Insulin preparation and analogues -enumerate Diabetic ketoacidosis out

Insulin preparation and analogues -enumerate Diabetic ketoacidosis outline treatment and management of diabetic ketoacidosis detail Oral hypoglycemic agents classify;biguanides moa,adverse effect, uses ; sulfonylureas moa, adverse effect, uses ;thiazolidinediones moa, pharmacological actions, adverse effect and uses : metformin moa adverse effect, uses Insulin different sources, indications, human insulin over conventional insulin advantages detail answer each for 2nd yr mbbs pharmacology refer kd tripathi add flowcharts and diagram

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Here is your complete, exam-ready pharmacology notes for 2nd Year MBBS. All topics are covered in detail:

What's covered above:

1. Insulin Sources

Three sources: Bovine, Porcine, Human (recombinant DNA)

2. Human Insulin Advantages (detailed table)

Less antigenic, no immune resistance, no lipodystrophy, unlimited supply, no animal-pathogen risk

3. Insulin Preparations - Full Enumeration

Rapid-acting: Lispro, Aspart, Glulisine, Inhaled insulin Short-acting: Regular insulin (only one given IV) Intermediate: NPH (Isophane) insulin Long-acting: Glargine (peakless), Detemir, Degludec (ultra-long, >42 h) Mixtures: 70/30 combinations

The pharmacokinetic graph from Lippincott is included showing onset/peak/duration curves for all types.

4. Insulin Analogues

How structural modifications produce altered kinetics (lispro - reversed B28/B29; glargine - precipitates at pH 7.4; detemir - fatty acid + albumin binding)

5. DKA - Complete Management

Outlined with pathophysiology flowchart, precipitating factors ("I's mnemonic"), the 4 pillars (Fluids → Insulin → K⁺ → Treat cause), step-by-step insulin protocol, K⁺ replacement rules, bicarbonate guidelines, and resolution criteria

6. Oral Hypoglycaemic Agents - Full Classification

All 6 classes enumerated with complete structure

7. Biguanides/Metformin

AMPK activation → ↓ hepatic gluconeogenesis (primary), MOA diagram, adverse effects (GI, lactic acidosis, B12 deficiency), uses

8. Sulfonylureas

SUR-1/K_ATP channel mechanism flowchart, adverse effects (hypoglycaemia most important, weight gain, chlorpropamide-specific: SIADH, disulfiram), uses

9. Thiazolidinediones (TZDs)

PPAR-γ mechanism, pharmacological actions (lipid, BP, inflammatory), adverse effects (oedema, heart failure, fractures, bladder cancer for pioglitazone), uses

10. Comparison Tables

All OHAs compared by MOA, site, hypoglycaemia risk, weight, HbA1c reduction

Insulin preparation and analogues -enumerate Diabetic ketoacidosis outline treatment and management of diabetic ketoacidosis detail Oral hypoglycemic agents classify;biguanides moa,adverse effect, uses ; sulfonylureas moa, adverse effect, uses ;thiazolidinediones moa, pharmacological actions, adverse effect and uses : metformin moa adverse effect, uses Insulin different sources, indications, human insulin over conventional insulin advantages detail answer each for 2nd yr mbbs pharmacology refer kd tripathi add flowcharts and diagram

Reading File

Finding Sources

Reading File

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Reading File

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Here is your complete, exam-ready 2nd Year MBBS Pharmacology notes. Everything is covered with full detail:

What's in these notes:

PART 1: INSULIN

Sources (3 types):

Bovine (3 AA differences - most antigenic), Porcine (1 AA difference), Human (recombinant DNA - least antigenic)

Human vs Conventional Insulin - 8 detailed advantages: Less antigenicity, no immune resistance, fewer allergic reactions, no lipodystrophy, faster absorption, monocomponent purity, unlimited supply, no animal pathogen risk

Insulin Preparations - Full Enumeration with table:

Rapid-acting: Lispro, Aspart, Glulisine, Inhaled (onset 5-15 min)
Short-acting: Regular insulin (onset 30-60 min) - the ONLY insulin for IV use
Intermediate: NPH/Isophane (SC only, never IV)
Long-acting: Glargine (peakless, 24 h), Detemir (~17 h), Degludec (>42 h, ultra-long)
Premixed combinations

Insulin Analogues - structural changes explained for each (lispro B28/B29 swap; glargine pH 4 precipitation; detemir fatty acid-albumin binding; degludec multi-hexamer depot)

Indications - absolute and relative

Two key diagrams included: Onset/duration curves from Lippincott + Katzung sulfonylurea K_ATP mechanism diagram

PART 2: DKA

Full outline: Definition, diagnostic triad (D-K-A), severity classification table, pathophysiology flowchart, precipitating factors, clinical features (Kussmaul breathing, fruity breath, pseudoacute abdomen)

Management - 4 pillars in detail:

Fluids: Phase 1 (0.9% NS bolus) → Phase 2 (0.45% NS) → D5W when BG ≤250
Potassium: Critical decision tree - hold insulin if K⁺ <3.3, replace 20-40 mEq/L if 3.3-5.5
Insulin: Regular IV only, 0.1 units/kg bolus then 0.1 units/kg/h, target ↓50-75 mg/dL/h
Bicarbonate: NOT routine; only if pH <7.0
Resolution criteria, monitoring schedule, transition to SC insulin

PART 3: ORAL HYPOGLYCAEMIC AGENTS

Full Classification (6 classes in a clean tree diagram)

Metformin (Biguanide): AMPK → ↓ hepatic gluconeogenesis (primary), full MOA flowchart, adverse effects (GI, lactic acidosis, B₁₂ deficiency), contraindications, uses

Sulfonylureas: SUR-1/K_ATP mechanism with diagram, generation-wise drugs, ADRs (hypoglycaemia #1, weight gain, chlorpropamide-specific SIADH + disulfiram), uses

Thiazolidinediones: PPAR-γ nuclear receptor mechanism, pharmacological actions (glycaemic, lipid, anti-inflammatory, NAFLD), ADRs (oedema, heart failure, fractures, bladder cancer), uses

Master comparison table for all 3 + visual adverse effects diagram from Lippincott