30.胰岛素——山东大学药理学英文课件Insulin.pptVIP

Part 2 Oral hypoglycemic agents Common characteristics (1) Orally effective and convenient (2) Slow and weak (3) NIDDM Ⅰ insulin sensitizer Rosiglitazone(罗格列酮) Englitazone (恩格列酮) Pioglitazone (吡格列酮) Troglitazone (曲格列酮) Ciglitazone （环格列酮） Pharmacological action 1.Improve insulin resistance, lower hyperinsulinemia and hyperglycemia Limosis and after-meal BS Blood insulin and blood fatty acid used in combination with other drugs Low incidence of hypoglycemia 2.Correct lipodystrophy ↓TG，↑TC and ↑HDL－C 3.Improve complication of NIDDM anti-atherosclerosis effect delay occurrence of albuminuria 4.Improve β-cell function Mechanism （PPARγ )过氧化物酶增殖体受体γ Clinical use NIDDM and IR Adverse reaction general reaction heptic toxicity Ⅱ. Sulfonylureas（磺酰脲类） The first generation: Tolbutamide(甲苯磺丁脲), chlorpropamide(氯磺丙脲). The second generation: glyburide(格列本脲), glipizide(格列吡嗪), gliquidone, glimepiride(格列美脲) The third generation: gliclazide pharmacokinetics Absorption: P.O Distribution: PPBR Elimination: liver Excretion:kidney Pharmacological effects Hypoglycemic action: weaker than Insulin (1)Increasing the release of Insulin from pancreatic βcell: (2) Enhancing the sensitivity of target cell to insulin ①Increasing the numbers of insulin receptors ②Increasing the affinity of insulin receptors (3) Decreasing the release of glucagons from pancreatic A cell by stimulating the release of somatostatin 2.Antidiuretic action: chlorpropamide ↑secretion of ADH 3.Effects on coagulation ↓adhesion and agregation of PLT ↑synthesis of plasminogen ↓sensitivity of microvessel to CA Clinical uses 1.NIDDM control hyperglycemia in NIDDM who can not achieve appropriate control with exercise and dietary modification alone. (1)alone (2)plus insulin 2.Diabetes insipidus（尿崩症 ） Adverse reactions 1. Hypoglycemia reactions 2. Gastrointestinal tra