Sulfonylureas, Metformin, Glucagon

Question 1

Sulfonylureas MOA (4)

Answer 1

1. Enhancement of insulin secretion
2. Bind to sulfonylurea receptor (SUR) on pancreatic B cells
3. Closes ATP-dependent K channels, influx of Ca
4. Suppresses hepatic glucose production

Question 2

Sulfonylureas Generation 1 (4)

Answer 2

1. Acetohexamide
2. Chlorpropamide
3. Tolazamide
4. Tolbutamide

Question 3

Sulfonylureas Generation 2 (3)

Answer 3

1. Glimepiride
2. Glipizide
3. Glyburide

Question 4

Sulfonylureas PK/PD (3)

Answer 4

1, Metabolized by the liver

2. 2nd generation more ‘potent’ than 1st generation sulfonylureas
3. All sulfonylureas equally effective at equipotent doses

Question 5

Sulfonylureas ADE (5)

Answer 5

1. Hypoglycemia
2. Hyponatremia
3. Weight gain
4. Rashes
5. Abdominal discomfort

Question 6

Sulfonylureas Interactions w/ Medications

1. Displacement from protein binding sites (3)
2. Alters hepatic metabolism (3)
3. Alters renal excretion (1)

Answer 6

1. Warfarin, salicylates, sulfonamides
2. MAOIs, rifampin, cimetidine
3. Allopurinol

Question 7

Sulfonylureas Pearls (5)

Answer 7

1. HbA1c reduction of 1.5-2%
2. FPG reduction of 60-70 mg/dL
3. Generally dosed once daily
4. Adverse events increased when taken on empty stomach or if meals are skipped
5. Take ~30 minutes prior to meals

Question 8

Metformin (Glucophage) MOA (3)

Answer 8

1. Increases insulin sensitivity
2. Decreases hepatic glucose production
3. Decreases intestinal glucose absorption

Question 9

Metformin (Glucophage) ADE (4)

Answer 9

1. Abdominal discomfort (N/V/D especially with IR)
2. Metallic taste disturbances
3. Lactic acidosis (rare but serious complication)
4. Decreased B12

Question 10

Metformin (Glucophage) Contradindications (2)

Answer 10

1. Renal impairment

2. Radiographic contrast – Hold day of procedure, Restart 2-3 days after procedure

Question 11

Metformin (Glucophage) Pearls (6)

Answer 11

1. HbA1c reduction of 1.5-2%
2. FPG reduction of 60-80 mg/dL
3. Decreases plasma triglycerides and LDL-C by 8-15%
4. Increases HDL by 2%
5. Modest reduction in weight
6. Only oral agent approved for pediatric use

Question 12

Managing Hypoglycemia (2)

Answer 12

1. 15 grams CHO

2. Glucagon

Question 13

Glucagon (GlucoGen) MOA

Answer 13

Stimulates adenylate cyclase increasing cAMP and gluconeogenesis

Question 14

Glucagon (GlucoGen) PK

Answer 14

Onset within 5-10 min

Question 15

Glucagon (GlucoGen)

ADE (2)

Answer 15

1. Hypotension

2. N/V

Question 16

Glucagon (GlucoGen) Admin (3)

Answer 16

IV, IM, SC

Question 17

Glucagon (GlucoGen) Place in Therapy

Answer 17

Acute hypoglycemia episodes

Question 18

Medications increases glucose effects (7)

Answer 18

1. Diuretics – increases
2. Glucocorticoids – increases
3. Nicotinic Acid – increases
4. Oral contraceptives – increases
5. Phenytoin – increases
6. B-Blockers – increases
7. Clozapine – increases

Question 19

Medications decreasing glucose effects (4)

Answer 19

1. Ace I – decreases
2. Alcohol – decreases
3. Pentamide – decreases
4. Salicylates – decreases