Medical Today

Pharmacology.
Sertraline is an SSRI similar to fluoxetine, which indirectly results in a downregulation of -adrenergic receptors. It has no clinically important effect on noradrenergic or histamine receptors and no effect on MAO. It lacks stimulant, cardiovascular, anticholinergic, and convulsant effects. Sertraline has antidepressant effects equal to TCAs and fluoxetine and might have anorectic effects and efficacy in OCD.

Pharmacology.
Pioglitazone is a thiazolidinedione anti-hyperglycemic agent used to improve insulin sensitivity in patients with type 2 diabetes. Insulin-dependent glucose disposal in skeletal muscle is improved and hepatic glucose production is decreased; both actions contribute to pioglitazone’s glucose-lowering effects. Pioglitazone is only effective in the presence of insulin; by itself it does not lead to hypoglycemia and does not increase insulin secretion. Because insulin is required for its action, pioglitazone should not be used in patients with type 1 diabetes.

Pharmacology.
Morphine and other opioids interact with stereospecific opiate receptors in the CNS and other tissues. Opioid analgesia is caused by actions at several CNS sites. Morphine and other mu opioid agonists inhibit nociceptive reflexes through inhibition of neurotransmitter release, have inhibitory actions on neurons conveying nocicep-tive information to higher brain centers, and enhance activity in descending pathways that exert inhibitory effects on the processing of nociceptive information in the spinal cord. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. Stimulation of kappa receptors results in analgesia, less intense miosis and respiratory depression, dysphoria, and psychotomimetic effects. It is unclear what the consequences of delta receptor stimulation are in humans. The relief of pain is fairly specific; other sensory modalities are essentially unaffected, and mental processes are not impaired (unlike anesthetics), except when given in large doses or to opiate-naive individuals. These drugs also have antitussive effects, usually at dosages less than those required for analgesia.

Pharmacology.
Metformin is a biguanide anti-hyperglycemic agent used in the management of type 2 diabetes mellitus. It does not affect insulin secretion; rather, it reduces hepatic glucose production and enhances glucose utilization by muscle. Reported increases in glucose utilization in muscle are 7-35%. In addition to blood glucose reductions (mean 53 mg/dL), metformin may have beneficial effects on serum lipids.

Pharmacology.
Losartan is a selective, reversible, nonpeptide, competitive antagonist of the angiotensin II receptor (AT1), which is responsible for the physiologic effects of angiotensin II including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption. Losartan and other angiotensin II receptor antagonists are highly selective for the AT1 receptor over the AT2 receptor, whose physiologic function is unknown. Angiotensin II receptor antagonists have no inhibitory effects on ACE and therefore decrease blood pressure with no appreciable effect on kinin metabolism.