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Finks 5 on Sulfonylureas with DJ Barrow, PharmD Candidate

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The Finks 5 is an abbreviated review on a selected drug or pharmacotherapeutic class, which is summarized within 5-15 minutes. This Finks 5 is a summary on sulfonylureas peppered by Pharm.D. Candidate DJ Barrow and reviewed by Jennifer Campbell, Pharm.D., CDCES

Hey everybody this is shannon finks with the thanks five and today i have with me dj barrow who’s a fourth year pharmacy student today i’ll be presenting my things five on stefani ureas we’ve been talking about diabetes agents and sulfonylureas are not used often there are a few things you need to know to keep patients safe with their prescribed regimen so

We will talk about stefania ria’s role in therapy commonly used agents in their pharmacokinetics why you might still see sophomores being dispensed and more importantly the risk involved so you can communicate them to your patients we will summarize where they fall into the diabetes standards of care treatment and give you some tips you can share with your

Patients this is the beta cell within the pancreas sulfonylureas bind to sophomore receptor 1 on functioning beta cells this results in decreased influx of potassium due to the interaction with potassium sodium channel atpase and depolarization of the beta cell membrane this depolarization causes calcium to enter the cell through voltage-dependent calcium

Channels and ultimately results in the increased release of insulin this class of drugs is also known as secretogs because they increase the secretion of insulin each year the american diabetes association publishes a living guideline on the standards of care and diabetes the red box highlights where sulfonylureas are located within the treatment algorithm this

Will be discussed further metformin is the basis of all type 2 diabetic patients therapy unless it is contraindicated sulfonylureas are options that can be added to therapy if the patient does not have high risk or history for atherosclerotic cardiovascular disease chronic kidney disease or heart failure and is not at goal the goal for each patient should

Be individualized more strengthening goals are for patients who are otherwise healthy and less stringent goals for patients at high risk for hypoglycemia and other comorbidities other oral agents are often used before sophomores but a sophomoria is an alternative if cost is a major issue the most prescribed secretorgs are globuride glyphozide and glimepiride

These are the second generation sophani ureas and are used most often due to their increased potency when compared to the first generation they are given either daily or bid globuride has two available formulations the micronized formulation has an elimination half-life of four hours versus 10 hours for the regular formulation this is to decrease the potential

For hypoglycemia which this drug class is notorious for causing glyphozide also has two available formulations the extended release formulation is dosed once daily globuride should be avoided in renal impairment while glyphozide and glymepyride can be used at lower doses for hepatic adjustment as a drug class sulfonylureas can be used at lower doses in patients

With child pew a and b scores and should be avoided in child pure c-score next we’ll talk about dosing titrations for the different sulfonate reagents the first agent we’ll talk about is glyburide also known as diabeta or the micronized version micronase glyburide and micronized chloride are not equivalent re-titration is needed if switching between the different

Products now if a patient is being converted from insulin to glyceride there are important points to know first the patient is taking up to 40 units daily discontinue the insulin and initiate glaberate there are no transition periods required if the patient is taking greater than 40 units daily there is a transition period required first you will reduce the dose

Insulin dose by 50 while initiating the glaberide you can initiate the glyphorad at 2.5 to 5 milligrams by mouth daily titrate in increments of 2.5 milligrams weekly for a maintenance dose it can be between 1.25 to 20 milligrams by amount daily or in two divided doses the max daily limit for globularide is 20 milligrams a day the next dosing saturation we’ll

Talk about is for glyptozide for the immediate release formulation it’s also known as glucotrol and for the extended release formulation is google trial xl for the immediate release you will initiate at five milligrams by mouth daily before breakfast increase in 2.5 to 5 milligram increments weekly for the immediate release formulation the max daily dosing is

40 milligrams daily in doses greater than 15 milligrams should be divided into two daily doses for the extended release formulation you’ll initiate a five milligrams by mouth daily before breakfast increased by five milligram increments weekly the max dosing for extended release formulation is 20 milligrams daily the next dosing titration is for glimmerid also

Known as amorel you’ll initiate a one to two milligrams by mouth daily increase by one to two milligram increments every one to two weeks the max daily dosing for amarillo or glimepiride is eight milligrams per day for sophomore years you want to make sure to increase only when necessary make sure the patient is tolerating the regimen and has a clinical response

As therapy continues as the class they are known more for their risk than their benefits the major risk for self-harm areas are weight gain and hypoglycemia patients can also experience other annoying side effects such as rashes headaches gi symptoms and beta cell function loss there is a potential for siadh or syndrome of inappropriate antidiuretic hormone but

It is a rare occurrence this syndrome causes patients to retain sodium and fluid due to decreased renal excretion patients with siadh will report symptoms of nausea or vomiting memory impairment confusion seizures and they may experience a coma please educate your patients on this and make them aware of any intolerable side effects to discuss for future therapy

If you see them used it’s because they are cheap they may affect both fasting and postprandial glucose and have an a1c reduction of 0.8 in summary safani ureas are not commonly used and are not recommended as first line therapy but they do have a role when patients cannot afford other agents the main adverse effects are weight gain and hypoglycemia make sure

To communicate with your patients about the risk when they are prescribed savannah areas thanks dj for preparing the sphynx 5 and a special thanks to dr jennifer campbell for her peer review of this session you

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Finks 5 on Sulfonylureas with DJ Barrow, PharmD Candidate By Züp Med