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1. Question
A 64-year-old female is taking metformin, pioglitazone, and sitagliptin for T2DM. Her liver function tests were elevated (AST 132 u/L and ALT 140 u/L) and she tested positive for Hepatitis C. Which is the best recommendation at this time?
Correct
Answer & Explanation:
The answer is D
Explanation:
Metformin and pioglitazone should not be used in a patient with liver disease and elevated LFTs. Sitagliptin may be used in hepatic impairment. When the LFTs go back to a normal range, it can be considered to reinitiate metformin and pioglitazone.
Incorrect
Answer & Explanation:
The answer is D
Explanation:
Metformin and pioglitazone should not be used in a patient with liver disease and elevated LFTs. Sitagliptin may be used in hepatic impairment. When the LFTs go back to a normal range, it can be considered to reinitiate metformin and pioglitazone.
Renal disease:
Metformin is contraindicated in renal disease due to the potential for lactic acidosis. Metformin should be discontinued when the Scr is 1.4 mg/dL for females or 1.5 mg/dL for males. It should be understood that metformin does not cause renal dysfunction, but rather accumulation of the drug can contribute to toxicity (lactic acidosis) in the individual with renal dysfunction.
Mechanisms of action:
The primary role of metformin is to inhibit hepatic glucose output, thus exerting benefi cial eff ects on fasting blood glucose levels. Th e secondary role of metformin is to promote glucose uptake by fat and muscles, thereby improving insulin sensitivity. Th irdly, metformin has a minor role in decreasing intestinal absorption of glucose.