Oral Anti-diabetic Drugs

Oral Anti-diabetic Drugs Chua Mei Yi Several factors that need consideration when comparing two oral anti-diabetic drugs include degree of glycemic lowering needed to attain target goal range, effect of the medication on weight and lipid profiles, contraindications, side effects, cost, and potential level of adherence to the regimen. The two drugs for comparison are namely metformin and gliclazide. Besides having the same level of glycemic lowering percentage, both metformin and gliclazide are also considered one of the least expensive oral anti-hyperglycemic agents (Reinhold Earl, 2014; Mozaffari, 2013; Holt, Cockram, Flyvbjerg Goldstein, 2011). One of the potential problems with anti-diabetic medication, is that the conventional dosage form is given in 2 to 3 doses daily, and it causes a conflict in compliance rate for the elderly who has poor memories. In this circumstance, both metformin and gliclazide offers the option of single daily dose with either extended-release metformin or gliclazide modified release tablets. Of course the side effects, improvements and degree of glycemic lowering are the same as conventional tablets (Unger, 2013; Barnett, 2012). Metformin is well known for being the first line drug against diabetes type II treatment over the past decades for some reasons. First, Metformin as a biguanide, acts on pancreas independently, inhibiting the liver’s production of glucose, thus controlling blood glucose by improving insulin sensitivity and reducing insulin requirement. If it’s taken when blood glucose is normal or low, it does not stimulate insulin release in the pancreas, thus poses little threat of hypoglycemic (Lehne, 2013). Second, Metformin treatment results in a moderate reduction in circulating triglyceride levels, causing an improvement in lipid profiles that leads to the occurrence of weight loss (Goldstein Muller-Wieland, 2013). Third, having a high frequency of GI side effects due to the inhibition of carbohydrates being digested can be minimized by slow-dose titration and by taking the medication with food. No matter how safe a medication is, contraindications and adverse side effects still need to be observed. As for metformin, renal or hepatic dysfunction patients are contraindicated, and lactic acidosis due to metformin’s accumulation, is considered one of the rare but fatal adverse side effect. The only down side of metformin is, it should be withhold prior to radiological procedures involving contrast dye, as it predisposes patients to acute renal impairment (Reinhold Earl, 2014). Gliclazide, on the other hand, is classified as sulfonylureas. It works by increasing insulin release from pancreatic beta cells, driving blood glucose levels down, causing hypoglycemia if taken when blood glucose is normal or low, thus should only be prescribed to patients likely to have regular food intake. Driving or operating machinery during the initial treatment phase needs to be careful as hypoglycemia might occur (Lehne, 2013). Besides having minimal effect on lipid profile, Gliclazide causes undesirable weight gain due to increased insulin secretion and reduced glucose excretion (Meeking, 2011). Contraindications, particularly renal or liver disease patients, as well as rare but fatal adverse side effects of gliclazide, impairment of liver function, must still be observed (MIMS Australia, 2014). In conclusion, while there is significant debate regarding specific treatment for patients with type II diabetes, most experts agreed upon metformin’s usage as first line drug, judging from its effectiveness, generally well-tolerated cost effective and long term usage. References Barnett, A. (2012). Oxford diabetes library: Type 2 diabetes (2nd ed.). UK: Oxford University Press. Goldstein, B. J., Muller-Wieland, D. (2013). Type 2 diabetes: Principles and practice (2nd ed.). USA: Informa Healthcare. Holt, R. I. G., Cockram, C., Flyvbjerg, A., Goldstein, B.J. (2011). Textbook of diabetes (4th ed.). UK: Wiley-Blackwell. Lehne, R. A. (2013). Pharmacology for nursing care. (8th ed.). USA: Elsevier Saunders. Meeking, D. R. (2011). Understanding diabetes and endocrinology: A problem-orientated approach. UK: Manson Publishing Ltd. MIMS Australia. (2014). Mimsonline. Retrieved on 28.3.2014, from https://www-mimsonline-com-au.libraryproxy.griffith.edu.au/Search/Search.aspx. Mozaffari, M. S. (2013). New strategies to advance pre/diabetes care: Integrative approach by PPPM. USA: Springer. Reinhold, J. A., Earl, G. (2014). Clinical therapeutics primer: Link to the evidence for the ambulatory care pharmacist. USA: Jones Bartlett Learning. Unger, J. (2013). Diabetes management in primary care (2nd ed.). China: Williams Wilkins. MIMS Australia. (2014).

Eveline´s Decision in Eveline by James Joyce :: essays research papers

In the short story â€Å"Eveline â€Å" by James Joyce, Eveline, the protagonist is given the opportunity to escape from her hard unendurable life at home and live a life of true happiness at Buenos Ayres with Frank, her lover. Throughout the story, Eveline is faced with a few good memories of her past from her childhood and her mother, but she also faces the horrible flashbacks of her mother’s illness and her father’s violence. In the end, she does not leave with Frank, Eveline’s indecisiveness and the burden of her family’s duties makes her stay.   Ã‚  Ã‚  Ã‚  Ã‚  By not taking that opportunity, Eveline probably missed a life of exploration with Frank. Eveline would have had the chance to know what independence feels like and she would have had the chance to experience individual freedom. Instead, her life afterwards is a life of regret and imprisonment with her family. Being an only child, she is bound by her family’s actions and their duties. Eveline has taken on an incredible part of the burden in keeping the family together. Her father is an overbearing and unfair man who takes his daughters earnings for himself; and rather than appreciating her sacrifices, he ridicules her. As she now lives with her dad and her two brothers, she feels tired and frustrated with her dad’s commands and her everyday life. Everyday, she sadly waits for frank to come back into her life once again and fill her life with happiness. Eveline may possibily in the future live her freedom when her controlling father passes away, but p erhaps it will become too late for her to experience the freedom she wanted.

Importance of Home in the Wind in the Willows

WillowsThere’s No Place Like Home: An Analysis of Two Characters’ Journeys in â€Å"The Wind in the Willows† As discussed in this course, classic children’s literature often involves some kind of journey for a character, in which they temporarily leave home, only to discover a self-truth and a new appreciation for that which they often took for granted. Kenneth Grahame’s â€Å"The Wind in the Willows† is no exception. The two animals that most notably go through a transformation as a result of leaving home are Mole and Toad. While their reasoning and experiences along the way differ, they both prove changed characters, and for the better. The Wind in the Willows† begins with a busy Mole, caught in his spring-cleaning daze, and within the first paragraph he has decided to leave the work behind as â€Å"something up above was calling him imperiously† (Classics of Children’s Literature, pg. 637). Mole’s home is undergr ound, and as soon as he breaks the surface, the nature around him is described as very positive with words like â€Å"sunlight†, â€Å"warm†, â€Å"caress†, and â€Å"happy† (pg. 637). He takes in his surroundings and is pleased to â€Å"be the only idle dog among all [the] busy citizens† (pg. 637).He quickly comes across the river, something that he’s never seen before, and makes friends with Rat, a loyal and happy member of the River Bank. The experience on a boat is grand, and Rat doesn’t have to say much to convince Mole that venturing out was the best idea: â€Å"Absorbed in the new life he [Mole] was entering upon, intoxicated with the sparkle, the ripple, the scents and the sounds and the sunlight, he trailed a paw in the water and dreamed long waking dreams† (pg. 639). Rat goes on to teach Mole all the necessary â€Å"animal etiquettes,† different things about the inhabitants of the Wild Wood, and how to do river tasks, like rowing.Even though he fails in first attempts to fit in, Moles spirits are easily lifted by the comfort of his friends. Mole stays with Rat through the summer and continues learning and growing as a character. The pair goes to visit another friend, Toad, who is all too eager to travel and go on a journey with his horse drawn carriage. The night before they are supposed to leave, Mole says that he’ll do whatever Rat wants, but asks, â€Å"Shall we run away to-morrow morning, quite early-very early- and go back to our deal old hole on the river? † (pg. 647). Here, he mentions home for the first time, and seems to miss it.However, Rat declines, which suggests that Mole has not learned all he needs to and is not ready to return. The journey with Toad comes to a quick end, and Mole and Rat go back to the river. However, Mole does something out of character when he decides to set out on his own to meet Badger, an â€Å"important personage† (pg. 650). Agai nst Rat’s previous warnings, Mole goes into the Wild Wood and becomes afraid of noises and unfamiliar sights. Rat quickly comes to his rescue and says that even Toad â€Å"wouldn’t show his face here alone,† which suggests that Mole has become braver.After meeting Badger, Mole and Rat decide to return back to the river and Mole is very excited, â€Å"eagerly anticipating the moment when he would be at home again among the things he knew and liked† (pg. 663). When they begin their journey back, Mole feels summoned â€Å"like an electric shock† and he realizes where he is. â€Å"Now, with a rush of old memories, how clearly it stood up before him†¦the home had been happy with him, too, evidently and was missing him, and wanted him back† (pg. 665). Mole wants to see his old home, but at first Rat doesn’t think it’s a good idea and convinces Mole to move on. Emotion overcomes Mole, and he sobs.At this point, home is everything to him, and he finally does deserve to go back. Rat realizes that the trip back is very important to his friend, and they turn back to find Mole’s old dwelling place. They find it and begin making a fire, welcome in some friends, and eventually settle down to dinner. It is a splendid time, and Mole, upon going to bed, realizes â€Å"how much it all meant to him, and the special value of some such anchorage in one’s existence†¦[however] he did not at all want to abandon the new life and its splendid spaces†¦it called to him still, even down there, and he knew must return to the larger stage† (pg. 671).It is in this moment that Mole appreciates his home, but realizes that he has changed for the better, and is ready to go back up and out to see what great, new experiences await him. Toad is not so easily moved by his home/away/home journey. Before he is introduced officially in the story, Rat says that Toad is â€Å"always good-tempered, always glad to see you, always sorry when you go,† and goes on to add â€Å"perhaps he’s not very clever†¦it may be that he is both boastful and conceited† (pg. 644-645). There are many instances when Toad is a bit too proud, whether it be talking about his house or his heroic deeds at the end of the story.The fact that Toad is wealthy seems to go along with him being obsessed with the latest craze, as he can afford to indulge in them. However, because of his boastful attitude and unawareness of consequences, it seems fitting that when he becomes infatuated with cars and driving, he never really succeeds at mastering it. Toad is more than happy to leave his fine estate for â€Å"the open road† (pg. 646). Travel and the like excite him, and it seems that he takes his home very much for granted at this point. Later on in the story, his friends, in hopes that he might be cured of his â€Å"poop-poop† daze, hold him under house arrest.This sheds a negative light on his home, making it a prison from which he escapes. Toad’s version of freedom is finding a new car, dressing the part and driving like a maniac. He even steals several cars (stooping to a new low) and crashes them. Toad’s freedom, his escape, is reckless and irresponsible and therefore it is essential that he come to a resolution to change. When Toad is finally placed in jail, he begins to reflect on his mistakes, calling himself a â€Å"stupid animal† (pg. 684). He even thinks about Toad Hall and his friends and there seems to be a light at the end of the tunnel: â€Å"the cure was almost complete† (pg. 85).Not quite. Toad lucks out quite a few times, and several people take pity on him-the jailer’s daughter, the engine driver, the driving couple-even though he doesn’t really deserve it. Grahame uses these people to remind the reader that Toad isn’t all-bad, he’s just going through some kind of crisis. He even says that ità ¢â‚¬â„¢s when he’s at Toad Hall with his friends that he’s â€Å"at his best† (pg. 686). It is also interesting that as soon as Toad starts to think about how clever and amazing his actions are, karma finds him and he is once again running away from a pursuit.He is much like a child, throwing tantrums and being stubborn. When Toad ends up in the woods, he is finally finding his way back, feeling free in the wilderness. After being rescued from the river by Rat, Toad is excited to reveal all his adventures and cleverness. He even pledges to â€Å"lead a quiet, steady, respectable life†¦just as [he] used to in the good old days, before [he] got restless† (pg. 710). This proud moment is put on hold when he learns that Toad Hall has been seized. Suddenly, when he realizes his home is in danger, a fire is lit inside Toad, and he is ready to fight for it.Toad seems to have come to a breaking point, and the fact that he has to win his home back makes the ch ange in him more obvious. Although Toad, after the battle, still wants praise and to give speeches and sing songs (on his behalf), there is finally a complete turn around. Toad has a few last conceited moments, but it is only between him and his home. He sings to a room with empty chairs, which shows just how important the home was to his transformation. It was the last thing that would see him in his old ways, and the thing in which he would build a new life and character.At earlier instances, the reader may not be convinced of Toad’s change, but Grahame assures us saying, â€Å"He was indeed an altered Toad! † (pg. 724). Both of these animal characters in â€Å"The Wind in the Willows† have human qualities of wanting something more, something new to spark interest and passion. Grahame, through Mole and Toad, has shown the benefits of leaving home at some point so that it might be better appreciated upon return. Change is necessary to both these characters, and results in them both being much happier and satisfied with their lives.

Brilliant Lies - Original Script Writing Essay - 935 Words

Brilliant Lies - Original Script Writing Act One Scene One 1. The case between Susy and Gary is one where it is ones words against another. 2. From the first scene it would appear that Susy has got her heart set on getting 40 thousand dollars from the case. One would also get the impression that she is a slut and a bit of a player. Scene Two ========= 1. Gary is an uptight and aggressive character. Vince would appear to be lay back and nice. They however both agree that the sexual harassment laws are out to get middle class white males. Gary says Damned if you do, damned if you dont, which mean even if you†¦show more content†¦3. The Connor family is critical of each other. The father sexually abused his daughters at an age when they where developing into young ladies. Scene Four ========== 1. When Marion tells Susy that Vince and Gary said she made many private phone calls, slept at her desk and told married women about her drug taking Susy said Oh shit! Did they say that?. She obviously was not expecting them to tell Marion about those things. Williamson wants us to know that neither side is telling the complete truth. He wants us to decide what the truth is, if we ever do know the real truth! Scene Five ========== 1. Gary believes that Gay Armenians and Lesbian Turks are dictating the moral agenda. 2. Vince is not so sure that Gary is innocent of these allegations of sexual harassment. Also Vince saw Gary having launch with some Merchant Bankers and does not believe it when Gary says that they are some old college friends. This develops a rift between the two. Scene Six ========= 1. Williamson is trying to present Susy as a liar and a lazy person and someone who think of herself as sex goddess. Katie is presented as someone who would not usually lie, but could be talked into lying. Scene Seven =========== 1. 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