USMLE

Sulfonylureas

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Anti-Diabetic Drugs
  1. Insulin Overview
  2. Rapid Acting Insulin
  3. Short Acting Insulin
  4. Intermediate Acting Insulin
  5. Long Acting Insulin
  6. Metformin
  7. Sulfonylureas
  8. Canagliflozin
  9. Pioglitazone

Summary

Sulfonylureas are a drug class including the drugs glimepiride, glyburide, and glipizide. These drugs are used to lower blood sugar, to treat people with type 2 diabetes. An important risk to note is the potential to lower the blood sugar levels too much and cause hypoglycemia, especially in older adults. Patients taking sulfonylureas should avoid alcohol to avoid a disulfiram-like reaction. Importantly, sulfonylureas are sulfa drugs and may therefore cause drug allergies in certain patients - be sure to look out for a history of allergic reactions before giving the drug!

Key Points

  • Sulfonylureas
    • Key drugs
      • Glimepiride
      • Glipizide
      • Glyburide
    • Mechanism
      • Directly stimulates beta cells in the pancreas to release more insulin, thus decreasing blood glucose level
      • Increases tissue response to insulin
      • Decreases glucose production by the liver
    • Clinical Use
      • Hyperglycemia in Type II Diabetes Mellitus
        • Is most effective if administered 30 minutes before a meal
    • SE and AR
      • Hypoglycemia
        • Shakiness
        • Tachycardia
        • Weakness
        • Diaphoresis
        • Use extreme caution in the elderly
      • Avoid alcohol
        • When combined with alcohol, sulfonylureas may cause a disulfiram-like reaction (nausea, vomiting, chills, headache, “hangover” like symptoms)
        • Alcohol can also potentiate the hypoglycemia and lower blood glucose levels even further
      • Hypersensitivity / Allergy (Sulfa Allergy)
        • If a patient has had an allergic reaction to another sulfa-derivative drug (e.g. sulfonamides, thiazide diuretics) the order for sulfonylureas should be questioned
      • Weight gain
      • Photosensitivity