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There's a class of type 2 diabetes drugs that not only improves blood sugar control but may also lead to weight loss. This class of drugs is commonly called glucagon-like peptide 1 (GLP-1) agonists. A second class of drugs that may lead to weight loss and improved blood sugar control is the sodium glucose cotransporter 2 (SGLT-2) inhibitors. These include canagliflozin (Invokana), ertugliflozin (Steglatro), dapagliflozin (Farxiga) and empagliflozin (Jardiance).
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These drugs mimic the action of a hormone called glucagon-like peptide 1. When blood sugar levels start to rise after someone eats, these drugs stimulate the body to produce more insulin. The extra insulin helps lower blood sugar levels.
Lower blood sugar levels are helpful for controlling type 2 diabetes. But it's not clear how the GLP-1 drugs lead to weight loss. Doctors do know that GLP-1s appear to help curb hunger. These drugs also slow the movement of food from the stomach into the small intestine. As a result, you may feel full faster and longer, so you eat less.
Along with helping to control blood sugar and boost weight loss, GLP-1s and SGLT-2 inhibitors seem to have other major benefits. Research has found that some drugs in these groups may lower the risk of heart disease, such as heart failure, stroke and kidney disease. People taking these drugs have seen their blood pressure and cholesterol levels improve. But it's not clear whether these benefits are from the drug or the weight loss.
Low blood sugar levels (hypoglycemia) are a more serious risk linked to the GLP-1 class of drugs. But the risk of low blood sugar levels often only goes up if you're also taking another drug known to lower blood sugar at the same time, such as sulfonylureas or insulin.
Brain Blitz has a pumping and stimulating effect by expanding blood vessels, increasing muscle nutrition, providing oxygen to the muscles, which results in an increase in muscle pump. At the same time, it also improves mental function and neuro-body coordination by enhancing muscle memory.
Progesterone is sometimes used with another medication (a type of estrogen) as combination hormone replacement therapy (HRT) in women after menopause. Combination HRT can rarely cause very serious side effects such as heart disease (such as heart attacks), stroke, serious blood clots (such as in the lungs and legs), dementia, and breast cancer. Some of these risks appear to depend on the length of treatment and other factors. Combination HRT should be used for the shortest possible length of time at the lowest effective dose so you can obtain the benefits and minimize the chance of serious side effects from long-term treatment. Combination HRT should not be used to prevent heart disease or dementia. Discuss the risks and benefits of treatment and your personal health history with your doctor. If you take combination HRT, check with your doctor regularly (such as every 3-6 months) to see if you still need to take it.
If you use this medication for an extended period, you should have a complete physical exam at regular intervals (such as once a year) or as directed by your doctor. See Notes section. Warnings: Progesterone is sometimes used with another medication (a type of estrogen) as combination hormone replacement therapy (HRT) in women after menopause. Combination HRT can rarely cause very serious side effects such as heart disease (such as heart attacks), stroke, serious blood clots (such as in the lungs and legs), dementia, and breast cancer. Some of these risks appear to depend on the length of treatment and other factors. Combination HRT should be used for the shortest possible length of time at the lowest effective dose so you can obtain the benefits and minimize the chance of serious side effects from long-term treatment. Combination HRT should not be used to prevent heart disease or dementia. Discuss the risks and benefits of treatment and your personal health history with your doctor. If you take combination HRT, check with your doctor regularly (such as every 3-6 months) to see if you still need to take it.
Tell your doctor right away if you have any serious side effects, including: nausea/vomiting that doesn't stop, unusual vaginal bleeding (such as spotting, breakthrough bleeding), mental/mood changes (such as depression, memory loss), swelling of the hands/feet, frequent/burning/painful urination, breast lumps, dark patches on the skin or face (melasma), yellowing eyes/skin, stomach/abdominal pain, dark urine, unusual tiredness.
This medication may rarely cause very serious (possibly fatal) problems from blood clots (such as heart attack, stroke, blood clots in the lungs or legs, blindness). Get medical help right away if any of these very serious side effects occur: chest/jaw/left arm pain, weakness on one side of the body, trouble speaking, difficulty walking, sudden vision changes (such as blurred/double vision, loss of vision, bulging eyes), confusion, sudden severe headache, severe dizziness, fainting, trouble breathing, coughing up blood, pain/redness/swelling/weakness of the arms/legs, calf pain/swelling that is warm to the touch.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood clots, history of bleeding in the brain, liver disease, vaginal bleeding of unknown cause, a loss of pregnancy with some tissue remaining in the uterus ("missed abortion"), personal or family history of cancer (especially breast or other female organs), kidney disease, obesity, heart disease (such as past heart attacks, coronary artery disease, heart failure), high blood pressure, seizures, migraine headaches, asthma, high blood levels of cholesterol/fats, depression, diabetes, strokes, lupus.
Notify your doctor beforehand if you will be having surgery or will be confined to a chair/bed for a long time (such as on a long plane flight). You may need to stop the medication for a time or take special precautions because of the increased risk for blood clots. Ask your doctor for more details.
Regular complete physical exams which include lab and/or medical tests (such as blood pressure, breast exam/mammogram, pelvic exam, Pap smear) should be done while you are taking this medication. Follow your doctor's instructions for examining your breasts, and report any lumps right away. Keep all medical and lab appointments. Consult your doctor for more details. Missed Dose If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up. Storage Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
abnormal gait, anaphylactic reaction, arthralgia, blood glucose increased, choking,cleft lip, cleft palate, difficulty walking, dyspnea, face edema, feeling abnormal, feeling drunk,hypersensitivity, asthma, muscle cramp, throat tightness, tinnitus, vertigo, weight decreased, weightincreased.
Figure 3. A flow diagram for regulation of cerebrovascular blood flow. Blood flow is regulated through the energy state of functional units made up of metabolically coupled neurons and astrocytes. The energy state provides the set point that is responsible for determining the need for increase or decrease in flow to maintain that set point. The functional units communicate electrically with the capillary endothelium through the astrocyte, altering the endothelial membrane potential. The change in endothelial membrane potential propagates very rapidly (>1 mm/s) along the capillary to the penetrating arteriole and then further into the source arteries. The endothelial cells are coupled with smooth muscle cells that cover the endothelium of the arterial system. As the signal passes along arterial vessels, changes in endothelial membrane potential alter Ca2+ levels in the smooth muscle cells. Contraction and relaxation of the smooth muscle controls arteriolar and arterial diameter and thereby blood flow to the tissue.
Acute infection presents with purulent, foul, thin discharge with burning, itching lower abdominal pain and dyspareunia. Patients may also have postcoital bleeding. Vulva and vaginal mucosa appear erythematous. Greenish, frothy, malodorous discharge is sometimes present. "Strawberry cervix" is rarely present. Motile trichomonads are seen on wet mount and diagnosis can also be made by a positive culture, NAAT or rapid antigen probe test. Trichomoniasis is treated with 5-nitroimidazole drugs only (metronidazole or tinidazole):
Caused by rising vaginal pH (>4.5, normal range is 4.0-4.5) due to a shift in vaginal flora. About 50-75% of women are asymptomatic, but others present with thin, grayish vaginal discharge and/or odor that is described as "fishy." If your patient also complains of dysuria, burning, itching or other symptoms, consider mixed vaginitis (>1 pathogen).
Patients present with vaginitis symptoms (pruritis, burning, soreness, dysuria or dyspareunia). Higher risk patients are those with diabetes, antibiotic use, oral contraceptive use, pregnancy and immunosuppression. Candida is seen on wet mount. Vaginal pH is typically normal. Treatment is targeted at symptom relief.
Patients present with amenorrhea, irregular spotting, pelvic pain, missed period, history of PID, prior ectopic pregnancy. Pain becomes acutely worse with a ruptured ectopic and may lead to syncope. Patients may complain of shoulder pain due to blood irritating the diaphragm. On exam, evaluate for abdominal or adnexal tenderness. Sometimes an adnexal mass can be palpated. Obtain beta hCG level and pelvic ultrasound to locate the fetus.
You are concerned that your pregnant patient with abdominal pain, vaginal bleeding and hemodynamic instability has a ruptured ectopic pregnancy and immediately page Ob/Gyn for an emergent evaluation.You perform a FAST exam and note a large amount of free fluid in the pelvis. Her blood pressure improves with resuscitation and the first unit of PRBCs is infusing. The patient is Rh-negative, so you administer anti-Rho (D) immunoglobulin. Your surgical colleagues take the patient to the operating room. 041b061a72