A 63-year-old woman with T2DM has attempted diet control and exercise for the last 9 months. Her medical history remarkable for HF, HTN, hyperlipidemia, she currently takes enapril, atorvastatin and aspirin. Lab creatinine = 2.5 mg/dl, GFR = 35 and HG A1C = 8%. What is the Most appropriate treatment?
سؤال مجاني 8 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: A. Repaginate
- إجابة ثانية: E. Metformin and empagliflozin
Drug-naive T2DM with heart failure and CKD (eGFR 35). The pharmacology lecture calls repaglinide (a liver-metabolised meglitinide) the only oral agent safe in renal dysfunction at any GFR, and this matches the recalled exam key. Metformin should not be started at eGFR 30–45, and rosiglitazone (D) is contraindicated in HF.
- But the DM lecture slides recommend an SGLT2 inhibitor when HF or CKD predominates, and list metformin as contraindicated only below eGFR 30. That supports E (metformin + empagliflozin), which is also what current guidelines would choose.
- For the exam, go with the lecturer's key (A).
ليش كل خيار صح أو غلط
-
A
ليش صح
Supported by the pharmacology lecture: repaglinide (a meglitinide) is the only safe oral agent in renal dysfunction regardless of GFR. (The RT slides support E.)
✓ Anti-diabetic.pdf · p. 4 -
D
ليش غلط
Rosiglitazone is a thiazolidinedione, contraindicated in heart failure (it also causes weight gain and oedema).
✓ Endocrine ✳️.pdf · p. 8 -
E
ليش صح
Supported by the RT - DM slides: when heart failure or CKD predominates, they prescribe a low dose of an SGLT2 inhibitor such as empagliflozin. (The pharmacology lecture supports A.)
✓ RT - DM.pdf · p. 12
- المصدر
- Anti-diabetic.pdf · p. 4
RT - DM.pdf · p. 12
RT - DM.pdf · p. 10 - المحاضرة
- Diabetes Mellitus · Endocrinology · Module B
- ظهر في
- Endo bank