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Pharmacology — Glucose-Modifying Drugs and Diuretic Mechanisms

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GLUCOSE-MODIFYING DRUGS AND DIURETIC MECHANISMS

Metformin improves insulin resistance by increasing glucose utilisation in liver and muscle and increasing insulin sensitivity. It requires endogenous insulin for its action and does not itself cause hypoglycaemia.

Sulphonylureas cross the placenta and stimulate fetal beta cells. Hypoglycaemia is a characteristic adverse effect and may occasionally be severe. Tolbutamide has the lowest risk because of its relatively low potency and short duration of action. Chlorpropamide can stimulate antidiuretic hormone activity and is associated rarely with mild SIADH.

Drug effects on glucose are bidirectional: corticosteroids, thiazides and glucagon may cause hyperglycaemia, whereas ethanol, aspirin, gliclazide and atenolol may cause hypoglycaemia.

Diuretic classes can be distinguished by nephron site and transporter. Loop diuretics such as furosemide inhibit the sodium-potassium-2 chloride transporter in the ascending limb and are more potent than thiazides. Thiazides act in the cortical diluting segment/early distal tubule by inhibiting sodium-chloride transport and may cause hypokalaemia, hypochloraemic alkalosis, hyperuricaemia and hyperglycaemia.

Amiloride and triamterene conserve potassium by inhibiting epithelial sodium channels and produce relatively mild natriuresis. Osmotic agents such as mannitol and urea expand blood volume and may be used in cerebral oedema.

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Classification Relationships — through Subtopic3

9 assigned

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Diuretics→ Nephron site and transporter→ Loop versus thiazide diuretics

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Diuretics→ Osmotic diuretics→ Blood volume expansion and cerebral oedema

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Diuretics→ Potassium-sparing diuretics→ Epithelial sodium-channel inhibition

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Diuretics→ Thiazide diuretics→ Mechanism and adverse effects

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Diuretics→ Thiazide diuretics→ Na-Cl symport inhibition

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Drugs Interfering with Glucose Metabolism→ Biguanides→ Metformin mechanism

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Drugs Interfering with Glucose Metabolism→ Chlorpropamide→ Antidiuretic hormone effect

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Drugs Interfering with Glucose Metabolism→ Drug effects on blood glucose→ Hyperglycaemia and hypoglycaemia

Obstetrics and Gynaecology→ Basic→ Pharmacology→ General→ Drugs Interfering with Glucose Metabolism→ Sulphonylureas→ Placental and hypoglycaemic effects

Pharmacology — Glucose-Modifying Drugs and Diuretic Mechanisms

Additional Insight #46

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Classification Relationships — through Subtopic3

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