A 58-year-old man with type 2 diabetes on metformin and glimepiride presents with sweating and confusion 2 hours after lunch. His wife says he skipped breakfast. His blood glucose is 48 mg/dL. Compared to glimepiride, which sulfonylurea carries the HIGHEST risk of prolonged severe hypoglycemia due to its long half-life and renal excretion, making it particularly dangerous in the elderly?
- A Glibenclamide (Glyburide) ✓
- B Glipizide
- C Gliclazide
- D Glimepiride
Correct answer: A. Glibenclamide (Glyburide)
Explanation
Glibenclamide (glyburide) has an active metabolite and a long half-life (up to 10 hours), with renal excretion. It carries the highest risk of prolonged, severe hypoglycemia among sulfonylureas, especially in elderly patients and those with renal impairment. It has largely been phased out in many countries for this reason. Glimepiride and gliclazide are preferred for lower hypoglycemia risk.
Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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