Insulin, Thyroid, Steroids, ACEi, and Diuretics PDF

INSULIN by: Gorji Khwakaram  insulin is a peptide hormone produced by beta cells of the pancreatic islets; it is considered to be the main anabolic hormone of the body.it regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of glucos...

INSULIN by: Gorji Khwakaram  insulin is a peptide hormone produced by beta cells of the pancreatic islets; it is considered to be the main anabolic hormone of the body.it regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of glucose from the blood into liver, fat and skeletal muscle cells.in these tissues the absorbed glucose is converted into either glycogen via glycogenesis or fats (triglycerides) via lipogenesis, or, in the case of the liver, into both.glucose production and secretion by the liver is strongly inhibited by high concentration of insulin.  INDICATIONS Mainly type 1 diabetes mellitus to replace absent insulin secretion Also in type 2 diabetes mellitus to supplement < insufficient insulin  ROUTES OF ADMINSTRATION Injections : ( subcutaneously, intravenously, intramuscularly, intraperitoneal ) Inhaler Personal insulin pump PARTIAL REMISSION OR HONEY MOON PHASE IN TYPE1DM Insulin requirements can decrease transiently following initiation of insulin treatment, This has been defined as insulin requirements of less than 0.5 units per kg of body weight per day with an HbA1c < 7%. Ketoacidosis at presentation and at a young age reduce the likelihood of a remission phase, It is important to advise the family of the transient nature of the honeymoon phase to avoid the false hope that the diabetes is spontaneously disappearing Treatment: by reduce the dose of Insulin Accordingly  SOMOGYI PHENOMENON In children with High dose of Insulin at Night (Long acting) develop late night(3-4 a.m) Hypoglycemia - Counter regulatory hormon will increase Early morning Hyperglycemia. Treatment: Reduce the dose of Long acting Insulin at Night  DAWN PHENOMENON In children with Normal dose of Insulin at Night & Normal midnight glucose (Normoglycemia), Counter regulatory hormone may normally increase - Early morning Hyperglycemia. Treatment: Increase the dose of Long acting Insulin at Night  SIDE EFFECTS ØHypoglycemia ØHypokalemia ØWeight gain ØHypersensitivity reaction ( anaphylaxis ) ØInjection site complications : (lipodystrophy redness , itching and rarely infection ) THYROXIN By: Gorji Khwakaram  Introduction Ø1.Thyroid hormone increases the metabolic rate of cells of all tissues Ø 2.In the fetus and newborn, thyroid hormone is important for the growth and development of all tissues including bones and the brain. Ø3.In adults, thyroid hormone helps to maintain brain function, food metabolism, and body temperature, among other effects  Levothyroxine is a synthetically prepared levo- isomer of the thyroid hormone thyroxine (T4, a tetra-iodinated tyrosine derivative) that acts as a replacement in deficiency syndromes such as hypothyroidism  Mechanism of action Levothyroxine acts like the endogenous thyroid hormone thyroxine. In the liver and kidney, T4 is converted to T3 ,the active metabolites.. Thus by acting as a replacement for natural thyroxine Synthetic T4; 1.Increases basal metabolic rate 2.Increases glycogenolysis 3.Increases gluconeogenesis 4.Stimulates protein synthesis  Route of administration ØOral (tablets, capsule, powder ) ØIntravenously (vial)  Side effects ØCVS: palpitation…. ØCNS: nervousness ,headache , insomnia Ø Skin: Diaphoresis ØEndocrine: irregular hyperglycemia , hypocholesterolemia ØGIT: Nausea ,vomiting , diarrhea Ø Metabolic: weight loss , heat intolerance  STEROIDS HYDROCORTISONE &PREDNISONE P R E S E N T E D B Y: Erivan Essa CONTENTS Introduction Mechanism of action Route of administration Indications Side effects INTRODUCTION Corticosteroids are steroid hormone that produced in adrenal cortex of vertebrate as long as synthetic analog of these hormones. They involved in :Stress response ,regulation of inflammation ,protein and carb metabolism. Steroid are potent anti-inflammatory ,immunosuppressive,and anti-neoplastic.  ROUTES OF ADMINISTRATION Parenteral(IV,IM, intra-articular) Oral Inhalation Topical Rectal INDICATIONS Arthritis and SLE Inflammatory bowel disease: UC & C D Blood disorders:ITP Asthma Adrenocortical insufficiency Nephrotic syndrome Acute leukemia of childhood Post transplant immunosuppression SIDE EFFECTS Osteoporosis Hypertension Psychosis and irritability Hyperglycemia Impaired wound healing Depressed immunity &increased susceptibility to infection Drying and thinning of skin  D E X A M ET H A S O N E & M ET H Y L P R E D N I S O LO N E CONTENTS Mechanism of action Indications Administration route Side effects DEXAMETHASONE Mechanism of Action Potent glucocorticoid minimal to no mineralocorticoid activity Potent anti- inflammatory effect By inhibition of phospholipase A2 (inhibits prostaglandin and proinflammatory cytokines) ,Increasing capillary permeability and by suppressing migration (PMNs), increases surfactant synthesis INDICATIONS Respiratory (airway edema, croup,RDS) Adrenal cortical hyperfunction test ITP CNS (Meningitis,..) cerebral edema with space occupying leison,spinal cord compression) Inflammation ADMINISTRATION ROUTE Oral (tablet, syrup) Injections(IV&IM) SIDE EFFECTS Hiccup Gastric upset Easy Bruiseing sleeping problem Weight gain METHYLPRIDNESOLONE Mechanism ofAction Is potent glucocorticoid Minimal to no mineralocorticoid activity Same of other anti-inflammatory agents act by decreasing inflammatory cytokine cascade ,inhibit activation of T cell Decrease extravasation of of immune cell into CNS INDICATIONS Acute asthma Lupus nephritis Acute exacerbation of MS Autonimmune inflammatory disorders ( including juvenile idiopathic arthritis , IBD ,MS ,connective tissue disorders and systemic lupus erythematosus ) ADMINISTRATION ROUTES oral tablet intravenously Intramuscularly SIDE EFFECTS Nausea &vomiting Heartburn Headache Sweating Acne Insomnia Thank You Captopril, Enalapril & Spironolactone Halder Jamal September 22nd, 2022  Brand names Captopril: Captoten Enalapril: Vasotec Spironolactone: Aldactone Renin Angiotensin Aldosterone System “RAAS” ACEi K secretion Spironolactone  Indications for ACEi Hypertension Heart failure Prevention of CKD progression I proteinmen  Indications for Spironolactone antagonist Aldosterone kt sponing divultics Hypertension Heart failure Caddon Nephrotic syndrome Ascites in cirrhosis Hypokalemia (esp. 20 to diuretics use in HF) Hyperaldosteronism andry Anti-androgen (e.g PCOS, Acne, hirsutism)  Administration Oral tablets (all 3) Oral suspension (spironolactone) I.V (Enalapril)  Side effects of ACEi Hypotension Hyperkalemia Dry cough Angioedema Skin rash Altered taste  Side effects of Spironolactone GIT upset Hyperkalemia Menstrual disturbance Gynecomastia Androgen alagint Impotence Thank You FUROSEMIDE (LASIX) Prepared by: Green Tely Rasheed OBJECTIVES 1) Mechanism of action 2) Indications 3) Route of administration 4) Side effects MECHANISM OF ACTION Furosemide promotes diuresis by blocking tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle. This diuretic effect is achieved through the competitive inhibition of sodium-potassium-chloride cotransporters (NKCC2) expressed along these tubules in the nephron, This inhibition results in increased excretion of water along with sodium, chloride, magnesium, calcium, hydrogen, and potassium ions. INDICATIONS 1. H YPERTENSION 2. TREATM ENT FOR EDEM A - A C U TE P U L MO N A R Y ED EMA - C O N GES T I V E H EA R T FA I L U R E - H EPATI C C I R R H O S I S C O MP L I C ATED BY A S C I TES -N EP H R O T IC S Y N D R O ME 3. HYPERCALCAEMIA: ENHANCE CA ++ EXCRETION 4. HYPERKALEMIA: ENHANCE K + EXCRETION 5. ACUTE RENAL FAILURE ROUTES OF ADMINISTRATION 1. ORAL TABS 2. IM 3. IV SIDE EFFECTS 1. INCREASED URINATION, THIRST , DEHYDRATION 2. ELECTROLYTE DISTURBANCE 3. DIARRHOEA , NAUSEA , VOMITING , LOSS OF APPETITE 4. RAPID WEIGHT LOSS 5. FEVER 6. ITCHING OR RASH, ALLERGIC REACTION 7. OTOTOXICIT Y SILDENAFIL (REVATIO, VIAGRA) MECHANISM OF ACTION PHOSPHODIESTERASE 5 INHIBITOR INDICATIONS 1. PULMONARY ARTERIAL HYPERTENSION 2. ERECTILE DYSFUNCTION ROUTES OF ADMINISTRATION ORALLY & INJECTABLE - S TA R T S IT’S ACTION WITHIN 20 M I N U T E S O F A D M I N I S T R AT I O N -IT’S EFFECT LASTS FOR 2 HOURS  SIDE EFFECTS 1. HEADACHE 2. FLUSHING 3. IMPAIRED VISION 4. MI 5. VENTRICULAR ARRHYTHMIA Ø FDA IS RECOMMENDING THAT SELDINAFIL SHOULD NOT BE PRESCRIBED TO CHILDREN (AGES 1 TROUGH 17) FOR PULMONARY ARTERIAL HYPERTENSION THANK YOU Paracetamol, Ibuprofen, Diclofenac Prepared by: Qedirya Ahmed Mohemmed Tylenol, Mapap, Panadol  Paracetamol= acetaminophen Indication 1- antipyretic 2- painkiller (mild to moderate pain):- muscle ache, headache, sore throat, backache,toothache, dysmenorrhea  Routes of administration Orally (Syrup, tablet, chewable tab) Rectally (Suppositories) IM IV infusion  Side effect Very safe Allergy (very rare) Overdose — deliberate or accidental Hepatonecrosis ( In overdoses cases) and less frequently renal damage Antidote →N-acetylcysteine (NAC)  Ibuprofen Ibuprofen is a NSAID and non selective COX inhibitor. Indication 1- Antipyretic 2- Anti- inflammatory 3- Painkiller (mild to moderate) Mechanism of action  Routes of administration Orally (tab, syrub, capsule, chewable tab) ) Rectal (suppository) Topical Intravenous  Common side effect Constipation, diarrhea Potential kidney damage Bloating , stomach pain, ulcer Dizziness Nervousness Ringing in the ears  Diclofenac Diclofenac sodium sold under the brand name Voltaren is a NSAID Analgesic Antipyretic Anti- inflammatory  Mechanism of action As with all NSAID, diclofenac exerts it’s action via inhibition of COX 1 and COX 2 subsequently inhibition of prostaglandin.  Common side effect Stomach ache, Gastric ulceration Elevation of serum aminotransferase Renal impairment Retention of salt and water —-> hypertention Thank you