Relationship between Diabetes and

Alzheimer's

Nearly 21 million Americans in the United States have diabetes, a disease that

makes the body less able to convert sugar to energy. Scientists are finding more

evidence that could link Type 2 diabetes with Alzheimer’s disease, the most

common form of dementia and the seventh leading cause of death in the United

States. Recent reports revealed that impaired insulin signaling in the brain,

often a feature of diabetes, may negatively impact cognition, mood, and

metabolism all of which are common aspects of Alzheimer's disease. Although

the conditions are seemingly independent of each other, earlier studies have

found that people with type 2 diabetes are more likely to develop Alzheimer's

disease. However, the mechanisms behind this relationship have remained

hidden.

A recent study investigated the impact of blocking insulin receptors and

insulin-like growth factor (IGF1) receptors in mouse models. The work was

carried out at the Joslin Diabetes Center, affiliated with Harvard Medical

School in Boston, MA. The results reveal that interrupting these similar

pathways impaired both learning and memory.

Insulin receptors and learning

The researchers worked with both the hippocampus and the central amygdala,

areas of the brain that help with cognition function, as well as metabolic

control. They looked into how mice with disabled insulin and IGF1 receptors

tackled mazes, and the results were revealing.

VOLUME 36 ISSUE 4

Medical News

––

October – December 2018

In this issue .. ..

Medical News ------------- 1

Pharmaceutical

Authorities News --------4

Medication Safety

Updates -------------------- 5

7 ---------------- الصفحة العربية

Scientific Books: New

Release -------------------- 8

Now The bulletin is available online at: https://pharmacy.ksu.edu.sa/ar/node/1397

Both Bacteria and

Viruses Can Cause

Pneumonia, But One

Is Much Worse for

the

Both bacteria and viruses can cause

pneumonia, an infection

characterized by inflammation in

the air sacs of the lungs . In the

study, the researchers looked at

data from 2007 to 2014 on around

4,800 patients at a Utah hospital

who had been diagnosed with

pneumonia and hospitalized.

Around 80 percent of the patients

had been diagnosed

with bacterial pneumonia. The

researchers found that 34 percent of

the patients with bacterial

pneumonia had a major heart

complication within that 90-day

window, compared with 26 percent

of the patients diagnosed with viral

pneumonia.

Source ; https://www.livescience.com/64061-bacterial-pneumonia-heart-health.html

Drug & Poison

Information Center

BULLETIN

January – March 2009

Drug and Poison Information Bulletin 2

Medical News (cont..)

First, the researchers allowed the mice to explore the maze to familiarize themselves with its layout, and then they

blocked a pathway before reintroducing the mice to the labyrinth. These particular mice failed to analyze the new

barricade and instead tried to go through the maze as if it was the way it had always been. C. Ronald Kahn author

reported that this is the first study that shows a relationship between these disrupted pathways and cognition

problems. Also author sated that since these two receptors can partially compensate for one another, what we did

that was critical was this combined insulin and IGF receptor knockout. However the author also reported that it was

also important to do it in specific regions, since if it was everywhere it might have impaired brain development. By

knocking out both [receptors], we removed not only the primary way they work but the backup system that's already

built in.

Alzheimer's is not a normal part of aging

Alzheimer's disease is the most common cause of dementia, which is when a person is experiencing memory loss

and other cognition issues that are severe enough to interfere with daily life. Alzheimer's, though, is not a normal

part of aging, and while most of those who have it are 65 years of age and older, it can affect people who are younger.

Alzheimer's does not get better over time, and, in most cases, it tends to worsen until the person loses the ability to

carry on a conversation or respond to what is happening around them. There is no cure for the condition, but there

are treatments available that can slow down progression and may improve the individual's overall quality of life.

There are risk factors that scientists have associated with developing Alzheimer's disease. There are some factors

that people cannot control, for example, age, family history, and genetics. People might be able to influence other

potential causes, however, including head injuries and heart disease. Other conditions that can lead to vascular

damage, such as high blood pressure and stroke, may also be factors in Alzheimer's risk.

Diabetes is also a risk factor

Additionally, diabetes is a known risk factor for Alzheimer's disease. Other studies have shown a connection between

insulin pathways and premature cognitive decline, dementia, depression, and anxiety. Also, studies have helped

demonstrate that abnormal receptors are present more often in those who have both Alzheimer's and type 2 diabetes.

The current study is the first to target specific regions to help determine cause and effect. Next, the researchers want

to look at what happens when they cross the mice they used in this study with mice that are genetically prone to

developing Alzheimer’s. Investigating these connections, they say, may lead to recommendations of lifestyle

changes well before a disease process even begins. With diabetes and obesity, there is resistance in these pathways

and, therefore, we think that this could be an important factor as to why people with Alzheimer's disease and diabetes

have a faster-accelerated course or have more Alzheimer's disease.

Reference; Available at https://www.medicalnewstoday.com/articles/324458.php.

Medical News (cont..)

Diabetes and hypertension drug combo kills cancer cells

New research, published in the journal Cell Reports, states that a drug combination that kills cancer cells by depleting

them of energy. Metformin is a common drug in the fight against type 2 diabetes. It lowers blood sugar by slowing

the release of glucose from the liver and the absorption of sugar from food in the gut. Recently, scientists have

brought more uses of the drug to light. Physicians prescribe metformin to help treat polycystic ovary syndrome, and

some researchers have suggested that the drug may improve fertility and help regulate menstrual cycles. Some have

even suggested that metformin may improve longevity. Animal studies have found that the drug may influence the

metabolic processes associated with aging and age-related conditions, and clinical trials of metformin's effects on

human lifespan are currently under way. Around 2 years ago, researchers from the University of Basel in Switzerland

found that metformin, in combination with a blood pressure drug, can stop cancer tumors from growing.

In new research, scientists now show how this drug cocktail works: the combination of metformin and the

antihypertensive syrosingopine cuts off cancer's energy supply, resulting in the death of cancer cells.

Cutting off the energy supply of cancer cells

In order to keep the energy-generating machinery running, NAD+ must be continuously generated from NADH

adding both drugs such as metformin and syrosingopine prevent the regeneration of NAD+, but in two different

ways. Many cancer cells rely on glycolysis in their metabolism, which means that they break sugar down into lactate.

When there is too much lactate, however, glycolytic pathways are blocked. So, to avoid this, cancer cells dispose of

lactate via special transporters, and this is where the drug combination comes in. this study concluded that

syrosingopine efficiently blocks the two most important lactate transporters and thus, inhibits lactate export. High

intracellular lactate concentrations, in turn, prevent NADH from being recycled into NAD+. Metformin, meanwhile,

blocks the second of the two cellular pathways that help NAD+ regenerate. So, when metformin is combined with

syrosingopine, NADH can no longer be recycled into NAD+. This, in turn, creates an energy shortage. The energy

shortage ultimately leads to the death of cancer cells, which no longer have an energy supply. The combination of

the two drugs, therefore, "may prove a viable anticancer strategy," conclude the researchers.

Reference; https://www.medicalnewstoday.com/articles/324006.php.

3 Drug and Poison Information Bulletin

Cutting off the energy supply of cancer cells

The dose of metformin for treating diabetes is not enough to stop

tumors from growing. However, adding the blood pressure drug into

the mix boosts metformin's anticancer effects. The process start as

Cancer cells need a lot of energy to grow and spread as fast as they do.

However, an obstacle in the way of cancer's metabolic needs is a

molecule called NAD+. This molecule turns nutrients into energy.

Drug and Poison Information Bulletin

Pharmaceutical Authorities News

Opioids Don't Really Do That Much for Chronic Pain, Meta-Analysis

Finds

A study that draws on data from more than 100,000 people finds a link between diabetes and an increased risk of

osteoporosis, osteoarthritis, and rheumatoid arthritis. In the United States, over 100 million people are living

with diabetes and prediabetes. Type 2 diabetes is a chronic condition requiring lifelong management; the disease

impacts a number of systems in the body.

Once the investigators had controlled for risk factors, such as age, gender, and BMI, a significant pattern still

emerged. They found that people with diabetes were 33 percent more likely to have osteoarthritis; they were also

more likely to have rheumatoid arthritis and osteoporosis (the risk increased by 70 percent and 29 percent,

respectively).

Aside from these specific conditions, when compared with people without diabetes, those with diabetes were 27

percent more likely to report back pain and 29 percent more likely to have shoulder and neck pain. The particularly

pronounced relationship between rheumatoid arthritis and diabetes could be due to the presence of

chronic inflammation in both conditions. While use of steroids in the treatment of [rheumatoid arthritis also increase

the risk of the development of type 2 diabetes. The researchers demonstrated that people with diabetes who were

more active had a reduced risk of back, shoulder, and neck pain. The researchers hope that their findings might help

physicians guide their patients.

Healthcare professionals should make patients with diabetes aware that regular exercise is a recognized treatment

for diabetes and arthritis, and can have positive effects on both blood sugar control as well as musculoskeletal pain.

It is important to note that this study was observational, so cause and effect cannot be picked apart. There may be

risk factors that these conditions share that we do not yet understand. Also, as the authors explain, the data they used

are based on participants' self-reports, which makes them considerably less reliable.

Source; htps://www.medicalnewstoday.com.

4 Drug and Poison Information Bulletin 4

The results were presented at the European Association

for the Study of Diabetes Annual Meeting, held in Berlin,

Germany. In order to investigate, the scientists took data

from the 2013 Danish National Health Survey; in all, they

had access to the records of 109,218 people aged 40 or

older. Of these people, 8.5 percent were diagnosed with

diabetes; also, they were more likely to be male, older,

and have a higher body mass index (BMI).

Medication Safety Updates

5 Drug and Poison Information Bulletin

Aspirin Can Help Your Heart. Omega-3s Might. But Together? Maybe

Not

Senior author Robert Block, stressed the levels of omega-3 fatty acids in the blood might change the effects that

aspirin can have on heart health. Doctors often prescribe daily, low-dose aspirin for people at risk of heart attacks.

This is because the medicine acts an anti-coagulant and can help prevent blood clots. And omega-3s are thought to

help reduce the risk of heart disease, though a major trial called the VITAL study, also presented at the AHA

conference, found that omega-3s may have less of an impact on heart health than previously thought.

The fish-oil factor

In this new study, Block and his team turned to a much larger database called the Framingham Heart Study, which

dates back to 1948. Here, they looked at the association between the number of people in the study who took aspirin

daily and those who had a heart attack, stroke or some other cardiovascular event in the 30-plus follow-up years.

Once the investigators adjusted for factors such as age and heart disease risk, they found that people who took

aspirin daily and also consumed a low-dose of omega-3s had around a two-fold increased risk of developing heart

disease, compared with those who took neither substance.

A low dose of omega-3s meant that of all the fatty acids in the individual's blood, 4.2 to 4.9 percent were omega-

3s. This very specific amount translates to around one tuna sandwich a week. The study also found that people who

didn't take aspirin but consumed that same low amount of omega-3s had a 55 percent lower risk of heart disease,

than those who didn't take any omega-3s. But the researchers didn't see a link between aspirin and omega-3 for

more or less than that amount of fatty acids. So, to sum up the findings: Aspirin plus a small amount of omega-3s

was associated with a slightly increased risk of heart disease. A small amount of omega-3s plus no aspirin was

associated with a lower risk.

The odd effects may arise because aspirin and omega-3s work on the same molecular pathway, Block said. So,

whether or not people should take aspirin could depend on how much seafood the person eats or how much fish oil

they take. But it could also depend on genetic factors that can change the way aspirin and omega-3s are metabolized.

Reference; https://www.livescience.com/

The effects of omega-3s on heart health, also aspirin use was

established by author block. In 2015, Block published a small

study done on 30 participants, which investigated what

happens in the blood when people take aspirin and fish oil

together. The researchers had found that at moderate levels of

omega-3s in the blood, this combination would affect platelets

cells that play an important role in blood clotting but also lead

to dangerous blockages in blood vessels.

Medication Safety Updates

FDA Approves Sympazan (clobazam) Oral Film for Adjunctive Treatment of

Seizures Associated with Lennox-Gastaut Syndrome

Nov. 2, 2018 Aquestive Therapeutics, Inc. (NASDAQ: AQST), a specialty pharmaceutical company, announced

that the U.S. Food and Drug Administration (FDA) approved Sympazan™ (clobazam) oral film for the adjunctive

treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 2 years of age or older. Sympazan

is the first and only oral film FDA-approved to treat seizures associated with LGS. Previously, clobazam was

marketed as ONFI® and offered in two formulations – either tablet or oral suspension. It is berry flavored and

offered in 5 mg, 10 mg, and 20 mg dosages to meet a range of LGS patient and caregiver needs. Potentiation of

Sedation from Concomitant Use with Central Nervous System (CNS) Depressants Sympazan has a CNS depressant

effect. Caution patients and/or caregivers against simultaneous use with other CNS depressants or alcohol as the

effects of other CNS depressants or alcohol may be potentiated.

Source; https://www.drugs.com/newdrugs/fda-approves-sympazan-clobazam-oral-film-adjunctive-seizures-associated-

lennox-gastaut-syndrome-4858.html.

FDA Approves Tolsura (SUBA®-itraconazole capsules) for the

Treatment of Certain Fungal Infections

The US Food and Drug Administration (FDA) approved the New Drug Application (NDA) for Tolsura™ (SUBA®-

itraconazole) 65mg capsules. Tolsura is a new formulation of itraconazole indicated for the treatment of certain

systemic fungal infections in adult patients. Tolsura is indicated for the treatment of blastomycosis (pulmonary and

extrapulmonary), histoplasmosis (including chronic cavitary pulmonary disease and disseminated, non-meningeal

histoplasmosis) and aspergillosis (pulmonary and extrapulmonary, in patients who are intolerant of or who are

refractory to amphotericin B therapy). These serious infections most commonly occur in vulnerable or

immunocompromised patients, for example, those with a history of cancer, transplants (solid organ or bone marrow),

HIV/AIDS, or chronic rheumatic disorders, and are often associated with high mortality rates or long-term health

issues. Co-administration with certain drugs that either affect metabolism of itraconazole or whose metabolism is

affected by itraconazole. Hypersensitivity to itraconazole. Most common adverse reactions (incidence ≥ 1%) are

nausea, rash, vomiting, edema, headache, diarrhea, fatigue, fever, pruritus, hypertension, abnormal hepatic function,

abdominal pain, dizziness, hypokalemia, anorexia, malaise, decreased libido, somnolence, albuminuria, impotence.

Source;https://www.drugs.com/newdrugs/fda-approves-tolsura-suba-itraconazole-capsules-certain-fungal-

infections-4882.html.

6 Drug and Poison Information Bulletin

العربية الصفحة

Drug and Poison Information Bulletin 7

الهيئة العامة للغذاء والدواء . المصدر:

"الغذاء والدواء" تلغي وتعلّق مستحضرات دوائية لعدم مطابقتها للمعاير الفنية

19/01/1440

المستحضرات الدوائية، لعدم مطابقتها للمعايير الفنية وعدم تكافئها حيوياً قررت الهيئة العامة للغذاء والدواء إلغاء تسجيل مستحضر دوائي، وتعليق تسجيل عدداً من

.مع المستحضر المرجعي

الت من جميع وخاطبت الهيئة الجهات الصحية المعنية إليقاف استخدام تلك المستحضرات في حال وجودها لديها، كما ألزمت وكالء المستحضرات بسحب التشغي

.الجهات المستفيدة

الغذاء والدواء" أن لجنة تسجيل شركات ومصانع األدوية ومنتجاتها اتخذت قرارات بخصوص سحب وتعليق وإلغاء عدد من المستحضرات، شملت وأوضحت "

برقم تسجيل (Angiotec 10 mg Tablet)( و00-171-31برقم تسجيل ) (Angiotec 5 mg Tablet) سحب وتعليق تسجيل جميع التشغيالت من مستحضر

، وكذلك جميع التشغيالت من (JPM) ( وتنتجها الشركة األردنية إلنتاج األدوية00-171-33برقم تسجيل ) (Angiotec 20 mg Tablet)( و32-171-00)

Lipomax )( و07-370-35برقم تسجيل ) (Lipomax 20 mg F.C Tablet)( و07-370-36برقم تسجيل ) (Lipomax 40 mg F.C Tablet) مستحضر

10 mg F.C Tablet) ( مع المستحضر 07-370-34برقم تسجيل ً ( وتنتجها الشركة السعودية اليابانية للمنتجات الصيدالنية )ساجا(، وذلك لعدم تكافئه حيويا

.المرجعي

تجه مصنع الخليج ( الذي ين02-186-161برقم تسجيل ) (Dialon 500 mg F.C Tablet) كما تضمنت القرارات سحب جميع التشغيالت من مستحضر

.ي(للصناعات الدوائية )جلفار(، بسبب عدم مطابقة المستحضر للمعايير الفنية )فشله في اجتياز تحليل الذوبانية المقارنة بالمستحضر المرجع

نع الخليج للصناعات (، وينتجه مص10-186-279الذي يحمل رقم التسجيل ) (Glymide 5 mg Tablet) وإضافة إلى ذلك، ألغت الهيئة تسجيل المستحضر

.هـ25/10/1439الدوائية )جلفار( الذي سبق سحبه وتعليق تسجيله بناًء على قرار اللجنة الصادر بتاريخ

.وأشارت الهيئة إلى وجود بدائل مسجلة للمواد العالجية نفسها، داعية إلى مراجعة الطبيب المعالج أو الصيدلي لمعرفة تلك البدائل

، أو ٨٠٠٢٤٩٠٠٠٠لكين إبالغ المركز الوطني للتيقظ والسالمة الدوائية عند حدوث أي أعراض جانبية لألدوية عن طريق: الرقم المجاني: وأهابت الهيئة بالمسته

https://ade.sfda.gov.sa، أو الرابط: npc.drug@sfda.gov.sa، أو البريد االلكتروني19999، أو الرقم المّوحد: ٠٠٩٦٦١١٢٠٥٧٦٦٢الفاكس:

الهيئة العامة للغذاء والدواء .المصدر:

Editor-in-chief:

Mohamed N. Al-Arifi, PhD

Professor of Clinical Pharmacy

Director of Drug & Poison Information Center

Editors:

Abdulaziz M. Alhossan, PharmD, MPH, BCPS

Sultan M. AL-Ghadeer, PharmD, BCPS

Yazed S. AL-Ruthia, BS.C Pharm, PharmD, PhD

Drug & Poison Information Specialist’s

Salmeen D Babelghaith, PhD

Syed Wajid Ali, M. Pharma,

Rayyan A AL-Mansour, Higher Diploma.

Address / Correspondence:

Drug & Poison Information Center, College of

Pharmacy, King Saud University. P.O. Box

2457 Riyadh 11451, Saudi Arabia. Tel:

4677352, 4677353, 4677354 Fax: 4676229

E-mail: copdpic@ksu.edu.sa

Feb 28-March 01, 2019 International

Conference on Bio-Pharmaceuticals

Theme: Novel Strategies and Innovations in

Pharmaceutical sciences, Osaka, Japan.

March 1-2, 2019. 24th International meet on

Pharmaceutical Biotechnology 2019.

Theme: “Providing a global platform to

explore and enhance the future of medicine

and pharmaceutical biotechnology. Paris,

France

March 18-19, 2019. 2th International

Conference on Pharmacoepidemiology and

Clinical Research. Theme: Broaden the

possibilities for Policy, Education, and

Advocacy in the field of

Pharmacoepidemiology and Clinical

Research, Dubai, UAE.

Upcoming Conferences

Davis's Drug Guide for Nurses (16th Revised edition) April Hazard Vallerand, PhD, RN, Faan, Dr.

Cynthia A Sanoski, Bs, Pharmd, Fccp, Bcps (Author)

Davis's Drug Guide for Nurses, Sixteenth Edition delivers all of the

information you need to administer medications safely across the

lifespan-well-organized monographs for hundreds of generic and

thousands of trade-name drugs. BONUS! FREE DIGITAL ACCESS.

Redeem the access code inside to unlock your one-year, free

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device with a web browser 5,000-drug database and appendices;

Cross-referencing of drugs; FDA drug news.

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