Sulfonylureas

Question 2

Class.

Answer 2

Sulfonylurea

Question 3

MOA.

Answer 3

• increase pancreatic insulin secretion

- may decrease insulin resistance

Question 4

Indication.

Answer 4

Type 2 diabetes

Question 5

Dose ranges:

Answer 5

Glimepiride:
1-4mg d

Glibenclamide:
2.5-20mg d (1/2 doses)

Glipizide:
2.5-40mg d (1/2 doses)

Gliclazide:
20–320mg d (1/2 doses)
CR: 30-120mg d

Question 6

A /Es?

Answer 6

• hypoglycaemia (increased risk: elderly, renal/hepatic impairment DIs) least likely with gliclazide/glipizide
• weight gain
• nausea, diarrhoea, headache
• metallic taste
• rash

Rare

• blood disorders (thrombocytopenia, agranulocytosis, aplastic anaemia, haemolytic anaemia)
• allergic reaction, SJS
• hepatotoxicity

Question 7

Label?

Answer 7

10a:
- Do not take more than one aspirin tablet or capsule each day while being treated with this medicine.

B
- ‘Take with or soon after food’

Question 8

Counseling.

Answer 8

• This medicine increases the amount of insulin your
  body releases, which then lowers your blood sugar levels. Some people can experience hypoglycaemia (also called a ‘hypo’) when their blood sugar levels drop too low. This is more likely to occur if this medicine is taken on an empty stomach rather than with a main meal. Do not take a dose if you skip a meal.
• Take with food to minimise risk of low blood glucose (hypoglycaemia)
• Can cause weight gain; maintain a healthy diet and regular exercise in the management of type 2 diabetes.
• Limit the amount of alcohol you consume, as alcohol can decrease your blood sugar levels. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
• Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure. Early warning signs and symptoms of a hypo include:
  >sweating
  > hunger
  > faintness
  > palpitations
  > tremor
  > headache
  > visual disturbance
• Do not take more than one aspirin tablet or capsule each day while being treated with this medicine. (10a)

Question 9

Monitoring.

Answer 9

• blood sugar levels
• hypoglycemia
• weight
• renal/hepatic function
• allergy to other non-antibiotic sulfonamide-containing medicines (e.g. thiazide diuretics, celecoxib) because of the risk of cross-sensitivity

Question 9

List.

Answer 9

• glibenclamide
• glimepiride
• gliclazide
• glipizide