p2
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11. A 57-year-old man with a 10-year history of type 2 diabetes mellitus comes to the physician fora routine examination. His last office visit was 6 months ago. He feels well. Current medications include enalapril and glyburide. He is 168 cm (5 ft 6 in) tall and weighs 84 kg (185 Ib), BMI is 30 kg/mZ. His pulse is 60/min, and blood pressure is 100/70 mm Hg. Funduscopic examination shows soft and hard exudates. Laboratory studies show
Hemoglobin Al. 12%
Serum
Urea nitrogen (BUN) 23 mg/dL
Creatinine 1.4 mg/dL
Urine protein 1+
Which of the following is the most appropriate additional pharmacotherapy?
O A) Atenolol
O B) Captopril
O C) Hydrochlorothiazide
O D) Metformin
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| tamerbashir
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D
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| p2
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explain
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| Adam
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Atenolol > no need for it as the blood pressure is 100/70.
Captopril > the patient is already tacking enalapril as nepho protective from diabetes, in addition captopril has more side effects than enalapril ( dry cough,...)
There's no indication here to use HCTZ..
The patient is diabetic and his BMI is 30, and he doesn't have renal insufficiency >>>>>> Metformin is a very useful drug here for both diabetes and obesity.
Edited by Adam on 01/17/08 - 09:55 AM
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| kpmle2
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D) Metformin
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| mediocre
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The HbA1c and Fundoscopy clearly show that Diabetes is not well controlled so add another anti-diabetic drug;
Metformin is the preferred First line drug almost universally if no CI exist, especially if bm>25
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