Drugs for Diabetes Mellitus + Endocrine + Gonadal Hormone + Thyroid Flashcards
Parentral hypoglycemic agent/Insulin/Insulin analogues /Insulin preparation
- Rapid acting/Ultra short acting
- Short actng
- Intermediate acting
- Long acting/Insulin analogues
page-474
AntiDiabetic drugs name ?
- Parental hypoglycemic agnets -INSULIN
- Oral H A - CHART
PAGE-474
Insulin analogous name ?
Rapid acting/Ultra short acting
1. I LISPRO
2. I ASPART
3. Human I recombinant inhaled
Short acting insulin
1. Regular-Natural-Soluble Insulin
Intermediate acting insulin
1.Isophane insulin
2.I Zn suspension
Long acting insulin
1.Protamine Zn I suspension
2.I glargine
3.I detemir
Bolus Insulin ?
short/rapid acting insulin that is given before meal to control post meal rise of blood sugar
476
Basal insulin ?
long acting insulin that is released slowly over a period of between 8-24 hours intemded to supply the basal level of insulin during the day and particularly at night time
page-476
Indications of insulin ?
- type-1 dm
- uncontrolled dm-ii
- dm in = 🤰 =RTA = severe infection = post operative patient
- d ketoacidosis
- d nephropathy
- d neuropathy
- d retinopathy
- hyperkalemia
477
A/E of insulin ?
- insulin hypersensitivity
- insulin resresistance
- insulin edema
- hypokalemia
- hypoglycemia
- obesity
- alopecia
- inc cancer risk
page 477
Hypoglycemia-Clinical features ?
- tachycardia
- palpitations
- severe sweating
- nausea
- hunger
- convulsion
- coma
- dealth
478
Tx of Hypoglycemia ?
- Mild H in a patient who can swallow
simple sugar/glucose in liquid form
Glucose gel,honey,sweet,dextrose tablet
2.Unconscious patient
Inj Glucagon(1mg) - (S/C - IM)
Inj 3mg- intranal restore
50% glucose solution IV infusion
page-478
Oral hypoglycemic agents ?
Insulin secretagogues
1.SulfonylUreas
1st Generation
-Tolbutamide
-TolAzamide
2nd Generation
-Glipizide
-Gliclazide
-glimepiride
2.Meglitinides=Repaglinide
Insulin sensitizers
Biguanide = Metformin
ThiazolidineDiones= PIO & ROSI glitazone
Mechanism of SulfonylUreas?
=Block ATP Sensitive K channel
=dec outward K efflux
=depolarization of B cell
=opening of voltage gated Ca channel
=inc intracellular Ca
=inc secretion of Insulin
page-483
Indication of SulfonylUreas?
- DM-II
- Combination of DM-I & DM-II
A/E of SulfonylUreas?
- Hypoglycemia
- Weight gain
- nausea
- vomiting
- Teratogenecity
- Aplastic anemia
- Hemolytic anemia
page-484
Contraindiaction ??
- 🤰
- Lactation
- Renal insufficiency
- Hepatic insufficiency
- Type-1 DM
Metformin Mechanism ??
=inc Glucose——-Lactose
=inc glycolysis
=inc glucose removal
=dec plasma glucagon
=dec hepatic & renal gluconeogenesis
=dec glucose absorption
Metfromin indication ?
- DM-2
- Insulin resistance syndrome
- Type-2 DM in obese persons
A/E of Metformin ?
- Anorexia
- nausea
- vomiting;diarrhea
- lactic acidosis
- acute kidney failure
- dec V-B12 absorption
- megaloblastic anemia
486
ThiazoLidineDione mechanism ?
- ThiazoLidineDione binds with PPAR-GAMA in muscle fat liver
- express the gene involve in lipid and glucose metabolism ,insulin signal transduction
- promotes glucose uptakle and utilization
487
Dipeptidyl peptidase IV Inhibitors name ?
GLIPTIN
sita-saxa-lina-alo-vilda
489
SitaGliptin Mechanism ?
=inhibit DPP-IV
=dec GLP-1 GIP
=degrade GLP-1 LIKE MOLECULES
=degrade incretin
=inc GLP-1 GIP
=dec postprandial glucose excursions
=inc glucose mediated insulin secretion
=dec glucagon level
489
SGLT-2 Inhibitors Name ?
GLIFLOZIN
empa-cana-dapa-ertu
491
SGLT-2 INHIBITORS mechanism ?
=G freely filtered by renal glomeruli
=reabsorbed in PCT
=Action of SGLT-2
=Causes-Glycosuria & Lower glucose level in DM-2 patient
page-491
which Genration of sulfonylurease is better ?
2nd
why 2nd one better ?
Higher potency: They are effective at much lower doses.
Improved safety profile: Lower risk of drug interactions and side effects. Longer duration of action: Allow for once- or twice-daily dosing, improving patient compliance. Reduced hypoglycemia risk: Compared to first-generation agents, though still a concern.
significant of MW of insulin ?
cannot pass blood placental barrier
molecular mechanism of insulin ?
471
I binds with the alpha-subunit of receptor
autophosphorylation of Beta-subunit
tyrosine kinase activity of beta subunit
phosphorylation of some cytoplasmic eenzymes
activation of some other enzymes
= inc glycogenesis
= effect on protein synthesis , lipolysis , lipogenesis
Gestational DM e ki diba ?
Insulin
molecular weight of Insulin ?
58K dalton
471
indication of HRT ?
reduce everyday symptoms of estrogen loss
to prevent long term complications of E deficiency
why insulin in GDM ?
etar HIgh MW
tai BPB cross kore na
no teratogenicity
tai GDM e Insulin
E & Porgesteron dose in HRT ?
E = 1-28 day of mens cycle
P = 14 - 28 day of mens cycle
inhalation glucocorticoides ?
493
Gonadal hormone name ?
Estradiol
estrone
estriol
progesterone
hydroxyP
medroxyP
dimethisterone
desogestrel
HRT ?
503
Post-menopausal hormone replacement therapy
risk of HRT ?
breast cancer
endometrial cancer
HRT kader diba ??
Women without a uterus - continuous Estrogen
women with uterus
- E+ progesteron to prevent endometrial proliferatio n
which OHA can be given in insulin resistance ?
sulfonylurease along with insulin
prof fatema mam
480
insulin resistance?
decline in number
/
affinity of receptors
/
defect in post-receptor mechanism
when A diabetic pt is called I resistance >
if need»_space; 200 units/day
immunogenic I R tx ?
by changing brand
anti-histamine
glucocorticoid
role of propranolol in insulin therapy ?
mask hypoglycemia
impair recovery from low blood sugar
indication of glucocorticoids ?
‘496
adrenocortical insufficiency
addison D
addisonian crisis
cushing syndrome
congenital adrenal hyperplasia
aldosterinism
A/E of Glucocorticoids ?
499
indications of POP/mini pill ?
contraception in lactating mother
HTN
Hepatic D
Psychosis
mental retardation
thromboembolism
emergency pill combo ?
ethinyl estradiol
mini pill other name ?
pop
emergency pill dose ?
2 tabs as early as possible within 72 hrs
then 2 tabs 12hr after the first dose
emergency pill content ?
ethinyl estradiol
2.5mg twiche daily for 5 days
immunosuppressive effect valo na > kharap ?
fatema mam ?
valo
clinical features of hypoglycemia ?
tachycardia
palpitation
severe sweating
tremulousness
nausea
hunger
sudden unconsciousness
Tx of hypoglycemic Pt ?
478
common A/E of insulin ?
hypoglycemia
How G cause PUD ?
Glucocorticoids primarily increase the risk of PUD by compromising mucosal defense mechanisms (via prostaglandin inhibition) and impairing mucosal repair, rather than directly increasing acid production. This makes them particularly risky when used in combination with NSAIDs or in patients with pre-existing risk factors for PUD.
principles of withdrawal of corticosteroids?
500
GIT A/E of glucocorticoids ?
PUD
pancreatitis
immunosuppressive action of corticostreoids ?
inhibit function of macrophage & APC - dec phagocytosis
inhibit activation of complement
imapired delayed hypersensitivity reaction
dec CMI
dec IL-1 IL-2
permissive effect ??//
small amount of G must be present for a number of metabolic reactions
although G donot produce the reactions by themselves
IN asthma
cathecolamine + corticosteroids
which effect it is ?
permissive effect
abrupt withdrawal effect of corticosteroids?
- feedback
adrenal / pituitary suppression
Anorexia - N V
Fever pain lethary
501
why Insulin is not given orally ?
Insulin is not given orally because it is a protein that is destroyed by digestive enzymes in the gastrointestinal tract before it can be absorbed into the bloodstream.
long term A/E of OCP ?
MI
venous thromboembolism
cerebrovascular D
cholecystitis
depression
cholagitias
insulin [preparation ?
474
short acting I ?
regular ‘
natural
solub le
rapid acting I >
lispro
aspart
which long acting Insulin use frequently ?
Long-acting insulins frequently used include insulin glargine, insulin detemir, and insulin degludec.
intermediate acting I ?
I Zn suspension
474
hormonal contraceptives name ?
combined pill
oral pill
OCP
POP
post coital
once a month
male pill
Depot
long term adverse effect of estrogen ?
Long-term adverse effects of estrogen therapy include:
- Increased risk of thromboembolism (e.g., deep vein thrombosis, pulmonary embolism).
- Increased risk of stroke.
- Elevated risk of breast cancer with prolonged use.
- Endometrial hyperplasia and cancer (if unopposed by progesterone in women with a uterus).
- Gallbladder disease.
(Source: Katzung & Trevor’s Pharmacology)
which glucocorticoides has less mineralocorticoid activity ?
dexamethasone
estrogen deficiency te aged wwomen der ki ki prblem hoy ??
- Osteoporosis
- Vasomotor symptoms (hot flashes)
- Vaginal atrophy
- Increased cardiovascular risk
- Cognitive decline
insulin indication ?
477
what is mineralocorticoid activity ?
Mineralocorticoid activity refers to the regulation of electrolyte and water balance, primarily by promoting sodium retention and potassium excretion in the kidneys, mediated by hormones like aldosterone.
insulin kokhon dei ?
khawar 30 min age
which beta blocker in thyrotoxicosis <
520
propranolol
atenolol
metoprolol
anti-thyroid drugs name ?
520
carbimazole
methimazole
propylthiouracil
lithium salt
iodide
amiodarone
OPC er severe A/E >?
Depression
sukanto sir
Hydrocotisone & dexamethasone er modde kontar anti-inflmmatory effect valo ?
Dexamethasone has better anti-inflammatory function compared to hydrocortisone due to its higher glucocorticoid potency and longer duration of action.
precautions of streoid therpay <
500
which streoid in Head injury >?
dexamethasone
heart effect of steroid ?
HTN
eye effect of steroid ?
cataract
glaucoma
Which enzyme is inhibited in anti-inflammatory action <
TAX2
Contraceptive fucntion of OCP ?
Contraception
non-contraceptive function of OCP ?
endometriosis
irregular mens
holy hajj to prevent mens
DUB
Functional ovarian cyst
what advice is given to prevent lipodystrophy ?
To prevent lipodystrophy, the following advice is given:
- Rotate injection sites regularly to avoid repeated trauma to the same area.
- Use proper injection techniques to ensure even distribution of medication.
- Avoid reusing needles to reduce tissue irritation.
- Monitor injection sites for early signs of lipodystrophy.
(Source: Katzung & Trevor’s Pharmacology)
non-diabetic use of Insulin ?
Non-diabetic uses of insulin include:
- Hyperkalemia management (to shift potassium into cells).
- Total parenteral nutrition (TPN) in critically ill patients.
- High-dose insulin therapy for beta-blocker or calcium channel blocker overdose.
- Anabolic purposes (misuse in bodybuilding for muscle growth).
(Source: Katzung & Trevor’s Pharmacology)
immunosppressive effect of steroid example ?
organ transplantation
which transporter in insulin mechanism ?
glucose
GLUT4
471
Amino acid no in insulin ?
51
A chain 21
B chain 30
Route of administration of insulin >
476
C peptide function ?
its level provides an index of B cell function in Pt receiving exogenous insulin
471
non-diabetic use of metformin ?
PCOS
Weight management
Graft rejection e steroid er kon effect >
immunosuppressive
which drug used with misoprostol >
mifepristone
why Misoprostol + Mifeprostone ?
medical termination of pregnancy
indication of progesterone ?
HRT
DUB
Contraception
endometriosis
premature labour
507
A/E OF progesterone /
headache
mood change
dec HDL
inc LDL
dec bone density
weight gain
contraindications of steroids ?
500
blood glucose kotor niche namle Hypoglycemia ?
< 70 mg/dl
when ergotamine contraindicated ?
during labour and before 3rd stage of labor
when oxytocin is used ?
active management of 3rd stage labor
long acting steroids >
betamethasone
dexamethasone
why PG are commonly used in therapeutic aborton >
much more effective than oxytocin
termination of pg - midterm abortion
short acting steroid <
cortisone
hydrocortisone
prednisone
prednisolone
methylP
intermediate acting steroid ?
triamcinolone
paramethasone
13-2-2025
12.30AM
