Metformin is preferred over phenformin because

Correct Answer: B

Rationale: Metformin is preferred over phenformin because it is less liable to cause lactic acidosis. Lactic acidosis is a rare but serious side effect of biguanide drugs like metformin and phenformin, characterized by the buildup of lactic acid in the body. Phenformin has a higher risk of causing lactic acidosis compared to metformin, leading to its withdrawal from the market due to safety concerns. Option A, stating that metformin is more potent, is incorrect as both metformin and phenformin belong to the same class of drugs and have similar potency in lowering blood sugar levels. Option C, suggesting that metformin does not interfere with vitamin B12 absorption, is also incorrect. Metformin has been associated with vitamin B12 deficiency due to its impact on B12 absorption in the gut. Option D, claiming that metformin is not contraindicated in patients with kidney disease, is partially correct. While metformin is generally considered safer in patients with kidney disease compared to phenformin, it still requires dose adjustment or caution in patients with impaired kidney function. In an educational context, understanding the differences between metformin and phenformin in terms of safety and side effect profiles is crucial for healthcare professionals prescribing diabetic drugs. This knowledge can help in making informed decisions to optimize patient outcomes while minimizing the risk of adverse effects.

Correct Answer: B

Rationale: In diabetes management, selecting the appropriate treatment is crucial for optimal patient outcomes. The correct answer, option B, "Insulin requirement more than 40 U/day," disfavors the use of oral hypoglycemics due to the advanced stage of the disease where insulin production or utilization is significantly compromised. Option A, "Age at onset of disease over 40 years," is not a direct contraindication for oral hypoglycemics as age alone does not determine the effectiveness of these drugs. Many individuals over 40 can still benefit from oral medications. Option C, "Fasting blood sugar level between 100-200 mg/dl," falls within the range where oral hypoglycemics are usually considered as a first-line treatment, so it does not disfavor their use. Option D, "Associated obesity," is not a strict contraindication for oral hypoglycemics. In fact, some oral medications may be beneficial in managing diabetes in obese individuals. Educationally, it is essential to understand the criteria for selecting appropriate diabetes treatments to optimize patient care. Knowing when to transition from oral hypoglycemics to insulin therapy based on factors such as high insulin requirements is crucial in managing diabetes effectively and preventing complications.

Correct Answer: B

Rationale: In the context of diabetic drugs, the correct answer to the question is B) Troglitazone. Troglitazone belongs to a class of drugs known as thiazolidinediones (TZDs) or glitazones. These drugs work by activating peroxisome proliferator-activated receptor gamma (PPAR-gamma), a nuclear receptor that regulates gene expression involved in glucose and lipid metabolism. By activating PPAR-gamma, troglitazone increases the expression of glucose transporter proteins, particularly GLUT4, which enhances cellular glucose uptake. This mechanism helps to reverse insulin resistance by improving the cell's ability to take up glucose, thereby lowering blood sugar levels. Now let's examine why the other options are incorrect: A) Glibenclamide: Glibenclamide is a sulfonylurea drug that works by stimulating insulin release from pancreatic beta cells. It does not reverse insulin resistance by increasing cellular glucose transporters. C) Acarbose: Acarbose is an alpha-glucosidase inhibitor that slows down the digestion and absorption of carbohydrates in the small intestine, thereby reducing postprandial blood glucose spikes. It does not directly increase cellular glucose transporters to reverse insulin resistance. D) Prednisolone: Prednisolone is a corticosteroid that is used to reduce inflammation and suppress the immune system. It does not target insulin resistance or increase cellular glucose transporters. Educational context: Understanding the mechanism of action of different classes of diabetic drugs is crucial for healthcare professionals involved in the management of diabetes. Knowing how each drug works helps in making informed decisions about treatment options based on the underlying pathophysiology of the patient's condition. In the case of insulin resistance, drugs like troglitazone that target cellular glucose transporters play a significant role in improving insulin sensitivity and glycemic control.

Correct Answer: A

Rationale: Nephrogenic diabetes insipidus is a condition where the kidneys are unable to respond to antidiuretic hormone (ADH), leading to excessive urination and thirst. Demeclocycline, which is the correct answer (Option A), is a tetracycline antibiotic known to induce nephrogenic diabetes insipidus as a side effect. Doxycycline (Option B), minocycline (Option C), and oxytetracycline (Option D) are other tetracycline antibiotics but are not associated with causing nephrogenic diabetes insipidus. It is crucial for healthcare professionals to be aware of the potential side effects of medications, especially in patients with existing health conditions like diabetes. Educationally, understanding the side effects of medications used in diabetic patients is essential for healthcare providers to ensure safe and effective treatment. This knowledge helps in identifying and managing any complications that may arise due to drug therapy, ultimately leading to better patient outcomes.

Correct Answer: A

Rationale: Diabetic ketoacidosis (DKA) is a serious complication of diabetes characterized by high blood sugar levels, ketones in the urine, and acidosis. The best management for DKA is prompt correction of hyperglycemia, dehydration, and electrolyte imbalances. Option A, crystalline insulin given intravenously, is the correct choice for managing DKA. Intravenous administration allows for rapid absorption and onset of action, making it the most effective in lowering blood glucose levels swiftly and reversing ketosis and acidosis. Option B, human insulin given intramuscularly, and Option C, Lente insulin given subcutaneously, have slower onset and are not ideal for the acute situation of DKA where quick correction is necessary. Option D, Isophane insulin given intradermally, is an incorrect choice as intradermal administration is not a common route for insulin delivery and would not provide the rapid effect needed to manage DKA effectively. Educationally, understanding the appropriate route and type of insulin administration in different clinical scenarios is crucial for healthcare providers managing diabetic patients. In emergency situations like DKA, timely and effective intervention can be life-saving, making the knowledge of the correct administration route essential for patient care.