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VOLUME 1 ISSUE 6 CASE MP	MP is a 60-year-old Hispanic woman who has recently been diagnosed with type 2 diabetes mellitus.
PHYSICAL EXAMINATION »  Height: 5 ft. 3 in. »  Weight: 180 lb. »  BMI: 32 kg/m2 »  Pulse: 81 »  Blood pressure: 140/75 mm Hg LABORATORY VALUES »  TC: 240 mg/dL »  LDL-C: 160 mg/dL »  HDL-C: 30 mg/dL »  Triglycerides: 250 mg/dL »  FPG: 160 mg/dL »  A1c: 8.0% CURRENT MEDICATIONS »  Ramipril: 5 mg/d »  Atorvastatin: 10 mg/d »  Metoprolol: 50 mg/d »  Aspirin: 325 mg/d NAVIGATION »  Q1: What is the risk for edema with the use of TZDs? »  Q2: What is the pathogenesis of TZD-associated edema? »  Q3: What is the pathogenesis of CHF with TZD use? »  Q4: What is the risk for CHF in persons using TZDs? »  Q5: How would you evaluate the risk for edema in MP? »  Q6: What if MP had mild New York Heart Association (NYHA) class I or II CHF? Would a TZD be contraindicated? »  Q7: What if MP had NYHA Class III or IV CHF? »  Q8: How should you evaluate this patient? »  Q9: MP shows no signs or symptoms of CHF at this visit, and her weight is stable. How should you proceed?	Q: What is the pathogenesis of TZD-associated edema? A: Multiple factors probably contribute to fluid retention and peripheral edema caused by TZD use, although the reasons are not fully understood. An increase in plasma volume may be a result of a reduction in renal excretion of sodium and an increase in sodium and free-water retention.2 Increased sympathetic nervous system activity,3 activation of vascular endothelial growth factor (VEGF),4 and changes in endothelial permeability5 may all contribute to this phenomenon.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.edu/jeffcme
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