WBR0673
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::A 52 year old obese man, with a past medical history significant for hypertension, dyslipidemia, diverticulosis, and chronic kidney disease and a past surgical history of cholecystectomy, presents to the physician's office for his annual check-up. Routine work-up shows HbA1c = 7.5%. The physician decides he wants to start oral anti diabetic therapy to treat the patient's condition. Which of the following medications must be avoided in the patient's condition?]] |
| Answer A | AnswerA::Pioglitazone |
| Answer A Explanation | AnswerAExp::Pioglitazone is a thiazolidinedione (TZD). It is not contraindicated in chronic kidney disease. It is contraindicated in heart failure. |
| Answer B | AnswerB::Pramlintide |
| Answer B Explanation | AnswerBExp::Pramlintide is an amylin analog that decreases glucagon. It is not contraindicated in renal failure. |
| Answer C | AnswerC::Metformin |
| Answer C Explanation | AnswerCExp::Metformin is a biguanide that is commonly used as a first line therapy for type 2 diabetes mellitus. It is contraindicated in renal failure and in patients among the age of 80 years. It has been associated, in rare cases, with lactic acidosis. |
| Answer D | AnswerD::Exenatide |
| Answer D Explanation | AnswerDExp::Exenatide is a GLP-1 analog that increases insulin and decreases the release of glucagon. It is associated with GI distress and pancreatitis. |
| Answer E | AnswerE::Glimepiride |
| Answer E Explanation | [[AnswerEExp::Glimepiride is a second generation sulfonylurea (SU). It is associated with hypoglycemia because SU are secretagogues, not sensitizers. It is not contraindicated in renal failure. Glipidize, on the other hand, is contraindicated in renal failure; whereas glyburide is contraindicated in liver failure.]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::The patient is newly diagnosed with type 2 diabetes mellitus, with an elevated HbA1c > 6.4 % and requires oral anti-diabetic pharmacologic therapy. Generally, metformin, a biguanide that acts as a sensitizer, is considered a first line therapy for patients with type 2 diabetes mellitus. However, it is contraindicated in renal failure and may not be initiated in patients above 80 years of age. In rare occasions also, it has been associated with lactic acidosis. Since the patient is known to have chronic kidney disease, metformin is thus contraindicated and must be avoided.
Educational Objective:
Metformin is contraindicated in renal failure |
| Approved | Approved::No |
| Keyword | WBRKeyword::metformin, WBRKeyword::diabetes, WBRKeyword::mellitus, WBRKeyword::type, WBRKeyword::2, WBRKeyword::contraindication, WBRKeyword::contraindicated, WBRKeyword::renal, WBRKeyword::failure, WBRKeyword::chronic, WBRKeyword::kidney disease, WBRKeyword::oral, WBRKeyword::antidiabetic, WBRKeyword::therapy |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |