jj123
Forum Newbie
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A patient is brought to ER due to 2 week history of progressive shortness of breath with exertion and leg swelling. He now requires two pillows for sleeping. He has had a 10 lbs weight gain during this period. He has a 15 years history of type II DM and hypertension that are poorly controlled. Two months ago, he began receiving a new diabetic medication that has been tiltrated upward during the past month. Crackles are heard at the lung bases bilaterally. Cardiac examination shows an s3 gallop. There is 2+peripheral edema of the lower extremities. Which of the drug is the most likely cause of the new symptoms of this patient?
a)acarbose
b)glyburide
c)metformin
d)repaglinide
e)rosiglitazone
I don't know what is the difference b/w choice b and e since both cause weight gain?
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| obgyne2b
Forum Junior
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I think the clues are in the part about titrating the DM meds upward and new onset cardiac problems. I haven't reviewed pharmacology yet, but I recall something about med interactions between DM and CHF meds--one of them you increase dose, the other, you decrease the dose...
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| me007
Forum Guru
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c?
weight gain in this case due to water retention. It is metformin - biguanides contraindicated in conditions predisposing to tissue anoxia like heart failure in this case or renal or hepatic disease.
they induce lactic acidosis, which likely to exacerbate those conditions.
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| new_n_lost
Politically InCorrect
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The Answer to this Question is E
Edited by new_n_lost on 03/10/07 - 06:26 PM
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| me007
Forum Guru
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can't find why it could be Tzds.
any ideas?
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| new_n_lost
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Biguanides can cause remarkable Lactic Acidosis esp in Pts who already have tissue anoxia ( any chronic Cardiopulmonary Dysfunction) but Thiazolidinediones cause remarkable weight gain, edema n anemia which will predispose the pt more towards CHF.
Thats y i choose TZDs
I may be wrong but i told my reason of choice.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| epica
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Pathogenesis of Edema With TZD Use (from PubMed)
The reasons for fluid retention and peripheral edema with TZD use are not fully understood and are likely to be multifactorial. The increase in plasma volume related to TZDs has already been cited and may result from a reduction in renal excretion of sodium and an increase in sodium and free water retention.30 TZDs may interact synergistically with insulin to cause arterial vasodilatation, leading to sodium reabsorption with a subsequent increase in extracellular volume, and thereby resulting in pedal edema. Increased sympathetic nervous system activity,31 altered interstitial ion transport,32 alterations in endothelial permeability,33 and peroxisome proliferator–activated receptor-{gamma}–mediated expression of vascular permeability growth factor34 represent other possible mechanisms for edema with these agents.
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| epica
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Troglitazone don't use in USA (because of this SE) anymore.
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| jj123
Forum Newbie
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It looks like choice e is correct. But glyburide causes weight gain too. Does it mean TZD causes more weight gain? I still don't understand.
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| jj123
Forum Newbie
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It looks like choice e is correct. But glyburide causes weight gain too. Does it mean TZD causes more weight gain? I still don't understand.
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| me007
Forum Guru
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to jj123
where is this q from if you don't know the ans?
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| jj123
Forum Newbie
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It is an NBME Q in forum 4 section 1 Q#50
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| me007
Forum Guru
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you should respect plans of others.
Some people planning to take NBME and such a "help" like posting nbme qs without warning is not good.
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| new_n_lost
Politically InCorrect
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Hey Buddy AS RULE WE ALL INFORM THE FORUM WHEN WE POST A NBME Q WE TELL EVERYONE THAT ITS AN NBME QUESTIONS COS MOST OF US INTEND TO DO THEM AS ASSESSMENT TESTS IF U START POSTING Q N THEN DO THE TEST THEN UR ASSESSMENT TURNS OUT TO BE FALSIFIED OR INCORRECT.
SO PLZ DO MENTION IT AS A NBME Q SO THAT THE REST OF US KNOW THAT
AND AS A FAVOR PLZ MENTION IT NOW ON THE TOPIC HEADING
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| jj123
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OK. I will do that later. I am new to the forum. I don't know the rules.
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