3/16(金) セミナー参加
◆今日の気持ち
(脳外科 3週目)
・今日の午前中はGFを教えていただこうと思っていたのに、忘れていた!!
・添付文書の確認、しばしば忘れてしまう…
●今の目標
・脳外科を味わいきる
●今日の新患・診断
・薬剤性高脂血症
●今日の病院滞在時間
8時半〜18時半
●今日行ったこと・見たこと・知ったこと
・DMと動脈硬化についてのセミナー参加
インスリン抵抗性を改善するピグアノイド・チアゾリジンは、のみ始めのBS低下率は低いけれど、SU薬よりもイベント発生率を下げる。またSU薬は数年すると効果がなくなってくる。β細胞も疲れてしまうし。それに、高インスリンの状態は食欲亢進をまねく…
ピグアノイドは特に肝にきく。50年近くの古さがある安い薬だから研究費もでなくて研究されていなかったけれど、見直されつつある。乳酸アシドーシスという致死的な副作用があって怖がられたけれど、新しい薬は副作用発生率はかなり減っている。VirusやLCがあると使いにくいけれど、脂肪肝・NASHには実はいいのではないかと言われつつある。そして、安い!
チアゾリジンは末梢の器官、特に脂肪に効く。脂肪が出している悪玉物質を抑える。だからイベントを抑えるには一番よい?? また脂肪が多い、太っている人にこそ、よく効く。特に女性には非常に効く。つまり、浮腫や心不全の副作用も出やすくなる…。女性には半分量の処方からがちょうどいいかもしれない。
グルコシダーゼ阻害薬。これもけっこうイベント発生率抑える。食後の血糖上昇速度を遅らせるだけでは説明がつかない?
HOME-R。BSとインスリンのバランスが保たれていればインスリン抵抗性と近似されるけれど、そのバランスが大きく崩れた進行DMでは近似できない。結局、太っている、ことがインスリン抵抗性と相関性が高い。
・抗血小板薬
胃潰瘍、消化管出血を強く注意。
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