各论II 28、抗糖尿病药.pptxVIP

Insulin and oral hypoglycemic drugs;A group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both 194 million people worldwide 90% cases are Type 2 ; CLASSIFICATION;CLASSIFICATION;CLINICAL FEATURES;Therapy of Diabetes Mellitus;Insulin and its action enhancers ;Structure of insulin;Insulin;Insulin;Interaction between insulin and its receptor IRS: insulin receptor substrate tyr: tyrosine P: phosphate;2. Clinical uses Type 1 diabetes mellitus (2) Type 2 diabetes mellitus: failure to other drugs or diet control (3) Diabetic complications: diabetic ketoacidosis (酮症酸中毒), hyperosmotic nonketotic coma（高渗性非酮症性昏迷） (4) Critical situations of diabetic patients: fever, severe infection, pregnancy, trauma, operation (5) Others: intracellular lack of K+;3. Preparations ;Rapid Acting Insulin Analogues;3. Preparations ;Regular Insulin;3. Preparations ;Glargine (Lantus 甘精胰岛素);Mixed insulin;4. Adverse effects (1) Hypersensitivity: treated with H1 receptor antagonist, glucocorticoids, replaced by human or high purity insulin (2) Hypoglycemia: (sweating, hunger, weakenss, tachycardia, blurred vision, headache, coma, shock, etc.), drink glucose contained water, or treated with 50% glucose (3) Lipoatrophy: localized in injection sites (4) Insulin resistance: Acute: stress etc. induced, need large dose of insulin Chronic: need 200U/d and no complication ;4. Adverse effects (5) Increase body weight (6) Ametropic eye 屈光不正 (7) Edema ; Thiazolidinediones (TDs) 噻唑烷酮类化合物 Biguanides (双胍类) ; 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 ; Rosiglitazone 罗格列酮 ; 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