Pharmacology Final

less in 2nd generation than first, but still few

hypoglycemia

• chlorpropamide
• tolazamide

• hypoglycemia
• jaundice
• N/V
• Anorexia
• Pruitis
• Disulfiram Like reactions

• only effective in pt w functioning beta cells
• may be used in pt with sulfa allergy

stimulate release of insulin from beta cells by blocking atp dependant K+ channels

• rapid absorption
• recommended pre-prandial administration
• hepatic metabolism

hypoglycemia

renal or hepatic insuficiency

• ketoconazole
• miconazole
• erythromycin
• decrease biotransformation => hypoglycemia

repaglinide

• sulfonylureas
• metformin
• thiazolidinediones

• Metformin
• Only biguanide in the US

• does not cause hypoglycemia
• pt do not gain weight
• action does not depend on functioning beta cells

Food decreases absorption

• NVD
• anorexia
• flatulence
• lactic acidosis

renal or hepatic impairment

• Increases glucose uptake in the muscles
• Decreases gluconeogenesis in the liver

• Repaglinide lowers BG by stimulating insulin release
• Metformin improves glucose tolerance by lowing basal and postprandial BG

• pt. receiving gemfibrozil and itraconazole
• pt receiving contrast dye

• alcohol potentiates effect of metformin
• should not be used with NPH insulin
• may cause B12 deficiency
• Hepatic impairment

• cationic drugs
• amiloride
• digoxin
• procainamide

CYP2C8 and 3A4

with

• pioglitazone
• rosiglitazone

• increase insulin sensitivity in tissues
• decrease hepatic gluconeogenesis

• take with or without food
• metabolized by CYP450

• decreases plasma concentrations of oral contraceptives => pregnancy
• not recommended with insulin
• not recommended with nitrates