ANTIDIABETIC DRUGS: SUs

Question 1

2 classes of SUs

Answer 1

Short acting: gliclazide, tolbutamide
Long acting: glibenclamide, glimepiride

Question 2

MOA

Answer 2

• Stimulates B cell insulin secretion in the pancreas
• Reserves B cell function
• With time functions will decline so drug’s effect become suboptimal - as they only work if there is residual pancreatic b-cell activity

Question 3

Short acting SUs

Answer 3

lower risk of hypo
preferred in elderly + renal impairment
gliclazide, tolbutamide

Question 4

Long acting SUs

Answer 4

glibenclamide, glimepiride

Question 5

Long-acting in elderly

Answer 5

Associated with prolonged and sometimes fatal cases of hypoglycaemia
Caution in elderly as they are the most susceptible

Question 6

Side effects

Answer 6

• Hyponatraemia (glipizide, glimperide)
• Hypoglycaemia
• Weight gain
• GI
• Jaundice
• Hypersensitivity reactions in first 6-8 weeks e.g. skin rashes

Question 7

Why is pt individual target higher when on SUs?

Answer 7

High risk of hypoglycaemia which needs to be treated in hospital (hence why target is 7.0% instead of 6.5% when used)

Question 8

Sulphonylurea-induced hypoglycaemia

Answer 8

Treat in hospital - can persist for hours
Counsel patients to recognise HYPO symptoms, especially when driving.
Always carry sugary snack
Never miss meals

Question 9

Contraindications

Answer 9

• Avoid prescribing in acute porphyria (gliplizide is safe)
• Avoid in hepatic and renal failure

Question 10

SUs in renal impairment

Answer 10

Gliclazide can be used in significant renal impairment
Mostly metabolised by the liver

Question 11

Counselling points

Answer 11

• swallow whole
• w food

Question 12

Hypoglycaemia symptoms

Answer 12

Weakness
Confusion
Sweating
Slurred speech
Aggression
Fits
Loss of consciousness
Palpitations

Question 13

Interactions

Answer 13

Other oral antidiabetics
Alcohol
Warfarin + ACEi = hypo
NSAIDs = reduced renal excretion