3. A patient presents a new prescription for glipizide XL 10 mg. The patient has been taking the following medications regularly for the past year: Metformin 500 mg twice daily, Procardia XL 30 mg daily, Lisinopril 20 mg daily, Glyburide 5 mg twice daily. Therapeutic duplication exists between glipizide and:
Answer: B
Glipizide has therapeutic duplication with glyburide.
Glipizide and glyburide are both sulfonylureas that stimulate insulin secretion from the pancreas, thus resulting in therapeutic duplication when used together.
A) Procardia XL
Procardia XL is a calcium channel blocker used to treat hypertension and angina. It does not have any mechanism that overlaps with glipizide, thus there is no therapeutic duplication between these two medications.
B) glyburide
Glyburide is a sulfonylurea, just like glipizide, and both medications work by stimulating insulin release from pancreatic beta cells. Using both medications together leads to therapeutic duplication, which can increase the risk of hypoglycemia and is generally avoided in clinical practice.
C) metformin
Metformin is an antihyperglycemic agent that primarily works by decreasing hepatic glucose production and improving insulin sensitivity. Although metformin is often used in conjunction with sulfonylureas, it does not cause therapeutic duplication with glipizide.
D) lisinopril
Lisinopril is an ACE inhibitor used for hypertension and heart failure management. It does not share any pharmacological properties or mechanisms with glipizide, and therefore there is no therapeutic duplication present.
Conclusion
The correct answer is glyburide, as both glyburide and glipizide belong to the same class of medications that can lead to similar effects on blood glucose levels. The other options do not present any therapeutic duplication with glipizide, as they work through different mechanisms and are used for different therapeutic purposes.