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thewaltzy · 5 years

Text

Exenatide, Liraglutide, Dulaglutide, etc.

Class

GLP-1 Mimetic / Incretin Analogue

Indication

Type 2 Diabetes Mellitus

Adjunct in weight management

Mechanism of Action

Increases insulin secretion

Suppresses glucagon secretion

Slows gastric emptying

Activation of the glucagon like peptide 1 receptor increases insulin secretion from the beta cells of the Islets of Langerhans, while decreasing glucagon secretion from the alpha cells of the Islets of Langerhans

GLP-1 has been shown to inhibit gastropancreatic function by inhibiting central parasympathetic outflow thereby slowing the rate of gastric emptying

Dose

Exenatide

Initially 5 micrograms twice daily to be taken upto an hour before 2 main meals for at least 1 month, then increased (if necessary) up to 10 micrograms twice daily

Liraglutide

Initially 0.6 mg once daily for at least 1 week, then increased to 1.2 mg once daily for at least 1 week, then increased (if necessary) to 1.8 mg once daily

Dulaglutide

1.5 mg once weekly

Side effects

May cause weight loss

Decreased appetite

Constipation

Diarrhoea

Gastrointestinal disturbance

Nausea and vomiting

Renal impairment

Acute pancreatitis

Caution

Elderly

Pancreatitis

Mild to moderate hepatic impairment

Mild renal impairment

Congestive heart failure

Contraindication

Ketoacidosis

Pregnancy

Breastfeeding

Severe hepatic impairment

Moderate to severe renal impairment

Other points

May be used in combination with a sulphonylurea and metformin if triple therapy with metformin and 2 other oral drugs contraindicated, not tolerated or not sufficient in controlling blood glucose for patients whom

Have a BMI ≥35 Kg/m2, and specific psychological or other medical problems associated with obesity

Have a BMI <35 Kg/m2, and for whom insulin therapy would have significant occupational implications and/or weight loss would benefit other significant obesity-related comorbidities

After 6 months, the drug should be reviewed and only continued if there has been a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body-weight

Women should use effective contraception during treatment with modified-release exenatide and for 12 weeks after discontinuation

Source

BNF

Give the Receptor a Brake: Slowing Gastric Emptying by GLP-1; J Tong, D D’Alessio; Diabetes (2014 Feb) 63(2): 407 - 409

#Diabetes Mellitus #Diabetes #Uni #Medicine #Medication #Drug #T2DM #GLP-1 Mimetic #Incretin Analogue #Injection

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cancersfakianakis1 · 5 years

Text

Variations in right colic vascular anatomy observed during laparoscopic right colectomy

Abstract

Background

This study aimed to analyze right colonic vascular variability.

Methods

The study included 60 consecutive patients who underwent laparoscopic radical right colectomy and D3 lymph node dissection for malignant colonic cancer on the ileocecal valve, ascending colon or hepatic flexure (March 2013 to October 2016). The videos of the 60 surgical procedures were collected. Variations of right colonic vascular anatomy were retrospectively analyzed based on 60 high-resolution surgical videos of laparoscopic surgery.

Results

The superior mesenteric artery and vein were present in all cases; 95.0% (57/60) had the superior mesenteric artery on the left side of the superior mesenteric vein. The ileocolic artery and vein occurred in 96.7% (58/60) and 100% (60/60) of cases, respectively; 50.0% (29/58) had the ileocolic artery passing the superior mesenteric vein anteriorly. Thirty-three (55.0%) cases had a right colic artery, and 2 (3.33%) had a double right colic artery; 90.9% (30/36) had the right colic vein passing anterior to the superior mesenteric artery. Fifty-six (93.3%) cases had a right colic vein; 7 (12.5%) had a right colic vein accompanied by a right colic artery, 66.1% (37/56) had the right colic vein draining into the gastrocolic trunk of Henle, 23.2% (13/56) had the right colic vein directly draining into superior mesenteric vein, and 10.7% (6/56) had one right colic vein draining into the superior mesenteric vein and the other into the gastrocolic trunk of Henle. Fifty-three (88.3%) cases had a gastrocolic trunk of Henle: a gastrocolic trunk in 35.8% (19/53), a gastropancreatic trunk in 9.4% (5/53), and a gastropancreaticocolic trunk in 54.7% (29/53). The frequencies of middle colic artery and vein were respectively 100% (60/60) and 93.3% (56/60).

Conclusions

Right colonic vascular variations were classified in Chinese patients. Notable findings included a superior mesenteric artery positioned to the right of the superior mesenteric vein and variation in middle colic artery length. This knowledge may be helpful to colorectal surgeons and could potentially help to improve safety by reducing vascular complications during minimally invasive procedures.

http://bit.ly/2VQtjYa

#Oncology-Sfakianakis

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