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Hepatotoxicity
13%
20/157
Lactic acidosis
Pancreatitis
16%
25/157
Urinary tract infection
3%
4/157
Weight gain
54%
84/157
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This patient with a disulfiram-like reaction to alcohol is most likely taking the sulfonylurea drug class for diabetes. Meglitinides also target ATP-gated potassium channels and have a side effect of weight gain. Glucose normally triggers insulin release from pancreatic β cells by increasing intracellular ATP. This increase in ATP closes ATP-gated potassium channels and thereby leads to depolarization of the β cells and subsequent release of insulin. Both sulfonylureas and meglitinides work by binding to and closing these ATP-gated potassium channels, though the two drugs bind to different sites on the channel. Side effects of sulfonylureas include a disulfiram-like reaction to alcohol, and side effects of meglitinides include weight gain. Incorrect Answers: Answer 1: Hepatotoxicity is a side effect of thiazolidinediones; however, these drugs do not interact with ATP-gated potassium channels. Answer 2: Lactic acidosis is an important side effect of biguanides such as metformin; however, these do not interact with ATP-gated potassium channels. Answer 3: Pancreatitis is a side effect of GLP-1 analogs such as exenatide; however, these do not interact with ATP-gated potassium channels. Answer 4: Urinary tract infections are a complication of SGLT-2 inhibitors such as canagliflozin; however, these do not interact with ATP-gated potassium channels. Bullet Summary: Meglitinides and sulfonylureas both stimulate insulin release through binding to ATP-gated potassium channels.
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