THE HUBERT KAIRUKI MEMORIAL UNIVERSITY

FACULTY OF MEDICINE

DEPARTMENT OF CLINICAL PHARMACOLOGY.

ONLINE ASSIGNMENT 3

NAME OF FACILITATOR; DR. AMANI

NAME OF STUDENT; AMON S AMON

REGISTRATION NO.; HK/MD/18/2164

QUESTION 1

Using three case scenarios of your choice explain three different approaches that are used globally for
the treatment of patients with type 2 DM.

-case scenario 1

If the patient with type 2 DM has a main problem of not sensing insulin[has low insulin sensitivity].

In this case we will use Insulin sensitizers like Thiazolidinediones[TZDs]which will help increase insulin
sensitivity to the patient which will increase insulin intake to the tissues and decrease glucose release in
to the blood stream hence treat the type 2 DM. These drugs also decrease or inhibit release of free fatty
acid from adipose tissue hence decrease the glucose present in the blood stream.

-case scenario 2

If the patient’s biggest problem is the release of large amount of glucose from the liver[high
glycogenolysis]

In this case we will use Biguanide such as Met Formin which will help decrease glycogenolysis in the
liver hence glucose will not be released to the blood stream from the liver and this will decrease the
absorption of sugar in the intestines this will help maintain the glucose present in the blood stream and
help treat type 2 DM. These drugs also help increasing glucose uptake to the tissues hence control
glucose level in the blood stream.

-case scenario 3

If the patients biggest problem is secreting low amount of insulin[has insufficient insulin]

In this case we will use insulin secretagogues such as sulfonylureas which will stimulate the beta
cells of the pancreas to release more insulin. They do this by inhibiting the K+ transporter preventing the
efflux of K+ causing deporalization of the beta cells which leads to release of insulin from vesicles. This
will help increase the amount of insulin the blood stream hence sufficient insulin will be produced as
needed.
QUESTION 2

Explain in details parameters that you will use to monitor patients on pharmacological treatment of
their diabetic conditions.

In monitoring patients on pharmacological treatment of diabetic conditions we use parameters such

as;

a)Glycosilated haemoglobin; this is when we check on the amount of glucose present in the
haemoglobin. It normally should be 5.5% but if it is 6.5% then it is hyperglycemia.This is usually an
indicator of chronic hyperglycemia hence it is a very important parameter to consider as it tells us how
to pharmacologically monitor a patient with high or low glycosylated haemoglobin. If the patient has
high glucose level in the haemoglobin then there needs to be an immediate monitoring of the patient as
the patient already has chronic hyperglycemia which needs to be dropped back to normal by different
types of drugs either insulin sensitizers, insulin secretagogues or biguanides.

b)Fasting blood sugar level for 12hours; this normally should be <100mg/dl but if its >126mg/dl then it is
hyperglycemia and it needs monitoring to lower it to normal levels hence the pharmacological
treatment of this parameter is the use of drugs such as glucosiodise inhibitors like Acarbose which will
inhibit glucosiodise enzyme causing decrease in glucose absorption hence lower blood glucose.

c)Ketosis and ketonuria;this is the presence of keto acids in the blood and eventually in the
urine[ketonuria].This is mostly in type 1 DM cause of low amount of insulin hence causes the release of
fats from fat cells which in turn are converted to ketones. The accumulation of ketones in type 1 DM is
an emergency situation which needs to be immediately controlled hence this parameter is important in
monitoring these patients.

d)Glycosuria;This is the presence of glucose in the urine and normally it does not happen but incase
there is glucose in the urine then it is a sign of hyperglycemia and needs monitoring as soon as possible
by medications like biguanides,insulin secretagogues and insulin sensitizers which will help lower the
glucose level.

QUESTION 3

Compare and contrast antiresorptive drugs from anabolic agents used in the treatment of bone
disorders.

SIMILARITIES OF ANTIRESORPTIVE DRUGS AND ANABOLIC AGENTS

-They are both used in treatment of bone disorders such as osteoporosis.

-They both have a potential to improve bone density and bone strength hence all used in treatment of
osteoporosis.

-They both help prevent and reverse bone fragility by bone remodeling

-They both depend on the effects of calcium levels in the bones and blood stream.

-Their effects can both be seen in strontium ranelate.

DIFFERENCES OF ANTIRESORPTIVE DRUGS AND ANABOLIC AGENTS.

ANTIRESORPTIVE DRUGS ANABOLIC AGENTS

1.They are drugs that decrease bone loss hence
increases the bone strength
2.These drugs activates/affects the osteoblasts
3.Its examples are
bisphosphonates,calcitonin,calcium and selective
oestrogen receptor modulators[SERMs]
1.These are agents which increase bone
formation hence increases bone mass
2.These are resorptive agents and they stimulate
the osteoclasts
3.Its examples are parathyroid hormone[PTH]
and teriparatide.