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► This is a clinical question based on pharmacotherapeutics. It also includes extra information that will help you to find the correct answer.

Hello guys let’s jump into another important question a 54 year old obese patient with type 2 diabetes has a history of alcoholism in this patient metformin should either be avoided or used with extreme caution because the combination increases the risk of which of the following here are the options option a disulfiram-like reaction option b excessive weight

Gain option c hypoglycemia option d lactic acidosis option d serious hepatotoxicity this is a one-step question and you can answer it straight away but say you look at the question and you are not sure about the answer but don’t worry let’s figure it out together let’s jump into the options in this question option a is disulfrin-like reaction it is an alcohol

Drug interaction causing an unpleasant hypersensitivity to alcohol leading to nausea vomiting throbbing headache and general hangover-like symptoms similar to the effect caused by disulfiram administration these effects are caused by drugs that inhibits the enzyme alcohol dehydrogenase causing accumulation of acetaldehyde a toxic metabolite of alcohol drugs

That may produce disulfiram-like reactions with ethanol include the following oral hypoglycemics like chloropropamide some cephalosporins like cepheperazone cephamandol and cephetetin the antifungal grazia fulvin antibiotics like metronidazole nitrofuran1 and sulfonamides and many more now let’s go to option b excessive weight gain metformin is widely used and

Is considered a first-line therapy for diabetes management it is an insulin sensitizer that decreases free fatty acid release from adipose tissue metformin also decreases hepatic glucose output and intestinal glucose absorption hence has consistently demonstrated a weight loss effect however major therapeutic classes of medications used for type 2 diabetes

Such as insulin sulfonylureas megalatinide derivatives and thiazolidine ions have been associated with weight gain with the potential to offset the beneficial effects of glycemic control option c is to rule out the chance of metformin to cause hypoglycemia it is a well-known fact that metformin is associated with fewer hypoglycemic attacks than insulin and

Sulfonylureas and it may be the first-line pharmacological therapy of choice in these patients well the next option lactic acidosis is a commonly asked concept in competitive pharmacy exams although uncommon metformin associated lactic acidosis is a potentially fatal adverse effect significant renal and hepatic disease alcoholism and conditions associated with

Hypoxia for example cardiac and pulmonary disease surgery are contraindications to the use of metformin other risk factors from it form an induced lactic acidosis are sepsis dehydration high dosages and increasing age lactic acidosis appears to result from biguanide interference causing an increase in production and decrease in clearance of lactate leading

To higher cellular lactate levels in the presence of hypovolemia and acute kidney injury elevated metformin levels result in inhibition of enzymes involved in gluconeogenesis reducing conversion of pyruvate to glucose and inhibiting mitochondrial electron transport chain resulting in an increased conversion of pyruvate to lactic the common symptoms of lactic

Acidosis includes anorexia nausea vomiting altered level of consciousness hyperpnea abdominal pain and thirst the last option to this question is hepatotoxicity metformin is not considered intrinsically hepatotoxic it is only contraindicated in patients with advanced cirrhosis because it increases the risk of developing lactic acidosis now it’s end of all the

Options the absolute best answer to this question is option d lactic acidosis the

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