Pharma4😅

Question 1

drugs Depolarize the B cells and cause insulin secretion

Answer 1

Sulfonylurea
Glibenclamide long half life

n Can lead to prolonged hypoglycaemia, especially in elderly

n Gliclazide short half-life and, therefore, preferred agent

Question 2

Repa-glinide

Answer 2

Non-sulphonylurea insulin secretagogue n Three receptors.

n Similar action to sulphonylureas. Identical efficacy n Requires glucose to have effect

n Short plasma half-life

n 0.5mg with meals, max 16 mg/day

n Weekly increase in dose if required

n Weight neutral n Less severe hypoglycaemia.

Question 3

A-carb-ose

Answer 3

a-glucosidase inhibitor

n Delays absorption of carbohydrates n Allows beta-cell time to augment response

Decreases HbA1c by 1%, fpg by 1.5mmol/l No change in weight Modest decrease in triglyceride Dosage schedule

n With first bite. Start low, increase every 2 weeks.

Contraindicated in renal failure, IBD & cirrhosis Rarely used owing to poor efficacy and significant GI side effects

Question 4

Thia-zolidene-diones

Answer 4

PPARg-agonists n 👾👾Improve insulin sensitivity in Liver, skeletal muscle and adipocytes

👾👾Improve beta-cell function n Durable effect on glycaemia n Associated with weight gain

n Part of action of these drugs

😱😱Contraindicated in heart failure n Recent controversy about CV effects and increased risk of bone fractures

Question 5

Exena-tide

Answer 5

An injectable GLP1 analogous

Question 6

glip-tins

Answer 6

oral DPP4 inhibitors

Question 7

Orli-stat

Answer 7

Gastric and pancreatic lipase inhibitor

n Theoretical deficiency of fat soluble vitamins

Question 8

Sibu-tramine

Answer 8

Norepinephrine and serotonin reuptake inhibitor

n Contraindicated in depression n Blood pressure must be closely monitored

Question 9

Eze-timibe

Answer 9

can reduce LDL levels by

around 15-20% and is normally given as a monotherapy in statin-intolerant patients; if used synergistically with statins, it can cause a 20% reduction in LDL levels (which is actually better than simply doubling the dose of a statin as it reduces the ADRs of the statin).

Question 10

Fibrates

Answer 10

Activating PPARs induces the transcription of a number of genes that facilitate lipid metabolism. which acts to significantly reduce triglyceride production, and also lowers LDL and raises HDL. Whilst they can be used in conjunction with statins, they are mainly used directly for hypertriglyceraemias.

Question 11

Canagliflozin and empagliflozin

Answer 11

an inhibitor of the sodium glucose co-transporter-2 (SGLT-2), which is found almost exclusively in the proximal tubules of nephronic components in the kidneys. SGLT-2 accounts for about 90 percent of glucose reabsorption into the blood. Blocking SGLT-2 reduces blood glucose by blocking glucose reabsorption in the kidney and thereby excreting glucose (i.e., blood sugar) via the urine

Question 11

Pramlinitide

Answer 11

👾👾it is an amylin agonist secreted by the b cell of the pancreas, help regulate the blood glucose by slowing gastric emptying and promote satiety by hypothalamicreceptor ,and inhibit the inappropriate secretion of the glucagon.
👉🏿👉🏿 Pramlintide has been approved by the FDA, for use by type 1 and type 2 diabetic patients who use insulin.[5] Pramlintide allows patients to use less insulin, lowers average blood sugar levels, and substantially reduces what otherwise would be a large unhealthy rise in blood sugar that occurs in diabetics right after eating.

Question 12

Dx DM

Answer 12

FBG>=126
Post prandial =>20p
HbAc1=>6.5

Question 13

How is Diabetes Managed?

Answer 13

Reduce HbA1cto less than 7

Question 14

Rapid-acting and short-acting insulin preparations

Answer 14

🔴Regular insulin is a short-acting, soluble, crystalline zinc insulin. 🔴Insulin lispro, aspart, and glulisine are classified as rapid-acting insulins.

Question 15

B. Intermediate-acting insulin

Answer 15

NPH

Question 16

Long-acting insulin preparations

Answer 16

The isoelectric point of insulin ⚡️glargine [GLAR-geen] is lower than that of human insulin, leading to formation of a precipitate at the injection site that releases insulin over an extended period.

Question 17

Basal Bolus regimen

Answer 17

🔴 NPH background at night ,,regular 3 times before meal 🥘

🔴glargine or detemir background ,,lispro 3

Question 18

Pre-mixed insulin combination

Answer 18

NPH/Regular 70:30

Question 19

Principles of Drug Therapy in Type 2 Diabetes

Answer 19

Therapy should be escalated when previous management has started to fail

n As demonstrated by measurement of HbA 1c

n Patients should be made aware this will occur

n Lifestyle discussed on every occasion

😞😞 Start with oral agents (each lower HbA1c

n Metformin first, unless contraindicated n
Progress to multiple oral agents Progress to insulin

Question 20

Metformin

Answer 20

👾👾Action not fully understood. Receptor unknown,, Decreased hepatic glucose output by acting on the mitochondria
👾👾Increased glucose uptake in skeletal muscle and fat GLUT 1 and GLUT 4

👉🏿👉🏿Special benefits in overweight patients
Weight-neutral or weight-reducing ,,Improvement in cardiovascular outcomes

🤮🤮Side effects mitigated by slow dose titration (GI upset)

🌺Usual maximum dose is 1g bd

😱😱Contraindicated in metabolic failure (renal failure, hepatic failure and acute heart failure)as it cause lactic acidosis
😱Stop before radiocontrast media and

Question 21

Thia-zolidene-diones

Used in

Answer 21

Pre DM
DM2
PCOS

Question 22

Metformin

Used in

Answer 22

DM2,PRE DM
PCOS
NON alcoholic liver disease
Bladder ca

Question 23

Statin

General info

Answer 23

Statins are the most commonly used and
tolerated drug for lowering LDLs; depending on dosage used, LDL levels can fall between 5-35%, triglycerides by 10-35%, and increasing HDLs by around 5%😍😍😍

Question 24

Statin mechanism

Answer 24

👾👾Statins work by inhibiting the HMG~CoA reductase enzyme in the liver which would normally be used in the production of cholesterol.
👾👾Decrease in the plasma concentration of cholesterol causes an increase in the number of LDL receptors, which in turn increases the rate of LDL removal from the plasma.
Consequently, statins are used to reduce CVD risk; they are especially important in cases of 👉🏿👉🏿familial hypercholesterolaemia.

Secondary beenfits of statins appear to be as acting as

anti-inflammatories, plaque reduction, and reduction in thrombotic risk.

Question 25

Statin Adverse Drug Reactions


Answer 25

Statins appear to be well tolerated by the

general population. The only significant ADRs seen involve 🔫🔫increased transaminase levels and 🔫myopathies (more common with increasing age, can be checked by testing the CPK levels), yet only seen in 0.1% of individuals who take high doses. Other miscellaneous complaints reported include GI complaints, joint pain, and headaches.

Question 26

Cholesterol Absorption Inhibitors

Answer 26

👾👾act by

blocking the specific cholesterol transport protein NPC1L1 in the brush border. This causes a reduction in the amount of dietary cholesterol reaching the liver, which in turn causes a secondary upregulation of LDL transporter expression. Both of these combine to cause a lowered circulating cholesterol level
EX Ezetimibe