohol abuse

Therapeutic Use of Glucocorticoids

• Glucocorticoids are used for asthma, allergies, inflammation, autoimmune diseases, Addison’s disease, and lymphomas
• Examples include Prednisone, Dexamethasone, and Hydrocortisone

Adverse Effects of Contraceptive Pills

• Common effects are nausea, vomiting, headache, hypertension, and edema, depression, heavy breast, hypertension, MI, thrombophlebitis, dizziness
• Serious effects include thromboembolic events (DVT, MI, stroke) and increased risk of breast/endometrial cancer

Treatment of Diabetes Mellitus Type 1

• Insulin (short-, intermediate-, long-acting) is the main treatment
• Lifestyle modifications and continuous glucose monitoring are adjuncts

Pro- and Anti-Thyroid Drugs

• Pro-thyroid drugs like Levothyroxine and Liothyronine treat hypothyroidism
  • These can cause thyroid storm, arrhythmia, and angina
• Anti-thyroid drugs like Methimazole, Propylthiouracil, Potassium iodide, and Sodium I131 are used for hyperthyroidism
  • These can cause agranulocytosis, rashes, and metallic taste (Potassium iodide)

First-Line and Adjunctive Treatment of Asthma

• Short-acting ß2 agonists (Albuterol) are for acute asthma
• Inhaled corticosteroids and long-acting ß2 agonists (Salmeterol), and leukotriene receptor antagonists (Montelukast) are for prevention

Treatment Strategy for Different Stages of Asthma

• Mild asthma necessitates SABA as needed
• Moderate asthma necessitates ICS + LABA
• Severe asthma necessitates high-dose ICS + LABA + Oral steroids

Therapeutic Use of Theophylline

• Theophylline is an adjunct for asthma and COPD
• It bronchodilates via PDE inhibition
  • Tachycardia, nausea, and seizures are adverse effects

Treatment of Allergic Rhinitis

• First-line treatments are antihistamines like Loratadine and Cetirizine
• Intranasal steroids like Fluticasone, are used as adjunct

Non-Drowsy Antihistamines

• Loratadine and Fexofenadine are examples
• Selective H1 receptor blockade is the MOA

Antibiotics vs. Anti-Microbials

• Antibiotics are derived from natural sources (Penicillin)
• Anti-microbials include synthetic drugs (Sulfonamides, Fluoroquinolones)

Antimicrobial Spectrum

• Penicillin G has a narrow spectrum
• Amoxicillin has an extended spectrum
• Tetracyclines have a broad spectrum

MIC, MBC, Bactericidal, Bacteriostatic

• MIC is the lowest concentration that inhibits growth
• MBC is the lowest concentration that kills 99.9% of bacteria
• Bacteriostatic drugs inhibit growth
• Bactericidal drugs kill bacteria

Importance of Combined Anti-Bacterial Therapy

• It prevents resistance, treats mixed infections, and provides synergy
• RIPE therapy for TB is an example

Classification & MOA of Antibiotic Classes

• Cell wall inhibitors include Penicillins and Cephalosporins
• Protein synthesis inhibitors include Aminoglycosides and Macrolides
• DNA inhibitors include Fluoroquinolones
• Folate inhibitors include Sulfonamides

Examples of Antibiotic Classes

• Amoxicillin is a penicillin
• Azithromycin is a macrolide
• Ciprofloxacin is a fluoroquinolone
• Nitrofurantoin is a urinary antibiotic

Beta-Lactamase Inhibitors

• Clavulanic acid is an example
• They protect β-lactam antibiotics from degradation

Anti-Anaerobic & Anti-Protozoal Antibiotic

• Metronidazole is an example

First-Line Treatment of Tuberculosis

• They include Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE)

Anti-Candida Treatment

• Fluconazole and Clotrimazole are examples

Antifungal Drugs That Inhibit Ergosterol

• Azoles (Fluconazole, Ketoconazole) and Amphotericin B are examples

Anti-HIV Drug Classes

• NRTIs include Zidovudine
• NNRTIs include Delavirdine
• PIs include Indinavir
• HAART is a combination therapy

Examples of Anti-Influenza & Anti-Herpes Virus Agents

• Oseltamivir and Amantadine are anti-influenza agents
• Acyclovir and Valacyclovir are anti-herpes agents

Treatment of Malaria

• Chloroquine, Artemisinin, and Primaquine are drugs used

Cancer Chemotherapy Drug Classes & MOA

• Alkylating agents include Cyclophosphamide
• Antimetabolites include Methotrexate
• Mitotic inhibitors include Vincristine
• Topoisomerase inhibitors include Etoposide

Common Adverse Effects of Anti-Cancer Agents

• Common adverse effects include nausea, vomiting, diarrhea, stomatitis, anorexia, hair loss, somnolence, lack of strength, dizziness, peripheral neuropathy, erythema, rash, urticaria, and fever
• Bone marrow suppression is also a common adverse effect

MOA & Therapeutic Use of Cyclosporine & Mycophenolate

• Cyclosporine inhibits T-cell activation and is used in transplant rejection by blocking cytokine synthesis
• Mycophenolate inhibits B & T cell proliferation and is used in kidney transplants by blocking cytokine synthesis

ADR of Immunosuppressive Agents

• Infections, nephrotoxicity, hepatotoxicity, and bone marrow suppression are adverse effects

MOA & Therapeutic Uses of Fluoroquinolones, Artemisinin, Clotrimazole

• Fluoroquinolones inhibit DNA gyrase and treat UTIs
• Artemisinin generates free radicals and treats malaria
• Clotrimazole inhibits ergosterol synthesis and treats fungal infections

Therapeutic Uses of Methotrexate, Fluorouracil, Hydroxyurea, Vincristine, Amphotericin B

• Methotrexate is used for ALL and rheumatoid arthritis
• Fluorouracil is used for colon cancer
• Hydroxyurea is used for CML
• Vincristine is used for leukemias
• Amphotericin B is used for systemic fungal infections