Faculty of pharmacy
Pharmacology and toxicology department
Clinical Pharmacology
PO512
Assignment
Drug interaction with Anti-diabetic drugs
Amany Essma Ahmed 136097
Prof.Dr. Amany El-Brairy
Assistants
AL. Maha Shouman
AL. Heba Hossam
Introduction
Diabetes is considered as insulin secretion deficiency that diagnosed easily by low blood glucose level (Wilson, 2001). There are very common signs and symptoms such as polyphagia, polyuria and polydipsia, thus major complications will be observed from gangrene, glaucoma, kidney failure, and nervous diseases to cardiovascular complications (Wilson, 2001).
Classifications of anti-diabetic drugs
A. Injected insulin According to Wilson (2001), it is a chemically synthetic injected
…show more content…
Drug interactions
According to Inzucchi and McGuire (2008),
1. Insulin, alcohol, MAOI and salicylates: hypoglycemia
2. Dicumarol, chloramphenicol and MAOI: reduce hepatic metabolism of sulphonylurea
3. Sulfonamide, probencid and salicylates: reduce urinary excretion of sulphonylurea
2. Biguanides e.g. metformin
Mechanism of action
Anti-hyperglycemia will be achieved through many steps; decreasing glycogen breakdown, improving insulin sensitivity in the tissues and decreasing glucose synthesis by the liver and its absorption by the intestine (Inzucchi and McGuire, 2008).
Uses
Used mainly in controlling hyperglycemia, either alone or in combination with sulphonylurea. Also it has anti-hypertension effect (Inzucchia and McGuire, 2008).
Adverse effects
Cause lactic acidosis and many GIT problems such as anorexia, nausea and vomiting (Inzucchi and McGuire, 2008).
Drug interactions
As Inzucchi and McGuire (2008) said that,
1. Deficiency of vitamin B12 and folic acid when taken with it: decrease their absorption
2. Ibubrufen, propranolol, nifedipine and glyburide: hyperglycemia
3. Quinidine, cimetidine and trimethoprim: reduce metformin elimination and increase its serum concentration.
3. Alpha glucosidase inhibitors e.g. Miglitol
Mechanism of action
They inhibits alpha amylase enzyme that is responsible for carbohydrate digestion and so delay their absorption from the intestine in order to manage diabetes (Nathan, et. al., 2008).
Uses
Combine with
Answer: The combination of Insulin as well as oral hyperglycaemic drugs may be prescribed for Diabetes because they help in lowering the blood glucose levels. However the primary treatment doesn’t consist of these drugs. The primary treatment comprises of Diet control, Physical activity and Weight control. If after following the primary treatment strictly, no improvement in the blood glucose level is achieved then medication is suggested for the same. Insulin helps in maintaining the blood sugar levels. Note that insulin is not to be taken orally because the acids and digestive juices in the stomach destroy it. It has to be injected under the skin only. Taking insulin leads patient to experience Hyperglycaemic condition. The Hyperglycaemic drugs helps our body to react appropriately with the insulin so that the insulin hormone is able to help transfer glucose from blood to the cells successfully.
Diabetics have an insulin problem Diabetes is a result of insulin not performing its job correctly. Since insulin does more than remove glucose from the bloodstream, including producing proteins, storing fats, and other metabolic processes, diabetes can have severe consequences. If it is not treated properly diabetes can lead to heart disease, stroke, eye problems (including blindness), kidney failure, problems with teeth and gums, male sexual problems, nerve problems, and circulation problems. The circulation problems could result in foot or leg amputation (Reddy 2).
Iodine agents administered intravascularly may lead to renal failure. Ace inhibitors can decrease glucose levels and dose adjustments should be made during the administration of this medication. Adverse reactions include nutritional disorders, lactic acidosis, taste disorders, nausea, vomiting and diarrhea, and liver disorders. The implications metformin has on physical therapy treatment include the risk of lactic acidosis. Signs and symptoms that should be monitored for during physical therapy are muscular cramping along with gastrointestinal pain, shortness of breath, hypothermia, and coma.
There are many classes of medication which help control normal levels of glucose in the body. These medications work in different ways; sulfonylureas and meglitinides increase insulin production in different pathways, Thiazolidinediones increase insulin sensitivity by increasing the number of cells, Incretin mimetics increase insulin production as well as delay gastric emptying, Dipeptidyl Peptidase works in the gut, releasing incretin resulting in a prolonged secretion of insulin and Sodium glucose cotransporter reduces reabsorption of glucose and excreting excess glucose out of the urine (Demler & Rhoads, 2018).
lead to type 2 diabetes as well. The cause for type 2 diabetes, body becomes resistant to insulin
Chronic elevated glucose in blood (hyperglycemia) with disturbances metabolism of protein, fat and carbohydrate resulting from disorder in insulin secretion, insulin action, or both. (1) Expected to increase diabetic patients by 2025 to approximately 300 million people in the worldwide (2) In ancient times it was difficult to identify diabetes as the ability of patients to heal weak, the researchers think the diabetes resulting from defect in the bladder and kidneys are the cause of diabetes. (6)
We learned that Type 1 is an autoimmune condition where the body attacks its own beta cells in the pancreas via antibodies. Specifically, the person’s body produces antibodies that come down and destroy the beta cells in their pancreas. By having no beta cells, the person will not be able to secrete insulin; therefore, leaving the body in a hyperglycemic state. Some of the first symptoms of hyperglycemia are polyuria or polydipsia. Normal levels of blood glucose are between 70-110mg/100ml. Symptoms such as polyuria and polydipsia are diagnosed when diuresis via osmolarity of glucose becomes more than the Transport maximum (200mg/100ml). The protein responsible for this reabsorption of glucose is located in the proximal convoluted tubule, called the Sodium Glucose Transporter. In essence, 100mg/100ml of glucose can be easily reabsorbed, but 500mg of glucose will exceed the Tranport maximum. As a result, the person will have diuresis because 200mg will be reabsorbed, but 300mg will be left which ends up in the urine. This condition is also called diabetes mellitus or honey
By controlling high blood sugar kidney damage could be prevented. Also blindness, nerve problems, loss of limbs, and sexual function problems can be prevented with control.
Does antidiabetic medication create a possible risk for increased cognitive decline in older adults? In 2013, over 5 million older adults were estimated to have some form of cognitive decline, and it was estimated that 29.5 million older adults have type 2 diabetes. This is the largest increase for adults 65 and older in the United States (Alzheimer’s, 2015). As people continue to live longer the increase of type 2 diabetes in skilled nursing facilities has also grown from 16 to 23 percent (Zhang, 2010). Although, medications are used and needed for both conditions, type 2 diabetes can be a self-care and controllable disease through diet and increased exercise, yet cognitive decline only worsens over time.
Usually caused by autoimmune destruction of pancreatic beta cells, which produce and secrete insulin. By time symptoms develop, the damage to beta cells has progressed so far that insulin must be supplied exogenously, most often by injections. Reason for autoimmune attack is usually unknown, environmental toxins can be factors. People often have genetic susceptibility for disorder and are at increased risk of developing autoimmune diseases. Type-I usually develops during childhood and symptoms may appear abruptly. Classic symptoms are polyuria, polydipsia, and weakness. Acidosis due to excessive production of ketone bodies, ketoacidosis, is sometimes the first sign of diabetes. Blood test that detect antibodies to insulin, pancreatic islet cells, and pancreatic enzymes can confirm diagnosis and help predict development of
It stimulates pancreatic insulin secretion, decreasing blood glucose levels. Glyburide can cause a high risk of hypoglycemia and weight gain. Other side effects may include nausea. Food-Drug interactions: Avoid alcohol
In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can 't respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss.
Build up of health problems and blood problems that are caused by amino acids not producing enough protein in your body and without treating it can get worst "PKU
(3) Diabetes mellitus is a serious metabolic disease that results in hyperglycemia as a result of ineffective or total inaction of insulin secretion. This condition is most often the result of a defective pancreas that can lead to damage to the heart, kidneys and blood vessels.
Diabetes Mellitus is “a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. It is a disease which is caused by the insufficient insulin secretion or decrease in the peripheral effects of insulin. It is a serious problem in terms of morbidity and mortality. The hyperglycemia is associated with long term damage, dysfunction and failure of various organs especially the eyes, kidneys, nerves, heart and blood vessels. It’s associated with many complications which includes blindness of the eyes and amputations of the extremities. It is also associated with neuropathy, retinopathy, and cardiovascular diseases which lead to mortalities.