Diabetes Asthma

1. Insulin 1. Salbutamol
2. Metformin HCl 2. Symbicort
3. Sitaglipin phosphate a. Budenoside
b. Formoterol
Hyperglycemia
Insulin Salbutamol
Glucagon - short acting B2 adrenergic
Incretins SE/AE Precautions
- GLP-1 Hypokalemia Hypertension
- GIP Headache Hyperthyroidism
Type 1, 2, Gestational, other specific Hypotension Seizure
Complications Angioedema Stevens-johnson syndrome
- hyperglycemia Lactic acidosis Cardiac arythmia
- glycosuria Dryness of mouth Diabetes
Damage Paradoxical bronchospams
- ischemia Tacycardia
- poor wound healing Skeletal tremor
Exogenous Insulin
- Aspart  Novolog Symbicort
- Glulisine  Apidra - at least 6 years old
- Human  Afrezza - prevent bronchospasm
- Lispro Humalog  Budenoside
o steroid reduces inflammation
Adverse Effects Side effects  Formoterol
Confusion Pain o Long acting beta 2 adrenergic receptor
Headache Redness Side Effects Adverse Effects
Hunger Itching White patches in mouth.throat Hyperglycemia
Anxiety Swelling Throat irritation Visual disturbances
Fatigue Thickening at injection Stomach discomfort Wheezing/choking
Tachycardia site Cold
Sweating Large Weight gain Headache
Shortness of breath Flu

Metformin HCl Special Concerns

-  hepatic glucose prod =  insulin sensitivity 1. awareness of bronchospasm attack
-  absorption of glucose 2. side effects of bronchodilators
- meal improves
Sitaglipin phosphate
- DPP 4 inhibitor
- Regulate insulin after meal
Common SE AE Serious SE
Nausea Joint pain Severe
Vommiting Kidney prob stomachache
Stomachache Blisters Lactic acidosis
Diarrhea Signs of heart Abdominal
Headache Weight gain pain back
Metallic Taste Ankle foot Pancreatitis
edema Persistent
Tiredness nausea &
vommiting

Special Concerns
1. Awareness of Hypoglycemia attack
2. Monitor breathing
3. Side effects of insulin, metformin HCL, sitaglipin
phosphate
Stroke

1. Citicoline
2. Mannitol

Ischemic
Hemorrhagic
Transient Ischemic Attack

Symptoms
1. numbness
2. (-) speak, understand,
3. (-) seeing
4. (-) walking
5. headache
Conditions
- HBP
- Diabetes
-  cholesterol
- atrial fibrillation

Citicoline
- cytidine diphosphate-choline
- cytidine 5-diphosphatecholine
- intermediate generation
- oral
o  thinking skills (1000-2000 mg)
o chronic CV
o ischemic storke (500-2000 mg)
- intravenous
o chronic CV & thinking skills
- Intramuscular
o Chronic CV
Side Effects
Headache Low/High BP
Insomnia Blurred vision
Nausea Chest pain
Diarrhea

Mannitol
-  blood plasma osmolality = (+) flow of water from
tissue
- reduces: cerebral edema, intracranial pressure, CSF
volume & pressure
Side Effects
Headache Vomiting
Hypotension Arm pain
Hives Thirst
Diarrhea Irritation
Dry mouth Chills
Dehydration Arrythmia
Dizziness Nausea
Blurred vision
Runny nose
Electrolyte Imbalance
Special Concerns
1. awareness of episode of stroke
2. side effects of citicoline and mannitol