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πŸ’¬ GLP-1 and GIP/GLP-1 Receptor Agonists in Obesity & Type 2 Diabetes (2025 Update)

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert Understanding Semaglutide, Tirzepatide, and the Debate About Weight Regain 🧠 1. Why Everyone’s Talking About These Drugs In just a few years, GLP-1 receptor agonists (like semaglutide ) and the newer dual GIP/GLP-1 agonist ( tirzepatide ) have reshaped how we treat obesity and type 2 diabetes (T2DM) . They do much more than lower blood sugar — they suppress appetite , slow digestion , and help the body use insulin more efficiently. The result: major, sustained weight loss and better metabolic health while on treatment. Semaglutide 2.4 mg : typically 10–15% average body weight loss in trials. Tirzepatide : often 15–20% or more — the highest seen in modern studies. SELECT trial: proved semaglutide even reduces heart attacks and strokes in obese people without diabetes . ⚙️ 2...
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πŸ₯ Medication Reconciliation (Medicinal Reconciliation)

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert 1. Definition Medication reconciliation is a formal, systematic process of compiling the most accurate and complete list of all medications a patient is currently taking — including drug name, dose, frequency, and route — and comparing it with the physician’s active orders at every transition of care . πŸ”‘ Goal: To ensure the patient receives the right medications at all times , preventing errors such as omissions, duplications, dosing mistakes, or harmful drug–drug interactions . 2. Purpose & Importance Prevents medication errors during care transitions (admission, transfer, discharge). Reduces adverse drug events (ADEs) , a major cause of hospital morbidity. Ensures continuity of care across providers, facilities, and home. Improves patient safety, adherence, and clinica...
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πŸ“– Pharmacodynamics

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert Definition: Pharmacodynamics (Greek pharmacon = drug, dynamis = power ) is the study of what the drug does to the body . It covers: Mechanism of action (MOA) at molecular, cellular, and systemic levels Intensity and nature of pharmacological effects Adverse drug reactions and therapeutic index Dose–response relationships πŸ”Ή Core Concepts 1. Mechanism of Action (MOA) Drugs act by binding to specific targets : Receptors → Ξ²-adrenergic receptors (adrenaline) Ion channels → Ca²⁺ blockers (verapamil) Enzymes → Acetylcholinesterase inhibitors (neostigmine) Transporters → SSRIs (fluoxetine, blocks serotonin reuptake) πŸ‘‰ Interaction may stimulate, inhibit, or modulate physiological functions. πŸ”Ή Types of Drug Effects 1. Stimulation ↑ Activity of cells/tissues. ...
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πŸ“– Mechanisms of Drug Action

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert   Drugs influence the body through two main mechanisms: Non-receptor mediated actions Receptor-mediated actions πŸ”Ή I. Non–Receptor Mediated Mechanisms These don’t rely on binding to specific receptors. Instead, drugs act via physical, chemical, enzymatic, or structural properties . 1. Physical Actions Osmosis: Mannitol ↑ plasma osmolality → draws water out of brain/eye → used in cerebral edema, glaucoma. Adsorption: Activated charcoal binds toxins in the gut → prevents absorption in poisoning. Demulcents: Glycerin/syrup coat mucosa → soothe sore throat, pharyngitis. Radioactivity: Radioactive iodine (¹³¹I) destroys thyroid tissue in Graves’ disease, thyroid cancer. 2. Chemical Reactions Neutralization: Antacids (Al(OH)₃, Mg(OH)₂) neutralize gastric acid. ...
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πŸ“– Receptor Families: Mechanisms and Clinical Implications

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert   Receptors are specialized proteins on the cell membrane, cytoplasm, or nucleus. They bind ligands (drugs, hormones, neurotransmitters) to trigger biological responses. πŸ‘‰ Drug + Receptor → Complex → Biological Effect There are 4 major receptor families , each differing in location, signaling, and speed of response . πŸ”Ή 1. Ligand-Gated Ion Channels (Ionotropic Receptors) Location: Cell membrane Response time: Milliseconds (very fast) Mechanism: Ligand binding → channel opens → ion flow (Na⁺, K⁺, Ca²⁺, Cl⁻) → depolarization or hyperpolarization Examples: Nicotinic ACh receptor (neuromuscular junction) GABAₐ receptor (Cl⁻ influx, target of benzodiazepines/barbiturates) Glutamate receptor (excitatory transmission) Clinical use: Benzodiazepines enhance GABAₐ → ...
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πŸ“– Dose–Response Relationship (DRR)

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert   The dose–response relationship describes how the intensity or probability of a drug’s effect changes with increasing dose. It is a cornerstone of pharmacology and helps define: The minimum effective dose The therapeutic (optimal) dose The toxic or lethal dose ⚖️ Principle As drug dose increases, the effect increases — up to a maximum. Beyond this, higher doses give no further therapeutic benefit but may increase toxicity. πŸ”Ή Types of Dose–Response Relationships 1. Graded Dose–Response Relationship Seen in a single individual . Shows a continuous, incremental response as dose increases. Useful for studying potency and efficacy . Plots : Dose vs Response → Rectangular hyperbola. Log Dose vs Response → Sigmoid (S-shaped curve) → easier comparison of dr...
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⚖️ Therapeutic Window vs Therapeutic Index vs Margin of Safety

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By Dr. Sk Sabir Rahaman, MBBS , MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD   πŸ“ Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert   When prescribing drugs, clinicians balance two opposing outcomes: therapeutic benefit vs toxicity . To quantify and compare drug safety, pharmacologists use Therapeutic Index (TI), Therapeutic Window (TW), and Margin of Safety (MOS). πŸ”Ή 1. Therapeutic Index (TI) πŸ“Œ Definition: The therapeutic index is a ratio comparing the dose that produces toxicity (or lethality in animals) to the dose that produces the desired therapeutic effect. πŸ“ Formula: In animals (preclinical): TI = LD₅₀ / ED₅₀ LD₅₀ = dose lethal to 50% of test animals ED₅₀ = dose effective in 50% of animals In humans (clinical): TI = TD₅₀ / ED₅₀ TD₅₀ = dose toxic to 50% of patients πŸ“Š Interpretation: High TI → Safe drug (e.g., penicillin) Low TI → Narrow safety margin → requires monitoring (e...
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