A 59-year-old woman with a 12-year history of type 2 diabetes mellitus and compensated systolic heart failure (ejection fraction 40%) presents to her primary care physician for a routine follow-up. Two months ago, she was started on a new oral antidiabetic agent that activates a nuclear receptor in adipose tissue to increase adiponectin levels and improve peripheral insulin sensitivity. At today's visit, her blood pressure is 138/86 mmHg, heart rate is 94/min, and respiratory rate is 20/min. Physical examination reveals 2+ pitting edema of the bilateral lower extremities extending to the knees and bibasilar crackles on lung auscultation. Her hemoglobin A1c has improved from 8.4% to 7.1%, but her weight has increased by 4 kg since her last visit. Which of the following drugs is most likely responsible for her worsening symptoms?
- A)PioglitazoneGABARITO
- B)Empagliflozin
- C)Metformin
- D)Sitagliptin
- E)Acarbose
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 →