QuestionSBA
QuestionChoice
Visual acuity is not routinely measured before starting pioglitazone.
50343
e
Visual acuity should be measured before starting pioglitazone
QuestionChoice
There isn't an increased risk of prostate cancer when taking pioglitazone, there is however an increased risk of bladder cancer.
50341
c
There is an increased risk of prostate cancer in patients who take pioglitazone
QuestionChoice
Incidence of heart failure is increased when patients use insulin and pioglitazone together. If the patient has a previous cardiac history such as a myocardial infarction, the risk is also increased. If a patient develops heart failure on pioglitazone (or already has heart failure), the pioglitazone should be stopped.
50339
a
If he needs to use insulin alongside pioglitazone he is at an increased risk of developing heart failure
QuestionChoice
Renal function is not routinely measured before starting pioglitazone.
50342
d
Renal function should be measured before starting pioglitazone
QuestionChoice
Insomnia is an uncommon side effect of pioglitazone, therefore it is not a likely side effect he will experience.
50340
b
He is likely to experience insomnia after starting pioglitazone
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3651
Pioglitazone treatment increases the risk of heart failure
Topic
74
Elderly Care
10122
Case presentation: A 78-year-old diabetic man attends an appointment with the diabetic nurse to monitor his blood glucose.



**PH**
Type 2 diabetes mellitus, hypertension, hypercholesterolaemia

**DH**
Metformin 500mg PO BD, ramipril 10mg OD, amlodipine 10mg OD, atorvastatin 20mg PO OD.

Investigations: HbA1c 68 mmols/mol (<48 mmols/mol)

As this gentleman has a high HbA1c it is decided he should be started on another anti-diabetic medication. One of the medications offered to treat his diabetes includes pioglitazone.

Question: Select the most important information that should be provided for this patient.
a