Central Nervous System-Sleeping Pills (Click )
What are the bad effects of sleeping pills on long time use?
1.Insomnia
2.Somnambulance
3.Parasomnia
4.Metabolic disturbances leading to diabetes mellitus
5.Cardiovascular effects such as orthostatic hypotension, reflex tachycardia, and cardiac failure
6.Anticholinergic effects, such as blurred vision, digestive failure, dry mouth, constipation, urinary retention, premature ejaculation and myasthenia gravis.
Are sleeping pills cause infertility in women?
To view the figure clearly click on it
Yes. While natural sleep for 7 to 8 hours increases the power of fertility, sleeping pills and other psychiatry medicines increase the chance of temporary infertility.
What is diazepam?
It is a benzodiazepine compound. It is a long-acting sleeping drug. It is available in the trade name of Valium. Its effect lasts for up to 3 days.
What are the other long-acting benzodiazepines similar to diazepam?
Flurazepam, and Chlordiazepoxide.
Flurazepam is available under the brand name of Dalmane. It is now rarely available as it is discontinued by its producer, Mylan Pharmaceuticals in the U.S.A.
Chlordiazepoxide is available under the brand name Librium.
What is Alprazolam?
It is an intermediate-acting benzodiazepine compound available under the brand names of Alprax, Trika and Xanax. Its effect lasts for up to 10 to 20 hrs.
What are the other sleeping pills similar to alprazolam?
Temazepam under the brand name Restoril
Lorazepam under the brand name Ativan
What are the sleeping pills more frequently prescribed by doctors?
Alprazolam(Alprax), Diazepam (Valium), Chlordiazepoxide (Librium) and Zolpidem (Zoldem).
What is other important use of diazepam?
Epilepsy- Status Epilepticus-The most severe form of epilepsy.
Why zolpidem is the most frequently preferred sleep aid by psychiatrists?
Zolpidem is not a benzodiazepine and hence it is devoid of all the side effects of benzodiazepines. It is an atypical drug. Yet it has its own typical side effects such as
2.Lightheadedness (Headache)
3.Tiredness, dizziness, drugged feeling
4.Unsteady walking.
What are the side effects of prolonged use of zolpidem?
Zolpidem on long time use produces digestive problems.
Dry mouth
Recurrent headaches
Recurrent headaches
Muscle pain and lack of muscle control.
All the above problems are mainly due to anticholinergic effects.
What are the side effects of alprazolam (Alprax, Trika and Xanax)?
Lightheadedness, and anticholinergic effects.
Can alprazolam be taken along with paracetamol?
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| Fig-1 To view clearly click on the figure |
No interactions have yet been reported between alprazolam and paracetamol. But it does not mean that there are no interactions. Consult your doctor before combining to take these two medicines.
Can alcohol be taken along with alprazolam?
No alprazolam should not be combined with alcohol, opioids or any other narcotic.
Can alprazolam be combined with a cough syrup contains hydrocodone, codeine phosphate, or dextromethorphan?
No. It may result in severe sedation, serious respiratory depression, and death
Can alprazolam be combined with antihistamine cough syrup?
No. Antihistamines such as diphenhydramine hydrochloride should not be taken along with alprazolam. It may be fatal.
What are the other medicines that should not be taken along with alprazolam?
1.Antifungals like itraconazole, ketoconazole-They will make alprazolam ineffective
2.Antidepressants such as amitriptyline, fluoxetine, fluvoxamine nefazodone and antipsychotic drugs such as chlorpromazine and risperidone should not be combined with alprazolam
3.Antivirals such as delavirdine, indinavir must not be taken along with alprazolam.
Who should not take zolpidem?
Those who are addict to alcohol
Those who have the suicidal mentality
Those who have depression, and aggressive psychosis.
Those who have Attention Deficit Hyper Activity (ADHA)
Those who suffer a condition known as Myasthenia Gravis which is due to acetylcholine under-activity (Cholinergic deficiency)
Cardiovascular System-B.P.Medicine-Q/A:-
AMLODIPINE AND ANKLE SWELLING
What is amlodipine?
Amlodipine is a blood pressure medicine (Antihypertensive) that belongs to the group known as Calcium Channel Blocker or CCB. To study further please click here
How to identify CCB by its name?
Any medicine name that ends with a suffix - - dipine is a CCB. For example
amlodipine, nifedipine, with the exemptions of diltiazem and verapamil.
What are the reasons for peripheral and ankle swellings?
Oedemas or swellings are generally due to many underlying causes such as retention of body fluids due to renal failure, congestive heart failure, hypertension, and partial hypertension that means hypertension in the veins and hypotension in the arteries expressed as capillary hypertension.
How CCBs work?
CCBs blocks the inflow of Ca++ ions into the heart and arterial smooth muscle cells and thereby relaxing them opening widely to ease the blood flow in and out.
How amlodipine causes ankle swellings? Explain with a simple diagram:-
CCB- Calcium Channel Blocker
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| See how amlodipine blocks the calcium channel |
Amlodipine is an antihypertensive that belongs to a group of CCB.
Generally, all CCBs are prone to cause ankle swellings with amlodipine is the most causative and nifedipine is the least causative.
All CCBs especially amlodipine blocks calcium ions inflow in the smooth muscles of the heart, arteries and arterioles only and not in the smooth muscles of the veins and venules.
This causes blockage in the capillaries, the junction between the arterial and venous system. Capillary blood flow blockage causes capillary hypertension which results in oedema and swellings in various parts of our body including ankles and feet.
How to rectify this problem?
Consult your doctor, and get his guidance to reduce the dosage or to stop the medication completely.
Alternatively, a combination of an ARB (Angiotensin Receptor Blocker)like telmisartan and a diuretic like hydrochlorothiazide (Telma-H) is preferable but under the doctor's supervision.
Diabetes Mellitus Q/A:-
GLYCEMIC INDEX (GI) AND GLYCEMIC LOAD (GL)
Q: What is the Glycemic Index -GI?
A: The glycemic index of a food is the ranking scale in which the postprandial blood glucose level, raised by the carbohydrate content of the food is compared to that of a reference food that is generally pure glucose or white bread.
Q: What is the concept behind the glycemic index?
A: In the past carbohydrates are classified as simple and complex. Simple carbohydrates are usually a monosaccharide like glucose and fructose or disaccharides like sucrose and lactose.
A complex carbohydrate is a starch that is complexed with a large number of glucose molecules.
A simple carbohydrate after consumption can cause an immediate spike of the postprandial blood glucose level because it can be digested, absorbed, and metabolized quickly.
While a complex carbohydrate after consumption may cause a steady slow rise of the postprandial blood glucose level because of their slow digestion absorption and metabolism.
This is the concept behind the G.I.
The G.I scale is having a general range from 1-100
In a rough consideration let us say,
G.I of glucose is 100
G.I of starch is 1
The food that has a GI value of less than 100 means that food is expected to impact your blood glucose level less than the impact of pure glucose on your blood and vice versa.
The food that has a GI value of less than 100 means that food is expected to impact your blood glucose level less than the impact of pure glucose on your blood and vice versa.
The blood glucose-raising power of food is directly proportional to its glycemic index (G.I). But many times practically it proves wrong that we will see in the concept of Glycemic Load later.
Q: How the G.I measure the relative quality of carbohydrate-containing food?
A: 1. Foods containing carbohydrates that are easily digested absorbed and metabolized can be ranked with high G.I (>77)
2. Foods that are digested in the median level can be ranked with intermediate G.I (77-55)
3. Foods that are digested very slow can be ranked with low G.I (<55)
Q: How to measure G.I of a food?
A: Healthy volunteers are selected and are fed with a specified amount of the test food that contains 50 grams of glucose in a day and testing their blood glucose level prior to eating and after eating at equal intervals in two hours.
The next day the same test is performed with 50 gms of pure glucose. The test results are plotted as a curve.
The G.I = [ iAUCtest food/iAUCpure glucose]X 100
The result is multiplied by 100 to show it in percentage.
Q: Explain the above calculations with examples?
A: Backed potato has the GI 82 with respect to pure glucose and 116 with respect to white wheat bread.
This means the blood glucose-raising power of carbohydrates in a boiled potato is 82% of the blood glucose-raising power of the same amount of carbohydrate in pure glucose and 116% of that of the same amount of carbohydrate in the white wheat bread.
Hence the blood glucose response to the same amount of carbohydrate content of pure glucose, backed potato, and white bread can be ranked as follows:-
Pure glucose > Boiled potato > White bread.
100 > 82 δΈ¨ 116 > 100
Q: What glycemic index says?
A: Food with a high glycemic index is easily digested, absorbed, and metabolized so as to raise the blood glucose level with sudden spikes disregarding their total carbohydrate contents.
Q: Give an example of the above?
A: Cooked rice has more total carbohydrate than potato, but its GI value is only 50 relative to glucose and 69 relative to white bread.
Q: Why albeit black rice has more total carbohydrate than a boiled potato but has lesser GI value than a boiled potato?
A: Because the total carbohydrate content of black rice contains more fibres and less digestible glucose. Fibres are not easily digested, absorbed, and metabolized.
Q: How fibre contents influencing the GI values and blood glucose response?
A: Food with high GI and low fibre content produces immediate spikes in the blood glucose level while food with low GI and high fibre content produce a slow rise in the blood glucose level.
But foods with high and low GIs and equal fibre contents have no much differences in changing blood glucose levels.
Q: What are the drawbacks of glycemic index assessments?
A: Glycemic Index does not take account of differences in ethnicities, individual differences in metabolic capabilities, age, individual digesting power, and other different parameters.
The glycemic response to a particular food varies with different individuals.
GI does not measure insulin production due to a rise in blood glucose levels. Hence two foods have the same GI but release different amounts of insulin.
A lower GI value does not always mean the food is a better choice. A chocolate bar and one cup of brown rice may both have a GI of 55 but the overall nutritional value is different.
Q: What is Glycemic Load (GL)?
A: Many times as GI ranking disproves its accuracy and produces many errors with many foods. A food that has a higher GI value produces a lesser impact on blood glucose levels than a food with a lower GI value. This is because GI values are empirical and do not consider the amount of consumption of the food.
A new scale has been devised to correct this that is known as Glycemic Load (GL).
Q: How GL is calculated?
A: The formula for GL is,
(GI x n)/100 { n=the amount of carbohydrate content of a certain portion of the food}
Q: How food is ranked on the GL scale?
A: For one serving of food,
GL > 20 --- High
GL < 20 >10 --- Medium
GL =10 --- Normal
GL less than 10 --- Safe for Diabetics
Q: What is the difference between GI and GL?
A: The same food in different forms like refined or non-refined can show different GI values. The food is more refined and more processed, the higher its GI value.
Also, GI is influenced by many other factors like cooking methods, protein, and fat contents of the food.
But GL combines both quantity and quality of the carbohydrate it gives a more specific and concrete result.
A: How GL represent the amount of glucose consumption?
A: Approximately 1 unit of GL = 1gm of the glucose effect
For example, if you consume food with its serving limits that represent a GL of 20 that means you may have 20gms of glucose effects in your blood glucose level.
For example, watermelon's GI is high but a loaf of watermelon which is the normal serving quantity does not have much glucose effect on your blood.
Q: Explain with examples of how GL is correlated with GI?
Watermelon GI value = 72
100 gm of watermelon contains available carbohydrates = 5 gms Hence its GL value is (5 x 72)/100 = 3.6
{Note: Available Carbohydrate = Total carbohydrates-fibres)
From the above examples albeit watermelon has higher GI values(72) its GL value is only 3.6 in a 100gm serving amount.
Hence a diabetic can take 100 to 200gm of watermelon safely.
120 gm papaya contains approximately 15gms of available carbohydrates and its glycemic index (GI) is 60 then its GL is,
GL =(GI x n)/100 = (60 x 15)/100 =9 (Less than 10-safe)
Hence a diabetic can safely take papaya 60 to 120gm daily.
In general, to find out GL the amount of carbohydrate must be known that is available in google search.
Coconut water:- Glycemic Index-3
Available sugar -10 gms
Glycemic Load -(3 x 10)/100=0.3
Coconut sugar:- GI value - 40 (35 -50)
water is good for diabetes.
List of foods with their GI and GL value in a table form please click here.
Diabetes Updates:-Newer Diabetic Medicines
Q: What are the drawbacks of glycemic index assessments?
A: Glycemic Index does not take account of differences in ethnicities, individual differences in metabolic capabilities, age, individual digesting power, and other different parameters.
The glycemic response to a particular food varies with different individuals.
GI does not measure insulin production due to a rise in blood glucose levels. Hence two foods have the same GI but release different amounts of insulin.
A lower GI value does not always mean the food is a better choice. A chocolate bar and one cup of brown rice may both have a GI of 55 but the overall nutritional value is different.
Q: What is Glycemic Load (GL)?
A: Many times as GI ranking disproves its accuracy and produces many errors with many foods. A food that has a higher GI value produces a lesser impact on blood glucose levels than a food with a lower GI value. This is because GI values are empirical and do not consider the amount of consumption of the food.
A new scale has been devised to correct this that is known as Glycemic Load (GL).
Q: How GL is calculated?
A: The formula for GL is,
(GI x n)/100 { n=the amount of carbohydrate content of a certain portion of the food}
Q: How food is ranked on the GL scale?
A: For one serving of food,
GL > 20 --- High
GL < 20 >10 --- Medium
GL =10 --- Normal
GL less than 10 --- Safe for Diabetics
Q: What is the difference between GI and GL?
A: The same food in different forms like refined or non-refined can show different GI values. The food is more refined and more processed, the higher its GI value.
Also, GI is influenced by many other factors like cooking methods, protein, and fat contents of the food.
But GL combines both quantity and quality of the carbohydrate it gives a more specific and concrete result.
A: How GL represent the amount of glucose consumption?
A: Approximately 1 unit of GL = 1gm of the glucose effect
For example, if you consume food with its serving limits that represent a GL of 20 that means you may have 20gms of glucose effects in your blood glucose level.
For example, watermelon's GI is high but a loaf of watermelon which is the normal serving quantity does not have much glucose effect on your blood.
Q: Explain with examples of how GL is correlated with GI?
Watermelon GI value = 72
100 gm of watermelon contains available carbohydrates = 5 gms Hence its GL value is (5 x 72)/100 = 3.6
{Note: Available Carbohydrate = Total carbohydrates-fibres)
From the above examples albeit watermelon has higher GI values(72) its GL value is only 3.6 in a 100gm serving amount.
Hence a diabetic can take 100 to 200gm of watermelon safely.
120 gm papaya contains approximately 15gms of available carbohydrates and its glycemic index (GI) is 60 then its GL is,
GL =(GI x n)/100 = (60 x 15)/100 =9 (Less than 10-safe)
Hence a diabetic can safely take papaya 60 to 120gm daily.
In general, to find out GL the amount of carbohydrate must be known that is available in google search.
Coconut water:- Glycemic Index-3
Available sugar -10 gms
Glycemic Load -(3 x 10)/100=0.3
Coconut sugar:- GI value - 40 (35 -50)
water is good for diabetes.
List of foods with their GI and GL value in a table form please click here.
Diabetes Updates:-Newer Diabetic Medicines
DPP4-INHIBITORS-THE GLIPTINS
1. What is the Dipeptidyl peptidase-4 (DPP4) enzyme?
This enzyme is a glycoprotein. It behaves as an enzyme and as well as a cell receptor.
2. How it works and where it is present in the body?
It is available in two forms as soluble and insoluble forms in our body.
The soluble forms are circulating along with the blood plasma and with other body fluids. They function mainly as enzymes.
The insoluble forms are bound on the surface of the cell membrane at various organs of the body. They mainly function as receptors to perform cell responses, transductions, and cell death when the cell becomes old which is known as apoptosis.
3. Which forms are concerned with glucose metabolism and how?
The soluble enzyme forms DPP4.
They destroy incretin hormones and thereby inhibit or reduce insulin secretions.DPP4 causes a rise in unopposed glucagon secretions from the pancreas and thereby raise blood glucose level.
4. What are incretin hormones and how they function?
There are two types of incretin hormones.
a) Glucagon-like peptides-GLP-1-42
b) Glucose-dependant Insulinotropic Peptide or
Gastric Inhibitory Peptide-GIP.
They have secreted from the enteroendocrine cells of the duodenum GIP) and the intestine (GLP-1-42) into the blood within a few minutes of the food enters the digestive system.
The GLP-1-42 inhibits the glucagon secretions from the pancreatic alpha islets, and GIP stimulates insulin secretions from the beta islets. Both improve pancreatic beta-cells growth and survival.
Thereby both help the body to lower blood glucose levels.DPP4 counteracts these effects by destroying GLP-1(with 42 amino acids) and GIP.
5. What are Gliptins?
They are the modern anti-diabetic drugs
6. How they work?
They work by inhibiting the enzyme DPP4 and thereby enhance the effects of incretin hormones.
Inhibition of DPP4 results in increased secretions of insulin and decreased secretions of glucagon and thereby the blood glucose level is lowered.
7. Compare gliptins with a sulfonylurea:-
Sulfonylureas act directly on the pancreatic beta cells, block potassium entry through the ATP and open the calcium channels, and once calcium ion flows into the beta cells they release insulin.
Gliptins act by enhancing the incretin hormones by inhibiting the DPP4 enzyme and thereby increase the release of insulin from the pancreatic beta cells.
Gliptins are safer than sulfonylureas like glimepiride, glyburide, glibenclamide, and tolbutamide.
Sulfonylureas often cause serious hypoglycemia and weight gain. Hence gliptins are safer to use in diabetic patients without the risk of hypoglycemia and weight gain including the risk of renal insufficiencies.
Cardiocerebrovascular incidents are also common with sulfonylureas.
But some drawbacks like hospital stayed heart failure remains uncleared with gliptins.
8. Give some examples of gliptins and their trade names.
9. Which time gliptins should be taken?
Generally, all gliptins can be taken at any time according to the patients' convenience but better in the morning. The medicine should be taken at the same time fixed daily. If the first dosage has been taken at 9.00 am on the first day then every day 9.00 a.m is the time to be fixed for the subsequent dosages.
10. What are the general dosages for gliptins?
JANUVIA-SITAGLIPTIN:-
Januvia --- 25 to 100 according to the patient's kidney and liver conditions as follows:-
Renal conditions:
Normal (CrCl >50 ml/min) -100 mg/day--no dose adjust.
Creatinine Clearance=30-50ml/min-50mg/day
Creatinine Clearance <30ml/min - 25 mg/day
End-Stage Kidney Disease -25mg/day disregarding hemodialysis.
In liver insufficiency, the dose should be as follows:-
Mild to Moderate --- No dosage adjustment
Severe --- Not studied
GALVUS-VIDAGLIPTIN
This is the most recommended drug by doctors.
Galvus -50 -100 mg/day in normal conditions.
The 100 mg dosage can be divided into two, morning and evening at a fixed time with or without meals.
If metformin is combined then the drug should be taken with food as stomach upset is one of the side effects of metformin if taken on an empty stomach.
The dosage adjustments should be as per the advice of the doctor in kidney and liver impairments as in Januvia.
ONGLYZA:-
Normal -2.5 to 5mg/day taken at a fixed time regardless of meals. The tablet should not be split or broken.
In Renal failure- Mild (CrCl>50ml/min)- No need for dosage adjustment.
In moderate to severe (CrCl = or <50ml/min)-2.5mg/day disregarding hemodialysis.
The medicine should be given the following dialysis.
In liver functions:
Normal to Mild - No dose adjust
In moderate to severe and with the use of strong Cytochrome P 4 inhibitors like ketoconazole, itraconazole, clarithromycin, telithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, and saquinavir,) see for further ref. DRUG INTERACTIONS
TRADGENTA:
Normal --- 5mg/day
No dosage adjustments are required in renal and hepatic impairments.
ZITEN:-
Normal --- 20-40 mg /day once daily at a fixed time in the morning with or without meals.
Precautions :
MAO inhibitors and beta-blockers can increase the efficacy of the drug.
Steroids and thyroid hormones can attenuate the efficacy.
11. What are the general contraindications for gliptins?
A. Diabetes Mellitus-1
B. Keto acids formed.
12. What are the general side effects of gliptins?
A.Nasopharyngitis
B.Headache
C.Nausea, constipation and other GI-distress
D.Allergic hypersensitivity reactions, skin rashes, painful red pimple formations at the fingertips.
13. Can gliptins and sulfonylureas be used in patients with G6PD deficiency?
No. It may cause serious haemorrhages.
14. What is G6PD?
Glucose-6-Phosphate Dehydrogenase is an enzyme present in almost all body cells involve in regulating carbohydrate metabolism.
15. Why gliptins should not be used in insulin-dependent diabetes mellitus (DM-1), and in DM-ketoacidosis?
Gliptins and sulfonylurea are ineffective in DM-1and DM-ketoacidosis in which the damaged beta islet cells by the body's own immune system, are absolutely incapable of producing insulin.
16. What is Diabetic ketoacidosis?
When there is absolutely no insulin is available to use glucose the body begins to use stored fat for energy to cell activity. When the liver process and breakdown the fat ketone bodies are formed that make the blood more acidic. DM-ketoacidosis is more serious and more it can lead to coma and death.
DM-ketoacidosis more common in DM-1 and it is very rare in DM-2
17. Can gliptins be used in heart patients?
No. It has been reported that gliptins cause cardiac fibrosis, which may result in heart failure and heart attack.
Can gliptins be combined with metformin?
Yes. If doctors feel if it is necessary for some patients. But care should be taken with patients having gastric distress. (e.g) Janumet. (Sitagliptin with metformin).
Q) What is the general treatment strategy for insulin-dependent DM?
Gliptins are safer than sulfonylureas like glimepiride, glyburide, glibenclamide, and tolbutamide.
Sulfonylureas often cause serious hypoglycemia and weight gain. Hence gliptins are safer to use in diabetic patients without the risk of hypoglycemia and weight gain including the risk of renal insufficiencies.
Cardiocerebrovascular incidents are also common with sulfonylureas.
But some drawbacks like hospital stayed heart failure remains uncleared with gliptins.
8. Give some examples of gliptins and their trade names.
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| TENELIGLIPTIN ZITEN GLENMARK |
Generally, all gliptins can be taken at any time according to the patients' convenience but better in the morning. The medicine should be taken at the same time fixed daily. If the first dosage has been taken at 9.00 am on the first day then every day 9.00 a.m is the time to be fixed for the subsequent dosages.
10. What are the general dosages for gliptins?
JANUVIA-SITAGLIPTIN:-
Januvia --- 25 to 100 according to the patient's kidney and liver conditions as follows:-
Renal conditions:
Normal (CrCl >50 ml/min) -100 mg/day--no dose adjust.
Creatinine Clearance=30-50ml/min-50mg/day
Creatinine Clearance <30ml/min - 25 mg/day
End-Stage Kidney Disease -25mg/day disregarding hemodialysis.
In liver insufficiency, the dose should be as follows:-
Mild to Moderate --- No dosage adjustment
Severe --- Not studied
GALVUS-VIDAGLIPTIN
This is the most recommended drug by doctors.
Galvus -50 -100 mg/day in normal conditions.
The 100 mg dosage can be divided into two, morning and evening at a fixed time with or without meals.
If metformin is combined then the drug should be taken with food as stomach upset is one of the side effects of metformin if taken on an empty stomach.
The dosage adjustments should be as per the advice of the doctor in kidney and liver impairments as in Januvia.
ONGLYZA:-
Normal -2.5 to 5mg/day taken at a fixed time regardless of meals. The tablet should not be split or broken.
In Renal failure- Mild (CrCl>50ml/min)- No need for dosage adjustment.
In moderate to severe (CrCl = or <50ml/min)-2.5mg/day disregarding hemodialysis.
The medicine should be given the following dialysis.
In liver functions:
Normal to Mild - No dose adjust
In moderate to severe and with the use of strong Cytochrome P 4 inhibitors like ketoconazole, itraconazole, clarithromycin, telithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, and saquinavir,) see for further ref. DRUG INTERACTIONS
TRADGENTA:
Normal --- 5mg/day
No dosage adjustments are required in renal and hepatic impairments.
ZITEN:-
Normal --- 20-40 mg /day once daily at a fixed time in the morning with or without meals.
Precautions :
MAO inhibitors and beta-blockers can increase the efficacy of the drug.
Steroids and thyroid hormones can attenuate the efficacy.
11. What are the general contraindications for gliptins?
A. Diabetes Mellitus-1
B. Keto acids formed.
12. What are the general side effects of gliptins?
A.Nasopharyngitis
B.Headache
C.Nausea, constipation and other GI-distress
D.Allergic hypersensitivity reactions, skin rashes, painful red pimple formations at the fingertips.
13. Can gliptins and sulfonylureas be used in patients with G6PD deficiency?
No. It may cause serious haemorrhages.
14. What is G6PD?
Glucose-6-Phosphate Dehydrogenase is an enzyme present in almost all body cells involve in regulating carbohydrate metabolism.
15. Why gliptins should not be used in insulin-dependent diabetes mellitus (DM-1), and in DM-ketoacidosis?
Gliptins and sulfonylurea are ineffective in DM-1and DM-ketoacidosis in which the damaged beta islet cells by the body's own immune system, are absolutely incapable of producing insulin.
16. What is Diabetic ketoacidosis?
When there is absolutely no insulin is available to use glucose the body begins to use stored fat for energy to cell activity. When the liver process and breakdown the fat ketone bodies are formed that make the blood more acidic. DM-ketoacidosis is more serious and more it can lead to coma and death.
DM-ketoacidosis more common in DM-1 and it is very rare in DM-2
17. Can gliptins be used in heart patients?
No. It has been reported that gliptins cause cardiac fibrosis, which may result in heart failure and heart attack.
Can gliptins be combined with metformin?
Yes. If doctors feel if it is necessary for some patients. But care should be taken with patients having gastric distress. (e.g) Janumet. (Sitagliptin with metformin).
Q) What is the general treatment strategy for insulin-dependent DM?
A)As there is an absolute insulin deficiency or almost no insulin secretion at all because of the enormous or complete destruction of the beta cells these patients must receive a calculated dose of a type of insulin preparation suitable for their need.
Q) What is the general treatment strategy for a patient with non-insulin-dependent DM?
A) Diet control
Weight reduction
Oral hypoglycemic agents
Insulin injection added as if needed
Q) what are the effects of insulin?
A) insulin affects almost all tissues of the body, especially Liver, Muscle, and Adipose tissues
In the liver, it converts glucose into glycogen and promotes triglyceride formations
In muscle, it facilitates protein and glycogen synthesis and hence Insulin is a nonsteroidal anabolic hormone.
In adipose tissue, it helps the triglycerides to be stored and reduce circulating free fatty acids
Q) What type of insulin used in hyperglycemic emergencies?
A) Lispro and regular as they can be given through I.V. for rapid onset.
Q) What is the standard route of administration of insulin?
A) Subcutaneous.
Q) what are the sources of insulin?
A) Beef and Pork. Human insulin is made through bacterial recombinant technology
Q) What are the other three types of oral antihyperglycemic agents?
A) Sulphonylureas, Biguanides, and Alpha-glucosidase inhibitors
Q) What are the common treatment strategies of these agents?
A) To increase the secretions of insulin and the tissue response to it as by sulphonylureas, or to increase glycolysis in peripheral tissues as by biguanides or by decreasing the glucose absorption by the GI tract as by the Alpha-glucosidase inhibitors
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