Our fourth family are the glitazones.
Now we also call those TZD so either way you'll see that represented in the literature.
These drugs do something a little difference, they decrease insulin resistance
so they don't tell the pancreas to put out more insulin,
they help the body use the insulin that's there be more effective.
Now we'll likely use this with the biguanide or with the sulfonylurea
so we'll use TZDs with another medication.
Now they're not chemically related to those other medications and that's why we can use them together.
They're coming at the problem from different angles.
You see the name on your screen right there, underline that, pioglitazone,
it's the most common one that we use right now so that's why we're gonna dig a little deeper into that.
Because it's a TZD, it decreases insulin resistance.
That means my skeletal muscles are more likely to uptake that glucose out of the blood stream
and get it into my cells for energy.
Sadly, it also puts in my adipose tissues so it helps my cells be more likely to take that blood sugar
and move it from the blood stream into my cells
and that's what we're looking for in attacking insulin resistance.
It also might decrease glucose production
but predominantly we're gonna look at it taking the blood sugar out of the blood stream
and getting it into your cells.
Okay, now, the side effects with these, wanna look at, they'll have a headache,
they may have like some sinusitis, that's a really odd one, but they might also develop an upper respiratory infection.
If the patient has CHF, these medications can also cause fluid retention.
Whoa, don't speed by that.
If we've got somebody who kind of has a history of congestive heart failure or heart failure,
this medication is one we're gonna watch really closely
because we don't wanna make that any worse, so that's worth knowing,
that's worth making sure that you keep that in mind.
Now it might cause hepatotoxicity.
So, keep an eye on their liver, you know the signs when someone is starting to have liver problems.
They get kind of tired, if you started seeing their skin color change or their urine get darker
we know we've got some real problems on board.
One odd fact about this one is it does increase the risk for fractures in women.
Okay, now we've got a whole lot on that slide, right?
And if it wasn't enough for women, we've also got a risk for ovulation.
Release of eggs in premenopausal women, whoa, that would really get my attention,
but there's so much on this slide, how do we break it down?
Well, starting from head to toe, which one of these do you think would be the worst case scenario?
I don't like sinusitis, I don't want a respiratory infection and headaches aren't really fun either
but if it's gonna increase my risk for fluid retention,
that's absolutely one I'm gonna makes sure that I know.
So if a patient has a history of heart failure, I wanna be right on top of the risk for fluid retention.
Now, the other ones are kind of weird, the woman stuff?
So that's likely to stick out on you mind but if I was premenopausal
and then found out I got pregnant that would definitely give me a lot of stress.
So the risk for fractures, the premenopausal ovulation
those are kind of good to know but absolutely for sure I wanna keep in mind
it's gonna give me problems with fluid retention if I have a history of congestive heart failure.