tommyk
10-03-2006, 12:23 PM
Hy 2408 This concept on Pharm was just reported on the TEST…
q) 50-year-old obese man named Jesse McCartney presents to you in the UK for a regular checkup. He is a Beatles fan (not a Key point). He was diagnosed with type 2 diabetes a year earlier (Key point). He has been moderately compliant with dietary precautions and his morning glucose has been persistently between 150 and 200 mg/dL (Very key).
He is therefore started on glipizide. One month later, metformin is added because of continued poor control (Even MORE key point).
His other medications are propranolol and nifedipine for hypertension, and naproxen for joint pain due to osteoarthritis. On physical examination his blood pressure is 150/90 mm Hg, and he has a slight fourth heart sound. His routine electrolytes are checked and reveal a BUN of 29 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier (MOST key point). Which of his meds is most likely responsible for the increase in BUN and creatinine? What is the MECH of ACTION? Ask yourself why the others are wrong. (This is such a crucial concept you should know it more than your birthday).
a-Glipizide
b-Metformin
c-Propranolol
d-Nifedipine
e-Naproxen
a) Naproxen! It 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. The B.P. drugs listed don’t usually affect the kidneys.
q) 50-year-old obese man named Jesse McCartney presents to you in the UK for a regular checkup. He is a Beatles fan (not a Key point). He was diagnosed with type 2 diabetes a year earlier (Key point). He has been moderately compliant with dietary precautions and his morning glucose has been persistently between 150 and 200 mg/dL (Very key).
He is therefore started on glipizide. One month later, metformin is added because of continued poor control (Even MORE key point).
His other medications are propranolol and nifedipine for hypertension, and naproxen for joint pain due to osteoarthritis. On physical examination his blood pressure is 150/90 mm Hg, and he has a slight fourth heart sound. His routine electrolytes are checked and reveal a BUN of 29 mg/dL and a creatinine of 1.8 mg/dL; both had been normal 1 year earlier (MOST key point). Which of his meds is most likely responsible for the increase in BUN and creatinine? What is the MECH of ACTION? Ask yourself why the others are wrong. (This is such a crucial concept you should know it more than your birthday).
a-Glipizide
b-Metformin
c-Propranolol
d-Nifedipine
e-Naproxen
a) Naproxen! It 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. The B.P. drugs listed don’t usually affect the kidneys.