الاستاذ الدكتور رشاد مراد

1. Drugs Affecting the Pancreas الاستاذ الدكتور رشاد مراد

2. Insulin—A Lifesaver! • Sir Frederick Banting and Charles Best discovered insulin in the 1920s. • Previous research showed a link between the pancreas and diabetes. • Dogs with diabetes were kept alive with an extract from the pancreas, which was later isolated and purified into insulin.

3. Insulin—A Lifesaver! Before insulin, people with diabetes suffered complications and early death. Insulin is hailed as one of the most significant medical advances of the time. It extended the lives of millions of people around the world.

4. Insulin—A Lifesaver! Pharmacy techs help diabetic patients lead near-normal lives by • Helping them selectdiabetic supplies • Stressing the importance of insulin dosing and blood sugar monitoring

5. Number 3 – Discovery of Insulin • Gave us a better understanding of diabetes. • Insulin changed the live of millions of people. • In the pre-insulin period diabetes was a wasting disease coupled with starvation treatment. • Drs. Banting and Best insulin in the summer odiscovered f 1921

6. Oral Hypoglycemic Agents • Used to stimulate insulin secretion from the pancreas is patients with NIDDM. • Four Pharmacologic classes: • Sulfonylureas • Biguanides • Alpha-glucosidase inhibitors • Thiazolidinediones

7. Sulfonylureas • First class of oral hypoglycemics. • Drugs include: • Tolbutamide (Orinase) • Chlorpropamide (Diabinese) • Glipizide (Glucotrol) • Glyburide (Micronase) • Increase insulin secretion from the pancreas. • Side effect: hypoglycemia

8. Biguanide • Metformin (Glucophage) • Decreases glucose synthesis and increases glucose uptake. • Does not stimulate release of insulin. • Side effects: nausea, vomiting, decreased appetite

9. Alpha-glucosidase Inhibitors • Acarbose (precose) • Miglitol (glyset) • Delay carbohydrate metabolism • Side effects: flatulence, cramps, diarrhea, abdominal distention

10. Thiazolidinediones • New class of oral hypoglycemic agents. • Troglitazone (Rezulin) • Promotes tissue response to insulin, making available insulin more effective • Has no major side effects

11. Hyperglycemic Agents • Two agents: • Glucagon • Diazoxide (proglycem) • Increase blood glucose levels.

12. Glucagon • Given IM when IV live is unobtainable • Converts glycogen stores into glucose • Side effects: N/V, allergic reactions (rare)

13. Diazoxide • Inhibits insulin release • Typically used for patient with hyperinsulin secretion from pancreatic tumors • Not indicated for treating diabetes-induced hypoglycemia

14. D50 • Sugar solution given intravenously for acute hypoglycemia. • Primary side effect is local tissue necrosis if infiltration occurs

15. Generic Name: Brand Name: Classification: Dextrose 50% None Hyperglycemic DEXTROSE 50%

16. DEXTROSE 50%Actions • Rapidly increases serum glucose levels • Provides short-term osmotic diuresis

17. DEXTROSE 50%Indications • Coma of unknown origin • Hypoglycemia • Status Epilepticus

18. DEXTROSE 50%Contraindications • Intracranial hemorrhage • Delirium tremens • Use with caution in acute alcoholism - ineffective without thiamine; may make thiamine deficiency more severe • Severe pain

19. DEXTROSE 50%Dose: • Adult: 25-50 g IV bolus • Pediatric: 25% dextrose, 2-4 ml/kg IV bolus

20. Generic Name: Brand Name: Classification: Glucose (oral) Glucola, Insta-Glucose Hyperglycemic GLUCOSE

21. GLUCOSEActions • A quickly absorbed form of glucose to increase blood glucose levels

22. GLUCOSEIndications • Hypoglycemia • Conscious patients

23. GLUCOSEContraindications: • Decreased level of consciousness • Nausea/vomiting

24. GLUCOSEPrecautions: • Assure that the airway is patent

25. GLUCOSEDose: • ADULT: sipped slowly by the patient until a feeling of improvement is reported. It is not essential to administer the entire bottle. • PEDIATRIC: Same as adult

26. GLUCOSENotes: • Onset: Minutes • Peak: Variable • Duration: Variable • Glucola - 300 ml bottles • Glucose pastes and gels also available in various forms

27. Generic Name: Brand name: Classification: Glucagon None Hyperglycemic GLUCAGON

28. GLUCAGONActions • Protein secreted by the alpha cells of the pancreas (islets of Langerhans) • Causes a breakdown of stored glycogen to glucose (glycogenesis); increases circulating blood glucose • Unknown mechanism of stabilizing cardiac rhythm in beta-blocker overdose

29. Actions • Positive inotropic and chronotropic • Decreases GI motility and secretions, pancreatic secretions, and blood pressure

30. GLUCAGONIndications • Hypoglycemia • Beta-blocker overdose

31. GLUCAGONContraindications • Hyperglycemia • Known hypersensitivity

32. GLUCAGONAdverse Reactions • Hypersensitivity (protein-based drug) • Nausea/vomiting

33. GLUCAGONPrecautions • Caution with administration to patients with a history of cardiovascular or renal disease

34. GLUCAGONDose • ADULT: 0.5-1.0 mg IV; repeat 1-2 times if no response within 20 minutes • PEDIATRIC: Not used

35. GLUCAGONNotes • Onset: 1 minute • Peak: 30 minutes • Duration: Variable • Should always be used in conjunction with D5W • Must be reconstituted before administration. Must be used or refrigerated after reconstitution.

36. Generic Name Brand Name Classification Thiamine (Vitamin B) Betalin Vitamin THIAMINE

37. THIAMINEActions • Required for carbohydrate metabolism • Deficiency leads to anemia, polyneuritis, cardiomyopathy • Administration may reverse symptoms of deficiency, but effects are dependent upon duration of illness and severity of disease

38. THIAMINEIndications • Coma of unknown origin, especially if alcohol may be involved • Delirium tremens • Other thiamine deficiency syndromes

39. THIAMINEContraindications • Known hypersensitivity

40. THIAMINEDose • ADULT: 100 mg • PEDIATRIC: Rarely used

41. THIAMINEIncompatible/Reactions • Alkaline solutions • Barbiturates • Bicarbonate • Cephalosporins • Other antibiotics

42. THIAMINENotes • Onset: Hours • Peak: 3-5 days • Duration: Unavailable • Any comatose patient, especially those who are suspected to be alcoholic, should receive IV thiamine prior to the administration of D50 or Narcan

43. Drugs Affecting the Pancreas • Insulin Preparations • Three Sources: • Beef • Pork • Human • Differ primarily in their onset and duration of action and incidence of allergic reaction. • Preparations may be short acting, intermediate acting or long acting. (table 9-10)

44. Generic Name: Brand Name: Classification: Insulin Regular Insulin, Humulin R Antidiabetic INSULIN

46. Insulin Preparations • Also classified as nature (regular) or modified. • Natural insulins are used as they occur in nature. • Insulin can also be modified to increase their duration of action, decreasing the number of administrations necessary

47. Insulin Preparations • Modified insulin preparations include: • Neutral Protamine Hagedorn (regular insulin attached to a large protein to delay absorption) • Lente (attached to zinc) • Insulin preparations derived from beef or pork, lentes, may lead to allergic reactions. • Natural human insulin preparations do not have allergic reactions.

50. INSULINActions • Protein secreted by beta cells of the Islets of Langerhans • Responsible for promoting the uptake of glucose by the cells (muscle, cardiac, CNS, and all other tissue) • Necessary for carbohydrate, fat and protein metabolism • Converts glycogen to fat