Insulin Secretagogues

Question 1

What are the 2 classes of drugs in this category

Answer 1

sulfonylureas and meglitinides

Question 2

What is the mechanism of action

Answer 2

Sulfonylureas bind to and inhibit ATP sensitive K+ channels. K+ leads to depolarization of the cells causing influx of Ca+ into the cell –> activates beta cells in pancreas to secrete insulin

Question 3

What is a major contraindication of sulfonylureas and why

Answer 3

CKD. Insulin is secreted via the kidneys, someone with kidney injury can’t clear it

Question 4

What are the 4 major side effects

Answer 4

1) hypoglycemia
2) weight gain
3) heart attack
4) stroke

Question 5

What are the 3 types of drugs for sulfonylureas and start and max doses

Answer 5

1) gliclazide, start: 80mg max: 320mg
2) glimepiride, start: 30mg max: 120mg
3) glyburide, start: 5mg max: 20mg

Question 6

What are the major warnings/contraindications for glyburide

Answer 6

Contraindicated with CKD. Warning –> can increase risk of heart attack because it can cause the cardiac K+ channels to close. Also can cause hypoglycemia

Question 7

Who are Meglitinides ideal for

Answer 7

people with irregular eating patterns. Fast acting, can work within 1hr and can last for up to 4hrs

Question 8

Which drug is associated with Meglitinides. What do you have to remember when taking this drug.

Answer 8

Repaglinide. Take 15min before eating

Start: 0.5mg if A1C <8%, 1-2mg if A1C >8%
Max: 16mg

Question 9

How is Repaglinide excreted

Answer 9

Metabolized in liver and can be excreted in poo. Can be used in people with CKD.

Question 10

When is Repaglinide contraindicated. What special precautions is there to take when mixing with ____

Answer 10

Liver disease.

Caution when mixing with clopidogrel (Plavix) or gemfibrozil, 8x increase in hypoglycemia