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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 if MP had NYHA Class III or IV CHF? A: Neither currently available TZD (rosiglitazone, pioglitazone) included patients with Class III or IV NYHA cardiac status in clinical trials. TZDs should not be used in these patients at this time. MP is started on rosiglitazone 4 mg/d and instructed to call the doctor if she notices any edema, shortness of breath, or rapidly developing weight gain.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.edu/jeffcme
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