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Diabetes > Sulfonylureas > Flashcards

Sulfonylureas Flashcards

1
Q

What drugs are listed under the drug class sulfonyurea?

A
  1. Glibenclamide
  2. Gliclazide
  3. Gimepiride
  4. Glipizide
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2
Q

How do sulfonylureas work?

A

Sulfonylureas increase pancreatic insulin secretion; may decrease insulin resistance

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3
Q

What is the indication(s) for sulfonylureas?

A

T2DM

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4
Q

What are the precautions to sulfonylureas?

A
  1. Ketoacidosis (CI)
  2. T1DM (CI)
  3. Acute illness (i.e. MI, infection, trauma)
  4. Renal
  5. Hepatic - avoid in severe hepatic impairment
  6. Surgery
  7. Children
  8. Pregnancy
  9. Breastfeeding
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5
Q

What are the common adverse effects associated with sulfonylureas?

A

Hypoglycaemia

Weight gain

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6
Q

What affects the risk of hypoglycaemia with sulfonylurea use?

A

Risk of hypoglycaemia is increase with advanced are, renal, or hepatic impairment and interacting drugs

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7
Q

What are the infrequent adverse effects associated with sulfonylureas?

A 
Nausea
Diarrhoea
Metallic Taste 
Headache
Rash
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8
Q

What are the RARE adverse effects associated with sulfonylureas?

A 
Blood disorders
Allergic reaction
Stevens-Johnson syndrome 
Exfoliative dermatitis
Photosensitivity
Hepatotoxicity
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9
Q

What are the counselling points for sulfonylureas?

A
  1. Take with food to minimise risk of low blood glucose
  2. Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
  3. Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you’re unsure.
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10
Q

What are the practice points associated with sulfonylureas?

A
  1. Start with a low dose and increase slowly until control achieved
  2. Increasing dosage at the upper limit of dose range may achieve little additional hypoglycaemic effect
  3. Substitution with, or addition of, another sulfonylurea does not usually improve glucose control; instead consider combined treatment with other antidiabetic drugs or insulin, monotherapy with insulin or triple therapy with metformin and insulin.
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11
Q

Which of the sulfonyurea drugs has the highest risk of hypoglycaemia?

A

Few direct comparative data, however glibenclamide appears to have highest risk.

However, glimepiride (because of it’s active metabolites) and gliclazide (because of it’s long half life) can also cause severe hypoglycaemia

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12
Q

How can the risk of hypoglycaemia be mitigated?

A

Take sulfonylureas with food to minimise risk of low blood glucose.

Drinking alcohol decrease blood glucose. It can also mask warning symptoms of hypoglycaemia. avoid binge drinking and have something to eat when you drink alcohol.

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13
Q

What is the precaution surrounding sulfonylureas and patient’s with renal impairment?

A

Dosage reduction may be required in severe impairment because of increased risk of hypoglycaemia; glipizide or gliclazide preferred

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14
Q

What is the precaution surrounding sulfonylureas and patient’s requiring surgery?

A

Substitute with insulin treatment before surgery

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15
Q

Which sulfonylurea is administered only once daily?

A

Glimepiride - once daily.

Remaining sulfonyurea dosing regimens:

  1. glibenclamide: once or twice daily
  2. gliclazide: once or twice daily
  3. glipizide: once or twice daily
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16
Q

What is the dosage range for glibenclamide?

A

Adult, oral 2.5-15mg daily in one or two doses.

Max 20mg daily

17
Q

What is the dosage range for gliclazide?

A

Adult, oral 40-320mg daily in 1 or 2 doses (up to 160mg as a single dose).

CR tablet: oral, initially 30mg daily; increase dose, according to response, by 30mg daily at not less than 2-week intervals; max daily dose 120mg.

18
Q

What is the dose equivalent or IR and CR gliclazide tablets?

A

30mg of CR tablets are equal to 80mg of conventional tablets - gliclazide.

19
Q

What is the dosage range for glimepiride?

A

Oral, initially 1mg once daily, adjusted according to response in 1mg steps at 1-2 week intervals up to 4mg once daily.

20
Q

What is the dosage range for Glipizide?

A

Adult, oral 2.5-40mg daily in 1 or 2 doses; doses >15mg daily should be divided.

Diabetes (3 decks)

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