CC Sept 2015 Metformin and Renal disease

echoecho's version from 2015-10-14 01:55


Question Answer
*** What medication is the preferred initial medication for the management of type 2 DM?Metformin
When used as monotherapy, does Metformin cause hypoglycemia? weight gain?no; no
In the UKPDS (United Kingdom Prospective Diabetes Study), metformin use was associated with what?reduced all-cause mortality in the subgroup of obese patients
What is one major limitation on the use of Metformin?contraindicated in patients with renal insufficiency
*** When metformin was approved for use in the US in 1994, the FDA approved product label stated what contraindications to its use?that it was contraindicated in patients with renal dysfunction (as suggested by creatinine levels > 1.5 mg/dL in males or > 1.4 mg/dL in females)
Although the FDA has not modified these restrictions, regulatory agencies in Canada and the United Kingdom allow what?carefully monitored use of metformin in patients w/ renal disease and several large observational studies suggest that the benefits of metformin may exceed the risk in select patients with renal disease
What classification is metformin placed under?biguanide
What is metformin's mechanism of action?inhibition of aerobic respiration in mitochondria, with increased use of anaerobic metabolic pathways
Why was an earlier biguanide (Phenformin) withdrawn from the market?due to the risk of lactic acidosis
Why are there concerns regarding toxic serum levels of metformin in renal impaired patients? Have subsequent studies revealed this?1) because metformin is eliminated unchanged in the urine 2) no, there was no consistent associations between creatinine clearance, serum metformin levels and serum lactate levels as serum metformin levels generally remained w/in the therapeutic range even in pts w/ moderate renal disease
Metformin increased risk of latic acidosis in patients with GFR < ____?60
Among pts taking > 2000 mg of Metformin with GFR < ____, the hazard ratio was 13?45
Studies are vulnerable to a scertainment bias, what is this?physicians may be more likely to test for lactic acidosis in patients taking Metformin
The absolute risk appears to be ____ (low vs. high)?low
A seperate analysis of the same data base estimated that the absolute risk of lactic acidosis in patients with moderate kidney disease defined by what GFR was 17.18 cases per 100,000 patient years?30-60
Did another analysis suggest a net benefit to Metformin use in moderate renal disease?yes
A propensity score adjusted analysis of the multi-national REACH registry found that Metformin use in GFR 30-60 was associated with significant reduction in all cause mortality, true or false?true
A similar analysis of a Swedish data base found a statistically significant decrease in all cause mortality in pts w/ GFR between ___ and 60 mL (GFR)?40
Metformin may be of benefit in patients with _____ (minimal vs. moderate vs. severe) renal disease?moderate
*** Authors of a recent review of Metformin usein renal disease suggest carefully monitored Metformin therapy may be appropriate for patients with GFR between ____ and _____. They futher recommend limiting the dose to _____ mg daily in patients with GFR between 40-45?30-60; 1000 mg
*** Summary: the FDA approved product label states that Metformin is contraindicated in patients with renal dysfunction as suggested by a creatinine level > _____ in males and ____ in females due to the risk of what?1.5; 1.4; lactic acidosis
*** Summary: The absolute risk of lactic acidosis appears to be small in those with ______ (minimal vs. moderate vs. severe) kidney disease?moderate
*** Summary: for patients with GFR between ____ and ____, limit dose of Metformin to 1000 mg daily?30-45