Dr. Waleed's Endo Final Revision PDF

Dr. Waleed’s Final Revision for Pharmacology Section • 📝 Notes are initially written By: Yazeed Elshidi • 📑 Completed, Finalized, and designed By: Abdulaziz Alaati Just a quick recap regarding to Diabetes Mellitus (DM): • It’s one the common diseases and it has several types but the most importa...

Dr. Waleed’s Final Revision for Pharmacology Section • 📝 Notes are initially written By: Yazeed Elshidi • 📑 Completed, Finalized, and designed By: Abdulaziz Alaati Just a quick recap regarding to Diabetes Mellitus (DM): • It’s one the common diseases and it has several types but the most important is these Two Types (Type l DM & Type ll DM) - Type l DM is due to insulin de ciency (Lack of insulin) and a ects mainly Children and obviously is absolutely treated by giving Insulin - Type ll DM is due to insulin resistance as well decreased in normal insulin level. It means that amount of insulin doesn’t match with body needs in case of obesity • Treatment of Type l DM: - Dosage forms are IMPORTANT ( We have two dosage forms that the most commonly used: 1- Subcutaneous (S.C) and 2- IV) - Inhaled form that is produced by P zer, used for 3 up to 4 years then was pulled from the market because of falling to achieve body’s requirements as well its contraindications in respiratory conditions i.e COPD) - Classes of Insulin: 1- Rapid-acting (Lispro and Aspart) 2- Short-acting (Regular Insulin) 3Intermediate-acting (NPH and Lente insulins) 4- Long-acting (Insulin Glargine) - Long acting can be used in type 1 & 2 also used for achieving a basal level of insulin to avoid Ketoacidosis - Rapid-acting (Lispro and Aspart) are faster of action rather than Regular Insulin, A Qs may come as; Q/ which one of the following has faster action? A- Regular Insulin B- Lispro and Aspart - Because of faster action of Lispro and Aspart, So They must be TAKEN at The Same Time of Taking The First Bite of Food - Insulin has several Side E ects (SE) : 1- Hypoglycemia. ( The MOST Common SE) 2- Wait gain. 3- Skin rash at injection site. 4Lipodystrophies * If you ask Which of the following is considered the MOST Common SE of Insulin? The answer will be Hypoglycemia • Treatment of Type l DM (Con’d) - Intermediate-acting (NPH): is its peak e ect starts after the short acting decreases so it is used to control postprandial glucose level (A period between meals i.e a period from lunch to dinner) - Insulin and diabetic therapies are called as Personalized Medicine “means patient is treated by himself ” so after patient is diagnosed and given his treatment, he is educated by Diabetic team; a nurse tells the patient about all thing regarding to dose, time, test Blood Glucose, and so on. - Especially, as we know the common type 1 DM patients are Children, so mother is educated by that team how she can manage her kid - The important point that should be kept in mind is measuring The Blood Glucose before mother gives the insulin dose - Unit of insulin is the number of units/ml -U-, i.g 50U, 100U - 1CC contains 100U “Units” ( but people use 10 units to 50 units depending on weight, habits, and so on) - Expiration date of Insulin is very very important, * If it is inside or outside of the fridge? * If it is opened or not? w v58 i jlippinco.ee and let 1611 Casestudyji I again i I 163 t b a • Treatment of Type ll DM: - Anti-diabetic agents are classi ed based on their MOA, and we have: 1&2- Insulin secretagogues; (1- Sulfonylureas {Long-acting from 12 to 24 hours} and 2- Meglitinides “Repaglinide & Nateglinide” {Short-acting}) they stimulate the pancreatic secretion of insulin - Side E ects “SEs” of this class “Insulin secretagogues” are Hypoglycemia and Weight gain - Meglitinides have another Important SE that is Liver Toxicity - Meglitinides have a lot of drug to drug interactions and they are very very important to know them (Especially, Interaction of Repaglinide with immunosuppressant medications such as Cyclosporine & Tacrolimus, For example Repaglinide inhibits CYP3A4, therefore we should reduce the dose of Cyclosporine when is used along with Repaglinide) 3- Biguanides “Metformin”: - MOA: 1- Reduces hepatic glucose production. 2- Increases peripheral glucose utilization “Insulin Sensitizer”. - A case scenario: If a diabetic patient came to your clinic at rst time and you advised him to start life style modi cations, but you noticed his Hb A1c is little bit high, so what’s the 1st drug of choice to manage him? A- Give Insulin B- Prescribe Metformin C- Prescribe SU Prescribe TZDs “Glitazone”. The answer is prescription Metformin - Side E ects “SEs”: 1- Diarrhea (is the Most Common SE), 2Decreases Vitamin B12 “causing Vit. B12 de ciency” (so must be checked once or twice annually “yearly”), 3- lactic acidosis - a Rare SE (so it is contraindicated in Renal failure “Creatinine less than 30”) - Metformin usage in case of Heart Failure “HF”: It depends on stages of HF In Stage 1 & Stage 2, patient can be given Metformin In Stage 3, patient should be assessed, if patient’s serum creatinine is good and more than 40 also kidneys’ are good, patient can be given Metformin but if patient su ers from kidneys’ problems or systemic “clinical” symptoms cannot be given, even in Stage 2 (cannot be given if su ers from kidneys’ problems or systemic “clinical” symptoms) Giving or not depends on 1- Kidneys’ functions & 2- Clinical Symptoms. Examples of Qs can come in regards to this: Q1/ A patient su ers from HF Stage 3 but he doesn’t face any problems in his kidneys or even su er from hypoxias. Can you give Metformin or not? Answer is you can give him • Treatment of Type ll DM: (Con’d) Q2/ A patient su ers from HF Stage 2 he also su ers from problems in his kidneys and shortness of breath , in addition to his Creatinine level is less that 30. Can you give Metformin or not? Answer is you CANNOT give him 4- Alpha Glucosidase Inhibitors: - As Acarbose & Miglitol - MOA: Inhibit intestinal alpha-glucosidase so they decrease intestinal absorption of the mono- and polysaccharides. - They are contraindicated in IBD, colonic ulceration, & intestinal obstruction - SE: Flatulence “Bloating” 5- Thiazolidinediones (TZDs) “Glitazones”: - As Rosiglitazone & Pioglitazone - MOA: increase insulin sensitivity by activating Peroxisome proliferator-activated receptor y “gamma” to enhance muscle and fat utilization of Glucose - SE: Water retention - Patient with Cardiovascular problems. Can he be given TZDs or not? He should be assessed by his cardiologist rst 6- Glucagon-like peptide-1 (GLP-1) agonists: - Used in Type ll DM - They increase pancreatic secretion of insulin, “Incretin e ects” - Precaution: They are contraindicated in thyroid problems “e.g medullary thyroid carcinoma” * Route of administration is Subcutaneously “S.C” 7- Inhibitors of Dipeptidil peptidase-4 (DPP-4): - As Sitagliptin & Vildagliptin - They prevent incretin degradation 8- Inhibitors of reabsorption of glucose (SGLT2 inhibitors): - As Canagli ozin - MOA: They block sodium / glucose co-transport protein 2 (SGLT2) in renal proximal tubule, which is responsible for absorption of 90% of the ltrated glucose. Therefore they increase glucosuria and decrease plasma glucose levels. - SE: Renal impairment and Urinary tract infections UTIs. - Rarely used now aiolio 26 a bit it www.jay TIJNG