MEDICINEnotes

Q1095. A 65-year-old man is admitted with an extensive anterior STEMI and undergoes successful primary PCI. On the third day, he suddenly develops severe breathlessness, hypotension and pulmonary oedema. His blood pressure is 82/54 mmHg, and a new harsh pansystolic murmur with a palpable thrill is heard along the lower left sternal border. Echocardiography identifies a new ventricular septal defect with left-to-right flow.

#Investigation_in_Acute_Coronary_Syndrome@MediNote47

Oral hypoglycemic drugs

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لو الـ Patients من البداية مايتحملش Metformin is not tolerated or contraindicated (CI) Initial monotherapy اختار واحد: Gliptin. Sulfonylurea. Pioglitazone. Dual therapy إذا HbA1c أكبر من (7.5%): Gliptin + Pioglitazone. Gliptin + Sulfonylurea. Pioglitazone + Sulfonylurea. Insulin If HbA1c remains greater than 58 mmol/mol (7.5%) نتنقلوا للـ Insulin.

#Metformin First-line treatment. 1. Rule out renal failure (RF) before starting Metformin. 2. Reassess HbA1c after 3 months. If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug. #Dual_therapy اختار واحد من الاثنين اهما Metformin + Gliptin. Metformin + Sulfonylurea. Metformin + Pioglitazone. Metformin + SGLT-2 inhibitor. Reassess HbA1c after 3 months. If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy. #Triple_therapy اختار واحد من الثلاثة اهما Metformin + Gliptin + Sulfonylurea. Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor. Metformin + Pioglitazone + SGLT-2 inhibitor. If HbA1c remains above 7.5% despite triple therapy → Insulin therapy. لو كانت Triple therapy: Not effective. Not tolerated. Contraindicated. AND BMI greater than 35. نستخدموا: Metformin + Sulfonylurea + GLP-1 mimetic.

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