Anti Diabetic Agent (Dr.trully)

8/12/2019 Anti Diabetic Agent (Dr.trully)

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TRULY SITORUS

Depart. of Pharmacology & Therapy

Faculty Of Medicine Padjadjaran University

INSULIN & ORAL

HYPOGLYCEMIC

DRUGS


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It is a heterogeneous group of syndromes

all characterized by an elevation of blood

glucosecaused by a relative or absolute

deficiency of insulin.

Symptom:


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DMA. TYPE I (INSULIN DEPENDENT

DIABETES MELLITUS, IDDM) Absolute deficiency of insulin

Caused by massive -cell lesions or necrosis

Treatment: exogenous insulin

B. TYPE II (NON INSULIN DEPENDENTDIABETES MELLITUS, NIDDM)

Inability of -cell to produce appropriate

quantities of insulin Insulin resistance

Other unknown defects

Treatment: Hypoglycemic oral drugs insulin


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Insulin exogen

Beef

Pork

Human (by. E.colli, OOA


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MECHANISM OF ACTION


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PHARMACOKINETICS

Insulin p.o degradation

subcutaneous

IV: in hyperglycemicemergency


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ADVERSE EFFECT &

OVERDOSE TOXICITY

Hypoglycemia

Hypoglycemia brain damage !

Symptom of hypoglycemiaTachycardia

Confusion

Vertigo

Diaphoresis

Lipodystrophy

Hypersensitivity


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INDICATION

1. All patients with type I DMregardless of age

2. Patient who have ketoacidosis or hyperosmolar

coma

3. Patient with type II DM when diet restriction,

exercise and oral hypoglycemic agent havefailedto maintain satisfactory blood glucose

concentration

4. Patient with type II DMin presence of surgeryfever, infections, serious renal or hepatic

dysfunction, and other metabolic disturbances

5. Pregnantdiabetic women


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CONTRAINDICATION

There are no contraindications if the proper

indication exists.

Patients must be well educated regarding the

role of diet, exercise and illness in modifying

their insulin requirements.


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INSULIN PREPARATIONS

A. RAPID ACTION INSULIN

PREPARATION

Zinc insulin: sc

iv (in emergencies)

B. INTERMEDIATE ACTION INSULINPREPARATION

1. Semilente insulin suspension

2. Isophane insulin suspension

3. Lente insulin4. Insulin incombination

C. PROLONGED ACTION INSULINPREPARATION


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I. SULFONILUREAS

First generation

Tolbutamide, Chlorpropamide, Tolazamide

Second generation

Glipizide, Glyburide

II. BIGUANIDES

Metformin

III. GLUCOSIDASE INHIBITORS

AcarboseIV. REPAGLINIDE (?)

Repaglinide

V. THIAZOLIDINEDIONES

Troglitazone

ORAL HYPOGLYCEMIC AGENTS


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SULFONILUREAS

Mechanism of action

1. Stimulation of insulin release from the cells

2. Reduction of serum glucagon levels

3. Increased binding of insulin to target tissues

Pharmacokinetics

Oral, bind to serum proteins

Metabolized by liver

1stG : inactive, less active, active 2ndG: inert

Excreted by kidney or liver


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Side effect

Hypoglycemia (especially: chlorpropamide,

Glyburide)

Contraindication:

Renal or hepatic insufficiency

Pregnancy

Elderly


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INTERACTION


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METFORMIN

Used alone or in combination with sulfonilurea,

others

Drugs of choice in newly diagnosed type II DM

Decreasing hepatic glucose output

Reduced hyperlipidemia(LDL, VDL, cholesterol,

HDL)

Oral, unbound to serum proteinNot metabolized

Side effect: GI disturbance, hypoglycemic


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ACARBOSE

Inhibits glucosidase in intestinal

decreased the absorption of starch and

disaccharidesTaken with meals

Not cause hypoglycemia

Side effects: flatulencediarrhea

abdominal cramping


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REPAGLINIDE

Binds to the ATP- sensitive potassium

channels of cells release of insulin

Metabolized inactive

TROGLITAZONE

Decreases insulin resistance


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BIGUANIDES

METFORMINInhibiting gluconeogenesis

Reduce hyperlipidemia (LDL, VDL,

cholesterol, HDL)Not bound to serum protein

Is not metabolized

SE: hypoglycemic

Anti Diabetic Agent (Dr.trully)

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