tommyk
04-09-2006, 05:03 PM
Hy 2117
A 54-year-old overweight white male named Ted Kennedy presents for a routine physical examination.
He was diagnosed by YOU with type 2 diabetes 1 year earlier. He has been moderately compliant with dietary precautions and his morning glucose has been persistently between 150 and 200 mg/dL.
He is therefore started on glipizide (What are the side effects, please?). One month later, metformin is added because of continued poor control. His other medications are propranolol and nifedipine for hypertension, and naproxen, which he began approximately 2 weeks ago for severe knee pain due to osteoarthritis.
On physical examination his blood pressure is 170/90 mm Hg, and he has a soft fourth heart sound. The remainder of the physical examination is normal. His routine electrolytes are checked and reveal a BUN of 35 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier. Which of his medications is most likely responsible for the increase in BUN and creatinine? This is a tricky one…think of side effects…
Pick one:
Glipizide
Metformin
Naproxen
Nifedipine
Propanolol
a) Listen, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, may cause a usually mild renal insufficiency, possibly related to a mild interstitial nephritis or glomerulonephritis. Risk of NSAID-induced renal damage is increased in the elderly and in patients with underlying renal disease. Glipizide, a second-generation sulfonylurea, may predispose patients to hypoglycemia but is not associated with renal toxicity. Metformin does not induce renal damage but should be used cautiously in patients with underlying renal damage because of the possibility of developing lactic acidosis. Neither nifedipine nor propranolol has a tendency to adversely affect the kidneys.
A 54-year-old overweight white male named Ted Kennedy presents for a routine physical examination.
He was diagnosed by YOU with type 2 diabetes 1 year earlier. He has been moderately compliant with dietary precautions and his morning glucose has been persistently between 150 and 200 mg/dL.
He is therefore started on glipizide (What are the side effects, please?). One month later, metformin is added because of continued poor control. His other medications are propranolol and nifedipine for hypertension, and naproxen, which he began approximately 2 weeks ago for severe knee pain due to osteoarthritis.
On physical examination his blood pressure is 170/90 mm Hg, and he has a soft fourth heart sound. The remainder of the physical examination is normal. His routine electrolytes are checked and reveal a BUN of 35 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier. Which of his medications is most likely responsible for the increase in BUN and creatinine? This is a tricky one…think of side effects…
Pick one:
Glipizide
Metformin
Naproxen
Nifedipine
Propanolol
a) Listen, the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, may cause a usually mild renal insufficiency, possibly related to a mild interstitial nephritis or glomerulonephritis. Risk of NSAID-induced renal damage is increased in the elderly and in patients with underlying renal disease. Glipizide, a second-generation sulfonylurea, may predispose patients to hypoglycemia but is not associated with renal toxicity. Metformin does not induce renal damage but should be used cautiously in patients with underlying renal damage because of the possibility of developing lactic acidosis. Neither nifedipine nor propranolol has a tendency to adversely affect the kidneys.