Professional Documents
Culture Documents
4/26/2017
Tim Penyusun
• Dr. Nita Parisa
• Dr. Fauziah, M.Bmd
• Yeni Agustin, S.Si., M.Kes
4/26/2017
OUTLINES
PATHOGENESIS OF TYPE 2 DIABETES
MECHANISM OF ACTION
PHARMACOKINETICS
THERAPEUTIC USES AND DOSAGE
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
OUTLINES
PATHOGENESIS OF TYPE 2 DIABETES
MECHANISM OF ACTION
PHARMACOKINETICS
THERAPEUTIC
PHARMACODYNAMICS
USES AND DOSAGE
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
↓ 𝐼𝑛𝑠𝑢𝑙𝑖𝑛
↑ 𝐿𝑖𝑝𝑜𝑙𝑦𝑠𝑖𝑠
𝑠𝑒𝑐𝑟𝑒𝑡𝑖𝑜𝑛
TZDs + - TZDs
↑ 𝐺𝑙𝑢𝑐𝑎𝑔𝑜𝑛 ↑ 𝐺𝑙𝑢𝑐𝑜𝑠𝑒
𝑠𝑒𝑐𝑟𝑒𝑡𝑖𝑜𝑛 𝑟𝑒𝑎𝑏𝑠𝑜𝑟𝑝𝑡𝑖𝑜𝑛
HYPER
TZDs - GLYCEMIA + TZDs
↑ 𝐺𝑙𝑢𝑐𝑜𝑠𝑒 ↓ 𝐺𝑙𝑢𝑐𝑜𝑠𝑒
𝑝𝑟𝑜𝑐𝑢𝑐𝑡𝑖𝑜𝑛 𝑢𝑝𝑡𝑎𝑘𝑒
↑ 𝑛𝑒𝑢𝑟𝑜𝑡𝑟𝑎𝑛𝑠𝑚𝑖𝑡𝑡𝑒𝑟 ↓ 𝐼𝑛𝑐𝑟𝑒𝑡𝑖𝑛
𝑑𝑦𝑠𝑓𝑢𝑛𝑐𝑡𝑖𝑜𝑛 𝑒𝑓𝑓𝑒𝑐𝑡
Multiple defects type 2 diabetes: from Triumvirate to ominus
octet (DeFronzo, 2010)
Obesity-induced macrophage infiltration into
adipose tissue causes insulin resistance
insulin-sensitive tissue
(Tateya et al, 2013)
Insulin Resistance Mechanism
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
TZDs insulin sensitiser/glitazone
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
PHARMACOKINETICS
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
THERAPEUTIC USES AND DOSAGE
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
EFFICACY TZD
(Nesto et al, 2003; Pastromas et al, 2006; Brunton et al, 2010; Khrishnaswami et al, 2010;
Katzung et al, 2012; Rizos et al, 2016)
OUTLINES
PATHOGENESIS OF TYPE 2 DIABETES
MECHANISM OF ACTION
PHARMACOKINETICS
THERAPEUTIC
PHARMACODYNAMICS
USES AND DOSAGE
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
ADVERSE EFFECTS
(Nesto et al, 2003; Pastromas et al, 2006; Brunton et al, 2010; Khrishnaswami et al, 2010;
Katzung et al, 2012; Rizos et al, 2016)
OUTLINES
PATHOGENESIS OF TYPE 2 DIABETES
MECHANISM OF ACTION
PHARMACOKINETICS
THERAPEUTIC
PHARMACODYNAMICS
USES AND DOSAGE
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
CONTRA INDICATIONS
PLEIOTROPIC EFFECTS
ADVERSE EFFECTS
CONTRA INDICATIONS
DRUG INTERACTIONS
DRUG INTERACTIONS
(Scheen, 2007)
DRUG INTERACTIONS
DRUG INTERACTIONS
DRUG INTERACTIONS
(Scheen, 2007)
Regimen in Indonesia
Generic: Thiazolidinedion
Patent : Actos (15-30 mg), Gliabetes 30 mg,
Prabetic (15-30 mg), Deculin (15-30 mg),
Pionix (15-30 mg)
Once daily
With or Without Food
(Perkeni, 2011)
Metformin VS TZD
Source: Adapted from slide deck that accompanies Inzucchi SE, et.al. Diabetes Care 2015;38:140-49.
4/26/2017
Available at: http://care.diabetesjournals.org/content/38/1/140/suppl/DC2.
4/26/2017 (Perkeni, 2011)
CAUTION