氢化可的松.ppt

Biguanides 1. Pharmacilogical effects increasing glucose uptake in fat tissues and anaerobic glycolysis in skeletal muscles decreasing glucose absorption in gut, gluconeogenesis, and glucagon release. ?2. Clinical uses insulin-independent patients especially with obesity ? 3. Adverse effects severe lactic acidosis (less for metformin), malabsorption of vitamin B12 and folic acid? Thiazolidinediones (TDs) 噻唑烷酮类化合物 Rosiglitazone 罗格列酮 Pioglitazone 吡格列酮 Troglitazone 曲格列酮 Insulin action enhancers 1. Pharmacological effects Selective agonists for nuclear peroxisome proliferator-activated receptor-? (PPAR?, 过氧化物酶增殖体激活受体?). (1) Fat cells differentiate to a lot of small fat cells, and increase GLUT-4 expression (2) Increase signal transmission of insulin (Rosiglitazone increase insulin receptors) (3) Decrease leptin, IL-6 and TNF-alpha expression in fat cells (4) increase GLUT1,4 transcription and expression (5) Inhibit VEGF mediated angiogenesis, to prevent the complications. (6) Increase adiponectin level, recover the function of B cells Insulin action enhancers 1. Pharmacological effects (1) Lowering insulin resistance (2) Lipid metabolism regulation: TG, free fat acid, LDL ? (3) Effect on vascular complications in type 2 patients (4) Recover the function of B cells Insulin action enhancers 2. Clinical uses Used for treatment of insulin-resistant diabetic patients or type 2 patients 3. Adverse effects Increase body weight, Edema, headache, myalgia, GI reactions, hepatic damage (troglitazone) Insulin action enhancers Other oral hypoglycemic drugs Oral insulin secretagogues Sulfonylureas (磺酰脲类) Repaglinide Incretin (GLP-1) Mimetics Dipeptidylpeptidase IV (DPP-IV) Inhibitors Oral hypoglycemic drugs Sulfonylureas（磺酰脲类） Tolbutamide (D860) 甲磺丁脲 Chlorpropamide 氯磺丙脲 Glibenclamide 格列本脲 (优降糖) Glipizide 格列吡嗪 Gliclazide 格列齐特 (达美康) Sulfonylureas 1. Pharmacological effects Hypoglycemic effect: blocki