A 59-year-old woman with type 2 diabetes mellitus and a history of compensated heart failure with reduced ejection fraction (last echocardiogram showing EF of 40%) presents to her primary care physician for a follow-up visit. Two months ago, she was started on a new oral antidiabetic medication that activates a nuclear receptor to increase adiponectin levels and improve peripheral insulin sensitivity. At today's visit, her blood pressure is 138/86 mmHg, heart rate is 92/min, and weight has increased by 4.5 kg since her last appointment. Physical examination reveals 2+ pitting edema of the bilateral lower extremities and bibasilar crackles on lung auscultation. Her hemoglobin A1c has improved from 8.4% to 7.1%, but she reports progressive dyspnea on exertion and orthopnea over the past three weeks. Which of the following drugs is most likely responsible for her worsening symptoms?
- A)Empagliflozin
- B)Acarbose
- C)PioglitazoneGABARITO
- D)Metformin
- E)Sitagliptin
Explicação
Pioglitazone activates PPAR gamma and increases insulin sensitivity, but it can cause fluid retention, edema, and heart failure exacerbation. The delayed onset and worsening volume overload after initiation are classic clues. Ver explicação completa e trilha adaptativa →