ENDO + REPRO: SULPHONYLUREAS

Question 1

SULPHONYLUREAS: INDICATIONS

Answer 1

• Type 2DM

- Used when Metformin in contraindicated or in combo with M when blood sugar is not adequately controlled

Question 2

SULPHONYLUREAS: MOA

Answer 2

• Lowers blood sugar by stimulating pancreatic insulin secretion
• Block ATP-dependent K+ channels in pancreatic beta cell membranes, causing depolarisation of the cell membrane and opening of voltage gated Ca2+ channels
• The increase in intracellular Ca2+, stimulates insulin secretion

Question 3

SULPHONYLUREAS: ADVERSE EFFECTS

Answer 3

• GI upset (nausea, vomiting, diarrhoea, constipation)
• Hypoglycemia
• Rare hypersensitivity rxns include hepatic toxicity (eg cholestatic jaundice), drug hypersensitivity syndrome (rash, fever, internal organ involvement) and haematological abnormalities (agranulocytosis)

Question 4

SULPHONYLUREAS: WARNINGS

Answer 4

• Dose reduction required in patients with hepatic impairment
• Blood glucose should be monitored carefully in patients with renal impairment
• Prescribe with caution in patients at an increased risk of hypoglycemia including those with hepatic impairment (reduced gluconeogenesis), malnutrition, adrenal/pituitary insufficiency and the elderly

Question 5

SULPHONYLUREAS: INTERACTIONS

Answer 5

• Risk of hypoglycemia with co prescription of other antidiabetic drugs including:
• Metformin
• Thiazolidinediones
• Insulin
• Efficacy of (S) are reduced by drugs that elevate blood glucose (eg. Prednisolone, thiazide, loop diuretics)

Question 6

SULPHONYLUREAS: EXAMPLES

Answer 6

• Gliclazide