Insulin Secretagogues: sulfonylureas & meglitinides

Question 1

Meglitinides have a ____ onset and ____ duration than sulfonylureas

Answer 1

faster, shorter

Question 2

what medications are sulfonylureas?

Answer 2

Glipizide
- glucotrol, glucotrol XL*^

Glimepiride
- Amaryl*

Glyburide
- Micronized glyburide (Glynase)*

Question 3

Glipizide (Glucotrol) max dose

XR max dose

Answer 3

40 mg/day

20 mg/day

Question 4

Glimepiride (Amaryl) max dose

Answer 4

8 mg/day

Question 5

Glyburide max dose

Answer 5

20 mg/day

Question 6

micronized glyburide (Glynase)

Answer 6

12 mg/day

Question 7

Sulfonylureas
- CI
- warning
- side effects
- decreases A1C by:
- Glucotrol XL can leave a:
- glimepiride, glyburide are on the
- patients with a G6PD deficiency can be at
increased risk of:

Answer 7

• CI: sulfa-allergy*
• warning: hypoglycemia*
• SE: weight gain, nausea*
• 1-2%, decreased efficacy over time
• ghost tablet in stool
• beer’s criteria due to hypoglycemia risk
• hemolytic anemia

Question 8

what drugs are meglitinides?

Answer 8

Repaglinide

Nateglinide

Question 9

Take rapeglinide______ min before meals

max dose

Answer 9

15-30

16 mg daily

Question 10

Take nateglinide _____min before meals

Answer 10

1-30

Question 11

Raoeglinide and nateglinide are contraindicated in

Answer 11

Type 1 diabetes, DKA

Question 12

Warnings and side effects of repaglinide and nateglinide

Answer 12

hypoglycemia* caution with liver/renal impairment

weight gain* headache, URTIs

Question 13

Sulfonylurea and meglitinide drug interactions

Answer 13

insulin increases risk of hypoglycemia, avoid use with either drug class*

SUs are CYP2c9 substrates

Gemfibrozil and clopidogrel can increase repaglinide, CI

Alcohol can increased risk for delayed hypoglycemia when taking insulin or insulin secretagogues