Question

Discuss the pharmacologic treatment of at least five physiologic changes due to metabolic syndrome. How do these treatments work and what are their risks and benefits?

Answer 1

Physioligic changes due to Metablic Syndrome:

(1) High blood pressure (Hypertension) - the medications to control patients high blood pressure are:

a. Diuretics example Furosemide (Lasix) and Bumetadine (Bumex) this medications increase urination whixh reduces sodium and fluid in the body, it lowers blood volume that can help lower blood pressure. One major side effect or this drug is loss of potassium which is carried out of the body through urine along with sodium. Patients taking this medicine are usually advice to eat food reach in potassium like orange or banana.

b. Beta blocker - lower blood pressure by acting directly on the heart. These high medications reduce heart rate and force of pumping, as well as reduce blood volume.

• Acebutolol (Sectral)
• Atenolol (Tenormin)

c. ACE inhibitors - is a hormone in the body that causes blood vessels to narrow. The angiotensin-converting enzyme(ACE) inhibitors decrease the production of angiotensin and, in turn, that helps lower blood pressure.

• Benazepril hydrochloride (Lotensin)
• Captopril (Capoten)

d. Angiotensin II receptor blockers - The hormone angiotensin narrows blood vessels, but to do its job it needs a place to bind. That's where angiotensin II receptor blockers come in. They prevent angiotensin from binding to receptors on the blood vessels and that helps lower blood pressure.

• Azilsartan (Edarbi)
• Candesartan (Atacand)

e. Calcium channel blockers - Calcium increases the strength and force of contractions in the heart and blood vessels. Blocking its entry into smooth muscle tissue reduces this effect. Calcium channel blockers lower blood pressure by relaxing blood vessels and reducing heart rate.

• Amlodipine besylate (Norvasc, Lotrel)
• Clevidipine (Cleviprex)

f.  Alpha blockers - Alpha blockers cause blood vessels to dilate, thereby lowering blood pressure.

• doxazosin mesylate (Cardura)
• prazosinhydrochloride (Minipress)
• terazosin hydrochloride (Hytrin).

g. Alpha-2 receptor Agonist - works in the central nervous system to lower blood pressure.

• Methyldopa

h. Central Agonists -  work in the central nervous system rather than directly on the cardiovascular system.

• clonidine hydrochloride (Catapres)
• guanfacine hydrochloride (Tenex).

i. Pheripheral Adrenergic Inhibitors - work in the brain to block signals that tell blood vessels to constrict.

• guanadrel (Hylorel)
• guanethidine monosulfate (Ismelin)
• reserpine (Serpasil)

j. Vasodilators - relax artery wall muscles, and that causes blood pressure to drop.

• minoxidil (Loniten)
• hydralazine (Apresoline)
• minoxidil (Loniten)

(2) High blood sugar (Diabetes)

Medications:

a. Alpha-glucosidase inhibitors - these medications help your body break down starchy foods and table sugar

• acarbose (Precose)
• miglitol (Glyset)

b. Biguanides - decrease how much sugar your liver makes. They decrease how much sugar your intestines absorb, make your body more sensitive to insulin, and help your muscles absorb glucose.

• metformin-alogliptin (Kazano)
• metformin-canagliflozin (Invokamet)

c. Dopamine agonist - affect rhythms in your body and prevent insulin resistance.

• Bromocriptine (Cycloset)

d. DPP-4 inhibitors - DPP-4 inhibitors help the body continue to make insulin. They work by reducing blood sugar without causing hypoglycemia (low blood sugar) and help pancrease make more insulin.

• alogliptin (Nesina)
• alogliptin-metformin (Kazano)

e. Glucagon-like peptides - they increase B-cell growth and how much insulin your body uses. They decrease your appetite and how much glucagon your body uses. They also slow stomach emptying.

• albiglutide (Tanzeum)
• dulaglutide (Trulicity)

f. Meglitinides - these medications help your body release insulin but in some cases, it may lower your blood sugar too much.

• nateglinide (Starlix)
• repaglinide (Prandin)

g. Sodium glucose transporter (SGLT) 2 inhibitors - work by preventing the kidneys from holding on to glucose. Instead, your body gets rid of the glucose through your urine.

• dapagliflozin (Farxiga)
• dapagliflozin-metformin (Xigduo XR)

h. Sulfonylureas - work by stimulating the pancreas with the help of beta cells. This causes your body to make more insulin.

• glimepiride (Amaryl)
• glimepiride-pioglitazone (Duetact)

i. Thiazolidinediones - work by decreasing glucose in your liver. They also help your fat cells use insulin better.

These drugs come with an increased risk of heart disease.

• rosiglitazone (Avandia)
• rosiglitazone-glimepiride (Avandaryl)

(3) Abdominal Obesity - the only treatment needed for abdominal obesity is a healthy lifestyle, lose weight and engaging to physical activies like exercise.

(4) High serum triglycerides

(5) Low high-density lipoprotein (Hypoalphalipoproteinemia)

High triglycerides treatment and low high-density lipoprotein treatment are mostly the same the medication effect both diseases.

Medications:

a. Fibrates - lower blood triglyceride levels by reducing the liver's production of VLDL (the triglyceride-carrying particle that circulates in the blood) and by speeding up the removal of triglycerides from the blood.

• Bezafibrate
• Ezetimibe

b. Niacin - the inhibition of triglycerides synthesis by niacin results in accelerated intracellular hepatic apo B degradation and the decreased secretion of very-low-density lipoprotein and low-density lipoprotein particles.

c. Omega-3 fatty acids

d. Statins - work by reducing the liver's production of cholesterol. They block an enzyme called HMG CoA Reductase that the liver uses to make cholesterol

• Atorvastatin
• Fluvastatin