Thiazolidinediones and Pioglitazone Overview

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Questions and Answers

What is the primary function of thiazolidinediones in the treatment of type 2 diabetes?

To increase insulin production

To suppress glucose absorption in the intestines

To decrease insulin resistance and glucose production (correct)

To stimulate appetite

Which of the following is an example of a thiazolidinedione medication?

Exenatide

Glyburide

Rosiglitazone (correct)

Metformin

What unique feature distinguishes thiazolidinediones from other oral hypoglycemic agents?

They are only available as injectable medications

They exclusively treat type 1 diabetes

They require insulin for effectiveness

They activate PPAR gamma in the cell nucleus (correct)

What is a significant risk associated with prolonged, high doses of thiazolidinediones?

Bladder cancer Signup and view all the answers

How do thiazolidinediones affect insulin sensitivity?

They activate insulin-responsive genes Signup and view all the answers

Why might thiazolidinediones be preferred for clients with medication access issues?

They can be used as alternative medications for those with weight problems Signup and view all the answers

What is a notable side effect of thiazolidinediones that warrants a black box warning?

Heart failure due to fluid retention Signup and view all the answers

What happens to the risk of hypoglycemia when thiazolidinediones are combined with other antidiabetic medications?

The risk increases Signup and view all the answers

What should clients with a history of bladder cancer avoid?

Thiazolidinediones Signup and view all the answers

Which demographic requires caution when prescribing thiazolidinediones due to the risk of unintended pregnancy?

Premenopausal women Signup and view all the answers

What effect can thiazolidinediones have on LDL cholesterol levels?

Increase them Signup and view all the answers

What is a critical lab test that should be monitored throughout therapy with thiazolidinediones?

Hemoglobin A1c Signup and view all the answers

Which of the following medications, when combined with thiazolidinediones, can increase their levels?

Atorvastatin Signup and view all the answers

What is the recommended administration route for thiazolidinediones?

Oral Signup and view all the answers

What is a primary precaution for clients taking thiazolidinediones with mild heart failure?

Caution due to potential heart failure exacerbation Signup and view all the answers

Which of the following is NOT a recommended client teaching point for those on thiazolidinediones?

Encourage high-sugar diets Signup and view all the answers

What mechanism do thiazolidinediones primarily utilize to enhance insulin sensitivity?

Activation of the PPAR gamma receptor in the cell nucleus Signup and view all the answers

What is a significant concern for patients taking thiazolidinediones regarding cardiovascular health?

Increased risk of sudden cardiac death Signup and view all the answers

Which of the following statements about the use of thiazolidinediones is true?

They can be used in combination with insulin to improve glycemic control. Signup and view all the answers

What side effect can thiazolidinediones cause specifically in premenopausal women?

Ovulation leading to unintended pregnancy Signup and view all the answers

What is one of the therapeutic uses of thiazolidinediones?

Improving glycemic control in type 2 diabetes Signup and view all the answers

In addition to improving insulin sensitivity, what is another function of thiazolidinediones?

They reduce liver glucose production mildly. Signup and view all the answers

What adverse condition may thiazolidinediones exacerbate due to fluid retention?

Heart failure Signup and view all the answers

Which patient population should exercise caution when prescribed thiazolidinediones?

Premenopausal women because of ovulation risk Signup and view all the answers

What is the primary reason for monitoring lipid profiles in clients taking thiazolidinediones?

To detect possible increases in LDL cholesterol levels Signup and view all the answers

Which condition is specifically contraindicated for the use of thiazolidinediones?

Severe heart failure Signup and view all the answers

In which situation should thiazolidinediones be used with caution?

Clients prone to hypoglycemia Signup and view all the answers

Why should premenopausal women be cautious when using thiazolidinediones?

There is a risk of unintended pregnancy Signup and view all the answers

Which of the following statements about drug interactions with thiazolidinediones is correct?

Inhibitors of CYP2C8 can increase thiazolidinedione levels Signup and view all the answers

What should clients regularly monitor to prevent hypoglycemia while on thiazolidinediones?

Blood glucose levels Signup and view all the answers

Which of the following factors is most relevant in ensuring accurate dosing of thiazolidinediones?

The condition and severity of the client's response Signup and view all the answers

What additional education should be provided to clients regarding thiazolidinediones?

Awareness of signs of hypoglycemia and how to manage them Signup and view all the answers

What is the mechanism by which thiazolidinediones enhance insulin sensitivity?

Activation of peroxisome proliferator-activated receptor gamma Signup and view all the answers

Which of the following is a primary concern associated with the use of thiazolidinediones?

Potential for heart failure due to fluid retention Signup and view all the answers

What effect do thiazolidinediones have on glycemic control for patients with type 2 diabetes?

They stabilize blood glucose without risk of hypoglycemia Signup and view all the answers

In which population should thiazolidinediones be used cautiously due to a risk of unintended pregnancy?

Premenopausal women Signup and view all the answers

What unique clinical benefit do thiazolidinediones offer to clients who are overweight?

They decrease insulin resistance effectively Signup and view all the answers

What adverse effect related to bladder conditions may arise with prolonged use of thiazolidinediones?

Development of bladder cancer Signup and view all the answers

What might be a consequence of combining thiazolidinediones with other antidiabetic agents?

Increased risk of hypoglycemia Signup and view all the answers

What is the primary reason for the recent restrictions placed on the use of thiazolidinediones by the FDA?

Evidence linking to myocardial infarction and sudden cardiac death Signup and view all the answers

What is a primary lab test to monitor during therapy with thiazolidinediones?

Liver Function Tests (LFTs) Signup and view all the answers

Which client condition is contraindicated for the use of thiazolidinediones?

Severe heart failure Signup and view all the answers

Thiazolidinediones can potentially increase levels of which type of cholesterol?

LDL cholesterol Signup and view all the answers

What should premenopausal women using thiazolidinediones be educated about?

Importance of contraception Signup and view all the answers

Combining thiazolidinediones with which type of drugs may necessitate a dosage adjustment due to potential interaction?

CYP2C8 inhibitors Signup and view all the answers

In clients who have a history of stroke or TIA, thiazolidinediones can serve what role in their treatment?

Alternative hypoglycemic agents Signup and view all the answers

What is an important consideration for clients with mild heart failure when being prescribed thiazolidinediones?

They should be monitored for worsening of heart symptoms. Signup and view all the answers

Which medication can interact with thiazolidinediones and lead to a reduction in their therapeutic effect?

Rifampin Signup and view all the answers

What mechanism do thiazolidinediones primarily activate to enhance insulin sensitivity?

Peroxisome proliferator-activated receptor gamma (PPAR gamma) Signup and view all the answers

Which of the following populations should exercise caution when prescribed thiazolidinediones?

Clients with a history of liver disease Signup and view all the answers

What notable side effect associated with thiazolidinediones specifically affects women?

Causing unintended pregnancies through ovulation Signup and view all the answers

What serious cardiovascular risk is associated with the use of thiazolidinediones?

Myocardial infarction and sudden cardiac death Signup and view all the answers

Thiazolidinediones can lead to which condition when used at high doses over a prolonged period?

Bladder cancer Signup and view all the answers

When thiazolidinediones are combined with other oral antidiabetic medications, what is the primary concern?

Increased risk of hypoglycemia Signup and view all the answers

What is the primary function of thiazolidinediones in managing type 2 diabetes?

Decreasing insulin resistance and glucose production Signup and view all the answers

What should be monitored closely during therapy with thiazolidinediones?

Lipid profiles Signup and view all the answers

What should clients taking thiazolidinediones be particularly cautious about if they have elevated LDL cholesterol levels?

Increased LDL levels may exacerbate heart failure. Signup and view all the answers

Which of the following patient groups requires immediate discontinuation of thiazolidinediones?

Patients with a history of bladder cancer. Signup and view all the answers

What is a significant concern when combining thiazolidinediones with insulin?

Increased risk of heart failure due to fluid retention. Signup and view all the answers

Why is it important for clients to monitor their liver function tests while taking thiazolidinediones?

They can cause liver failure requiring dose adjustments. Signup and view all the answers

What adverse effect should clients be informed about regarding thiazolidinediones use?

Potential for heart and liver failure symptoms. Signup and view all the answers

What should be done if thiazolidinediones are combined with drugs that inhibit CYP2C8?

Reduce the thiazolidinedione dosage to prevent toxicity. Signup and view all the answers

What is a recommended action for clients to take regarding blood glucose monitoring while on thiazolidinediones?

Regularly monitor to avoid the risk of hypoglycemia. Signup and view all the answers

What should be the main concern for healthcare providers prescribing thiazolidinediones to clients with severe heart failure?

Risk of exacerbating fluid retention and heart failure. Signup and view all the answers

What is a significant risk associated with the use of thiazolidinediones in clients with elevated LDL cholesterol?

Increased LDL levels Signup and view all the answers

Which of the following should be monitored to assess the effectiveness of thiazolidinedione therapy?

Hemoglobin A1c Signup and view all the answers

Combining thiazolidinediones with which of the following may necessitate an increase in dosage?

CYP2C8 inducers Signup and view all the answers

What should be emphasized in client education for women of childbearing age taking thiazolidinediones?

The importance of contraception Signup and view all the answers

Which client condition is absolutely contraindicated for thiazolidinediones?

History of bladder cancer Signup and view all the answers

When assessing a patient on thiazolidinediones, which lab test is particularly important to monitor periodically?

Liver function tests Signup and view all the answers

What adverse effect should clients be educated to recognize and manage while on thiazolidinediones?

Signs of hypoglycemia Signup and view all the answers

Which demographic requires special caution when considering thiazolidinediones due to potential pregnancy risks?

Premenopausal women Signup and view all the answers

What effect do thiazolidinediones have on insulin-responsive genes?

They enhance their regulation. Signup and view all the answers

Which of the following is a contraindication for the use of thiazolidinediones?

Heart failure with fluid retention Signup and view all the answers

How do thiazolidinediones primarily reduce liver glucose production?

By activating PPAR gamma in the cell nucleus. Signup and view all the answers

What is a potential adverse effect of thiazolidinediones related to bladder health?

Bladder cancer with symptoms of blood in urine. Signup and view all the answers

In which situation should thiazolidinediones be used with caution?

In clients with a known history of heart health issues. Signup and view all the answers

Which population might see unintended pregnancy as a result of thiazolidinedione use?

Premenopausal women. Signup and view all the answers

Which physiological process do thiazolidinediones primarily target to enhance glucose control?

Improving insulin sensitivity in muscle and adipose tissue. Signup and view all the answers

What specific condition poses a black box warning for thiazolidinediones?

Heart failure. Signup and view all the answers

Study Notes

Thiazolidinediones

Thiazolidinediones, also known as glitazones, are a class of oral hypoglycemic agents used to treat type 2 diabetes.
They work by reducing insulin resistance and glucose production in the body.
They are commonly prescribed in combination with other diabetes medications but should be used with caution in individuals with heart failure, elevated LDL cholesterol, or a history of bladder cancer.

Prototypical Drug: Pioglitazone (Actos)

Pioglitazone is an example of a thiazolidinedione.
It acts on the peroxisome proliferator-activated receptor gamma (PPAR gamma), which regulates carbohydrate and lipid metabolism, enhancing insulin sensitivity.

Indications and Therapeutic Uses

Thiazolidinediones are used to improve glycemic control in individuals with type 2 diabetes.
These drugs might be suitable for individuals who are overweight, have a risk of hypoglycemia, or face medication affordability challenges.

Adverse Effects and Interactions

Thiazolidinediones can cause fluid retention and potentially exacerbate heart failure.
They carry a black box warning for heart failure.
In women of childbearing potential, these drugs can induce ovulation, increasing the risk of unintended pregnancy.
Prolonged high-dose use can lead to bladder cancer, characterized by blood in the urine, painful urination, or increased urgency.
Combining with other hypoglycemic agents, like insulin, increases the risk of hypoglycemia.
Concomitant use with CYP2C8 inhibitors, such as atorvastatin or ketoconazole, can increase thiazolidinedione levels, requiring dose adjustment.
Coadministration with CYP2C8 inducers, like rifampin or cimetidine, can decrease thiazolidinedione levels, necessitating dose adjustments.

Dosing and Administration

Dosage varies based on the individual's condition and response.
Thiazolidinediones are typically administered orally once daily.

Client Teaching

Patients must monitor their blood glucose levels regularly to avoid hypoglycemia.
Individuals should be educated about the signs and symptoms of hypoglycemia and how to manage it.
Premenopausal women must be advised on the importance of contraception.
Patients should be aware of adverse effects, including signs and symptoms of heart and liver failure.

Monitoring

Liver Function Tests (LFTs) should be assessed at baseline and throughout therapy.
Lipid profiles are important to monitor as these drugs can increase LDL cholesterol levels.
Hemoglobin A1c monitoring assesses the effectiveness of the treatment regimen.

### Key Considerations

Thiazolidinediones can also be used for patients who have had a stroke or transient ischemic attack (TIA)
Thiazolidinediones are not recommended for patients with a history of bladder cancer.
Use cautiously with patients with mild heart failure.

Thiazolidinediones

Thiazolidinediones, also known as glitazones, are a class of oral hypoglycemic agents used to treat type 2 diabetes.
They are often used in combination with other diabetes medications.
They work by reducing insulin resistance and glucose production.
They reduce insulin resistance in skeletal muscles and adipose cells, and reduce liver glucose production.
They can be used as alternatives in clients who are overweight or at risk of hypoglycemia.
They are also useful for clients with medication cost or access issues.

Important Drugs

Pioglitazone (Actos): Prototype drug in this class
Rosiglitazone (Avandia): Another common thiazolidinedione

### Mechanism of Action

Thiazolidinediones work by activating peroxisome proliferator-activated receptor gamma (PPAR gamma) in the cell nucleus.
PPAR gamma activates insulin-responsive genes, regulating carbohydrate and lipid metabolism.
This activation increases cellular insulin sensitivity, mainly in skeletal muscle and adipose cells.

Indications and Therapeutic Uses

Primarily used to improve glycemic control in clients with type 2 diabetes
Often used in combination with other diabetes medications, such as insulin or other oral antidiabetic medications.
Combining them with other diabetes medications can increase the risk of hypoglycemia.

Adverse Effects

Thiazolidinediones have a black box warning for heart failure.
Can cause fluid retention, potentially exacerbating or precipitating heart failure.
Can cause ovulation in premenopausal women, potentially leading to unintended pregnancies.
Prolonged use of high doses can lead to bladder cancer.
Symptoms of bladder cancer include blood in the urine, painful urination, and increased urgency.

Precautions and Contraindications

Precautions:
- Use with caution in clients with mild heart failure.
- Use with caution in premenopausal women due to the risk of unintended pregnancy.
- Use with caution in clients with elevated LDL cholesterol, as these medications can increase LDL levels.
- Use with caution in clients prone to hypoglycemia.
Contraindications:
- Contraindicated in clients with severe heart failure.
- Contraindicated in clients with a history of bladder cancer.

### Drug Interactions

Combining thiazolidinediones with insulin increases the risk of heart failure due to fluid retention.
Thiazolidinediones are metabolized by the CYP2C8 enzyme in the liver.
Combining thiazolidinediones with CYP2C8 inhibitors (such as atorvastatin or ketoconazole) increases thiazolidinedione levels, necessitating a reduction in dosage.
Combining thiazolidinediones with CYP2C8 inducers (such as rifampin or cimetidine) reduces thiazolidinedione levels, necessitating an increase in dosage.

Dosing, Administration, and Client Teaching

Dosing is individualized based on the client's condition, severity, and response.
Dosage guidelines should be consulted for specific directions.
Administered orally once daily.
Practice careful client selection to prevent adverse effects.
These drugs can also be used in clients who have a history of stroke or transient ischemic attack (TIA).

Client Teaching

Clients should regularly monitor their blood glucose levels to prevent hypoglycemia.
Clients should be educated on recognizing the signs and symptoms of hypoglycemia and how to manage it.
Premenopausal women should be counseled on the importance of contraception to avoid unintended pregnancy.
Educate clients about potential adverse effects, including the signs and symptoms of heart and liver failure.

Labs to Monitor

Liver Function Tests (LFTs): Assess at baseline and throughout therapy.
Lipid Profiles: Monitor lipid levels as these drugs can increase LDL levels in some clients.
Hemoglobin A1c: Monitor for effectiveness of treatment regimen.

Thiazolidinediones

Thiazolidinediones, also known as glitazones, are a class of oral medications used to treat type 2 diabetes.
They work by decreasing insulin resistance and glucose production.
Examples include pioglitazone (Actos) and rosiglitazone (Avandia).
The primary function is to improve glycemic control in individuals with type 2 diabetes.
The FDA has placed restrictions on thiazolidinediones due to potential links to myocardial infarction (MI) and sudden cardiac death.

Mechanism of Action

Thiazolidinediones activate peroxisome proliferator-activated receptor gamma (PPAR gamma) in the cell nucleus.
This activation leads to increased cellular insulin sensitivity, particularly in skeletal muscle and adipose tissue.
It also slightly reduces liver glucose production.

Indications and Therapeutic Uses

Thiazolidinediones are used to improve glycemic control in clients with type 2 diabetes.

Adverse Reactions

Patients may experience fluid retention which can exacerbate or induce heart failure.
These drugs can cause ovulation in premenopausal women, potentially leading to unintended pregnancy.
Prolonged use at high doses may increase the risk of bladder cancer.
Hypoglycemia risk is low with monotherapy, but increases when combined with other blood sugar-lowering medications like insulin.

Precautions and Contraindications

Use with caution in clients with mild heart failure, premenopausal women, elevated LDL cholesterol levels, and those prone to hypoglycemia.
Contraindicated in individuals with severe heart failure or history of bladder cancer.

Black Box Warning

These medications carry a black box warning for heart failure.

Drug Interactions

Combining thiazolidinediones with insulin increases the risk of heart failure.
Medications that inhibit CYP2C8 (e.g., atorvastatin or ketoconazole) can increase thiazolidinedione levels, potentially requiring dosage adjustments.
Medications that induce CYP2C8 (e.g., rifampin or cimetidine) can decrease thiazolidinedione levels, potentially requiring dosage adjustments.

Dosing, Administration, & Client Teaching

Dosing varies based on individual needs and response, consult drug dosing guidelines.
Administration: Oral, once daily.
Client Teaching:
- Monitor blood glucose levels regularly to prevent hypoglycemia.
- Educate on recognizing and managing signs and symptoms of hypoglycemia.
- Advise premenopausal women about the importance of contraception.
- Inform patients about potential adverse effects, including heart and liver failure.

Labs to Monitor

Liver Function Tests (LFTs): Assess LFTs at baseline and regularly throughout therapy.
Lipid Profiles: Monitor lipid levels, as these drugs can increase LDL levels.
Hemoglobin A1c: Monitor HbA1c to assess the effectiveness of the treatment regimen.

Thiazolidinediones

Category: Oral Hypoglycemic Agents
Prototype: Pioglitazone (Actos)
Examples: Rosiglitazone (Avandia), Pioglitazone (Actos)
Function: Reduce glucose levels by decreasing insulin resistance and production.
Unique Features: Frequently used with other diabetes medications, FDA restrictions due to potential MI and sudden cardiac death.
Mechanism of Action: Activate PPAR gamma receptors, increasing insulin sensitivity and reducing glucose production.

Indications and Therapeutic Uses

Diabetes: Improve glycemic control in type 2 diabetes.

Adverse Reactions

Black Box Warning: Can cause heart failure, potentially exacerbated by fluid retention.
Other Side Effects: Can cause ovulation in premenopausal women, which could result in unintended pregnancy. High doses, prolonged use, can cause bladder cancer.
Hypoglycemia: Low risk with monotherapy, increased risk when combined with other antidiabetic medications.

Precautions and Contraindications

Precautions: Mild heart failure, premenopausal women due to pregnancy risk, elevated LDL cholesterol, clients prone to hypoglycemia.
Contraindications: Severe heart failure, history of bladder cancer.

Drug Interactions

Insulin: Increased risk of heart failure due to fluid retention.
CYP2C8 Inhibitors (atorvastatin, ketoconazole): Increase thiazolidinedione levels, requiring dosage adjustment.
CYP2C8 Inducers (rifampin, cimetidine): Reduce thiazolidinedione levels, requiring dosage adjustment.

Dosing and Administration

Dosing: Varies based on condition, severity, and client response. Check drug guidelines for individual dosing. PO dosing, once daily.
Administration: Oral administration.

Client Teaching

Blood Glucose Monitoring: Clients should monitor blood glucose levels regularly to prevent hypoglycemia.
Hypoglycemia Recognition: Clients should be educated about the signs and symptoms of hypoglycemia and management.
Contraception: Educate premenopausal women about the importance of contraception to prevent unintended pregnancy.
Adverse Effects: Educate clients about potential adverse effects, including heart and liver failure.

Labs to Monitor

Liver Function Tests (LFTs): Monitor at baseline and throughout therapy.
Lipid Profiles: May increase LDL levels, monitoring required for some individuals.
Hemoglobin A1c: Monitor for effectiveness of treatment.

Overview of Thiazolidinediones

Thiazolidinediones, also known as glitazones, are a class of oral hypoglycemic agents primarily used to treat type 2 diabetes.
They work by reducing insulin resistance and glucose production.
Common examples include:
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
They are also considered alternative medications for overweight individuals or those at risk of hypoglycemia.
Thiazolidinediones can be beneficial for patients facing medication cost or access issues.
Important note: The FDA has placed restrictions on their use due to evidence linking thiazolidinediones to an increased risk of myocardial infarction (MI) and sudden cardiac death.

Mechanism of Action

Thiazolidinediones activate the peroxisome proliferator-activated receptor gamma (PPAR gamma) in the cell nucleus.
PPAR gamma activation triggers insulin-responsive genes involved in carbohydrate and lipid metabolism regulation.
This leads to increased cellular insulin sensitivity, primarily in skeletal muscle and adipose cells.
They also mildly reduce liver glucose production.

Indications and Therapeutic Uses

Diabetes Management: Thiazolidinediones are used to improve glycemic control in patients with type 2 diabetes.

Adverse Effects and Side Effects

Heart Failure: Thiazolidinediones carry a black box warning for heart failure, which can be exacerbated or triggered by fluid retention.
Ovulation and Pregnancy: They can induce ovulation in premenopausal women, potentially leading to unintended pregnancies.
Bladder Cancer: Prolonged use of high thiazolidinedione doses has been linked to bladder cancer, with symptoms like blood in urine, painful urination, or increased urgency.
Hypoglycemia: While the risk of hypoglycemia is low with monotherapy, it increases when used in combination with other blood sugar-lowering agents (insulin or other oral antidiabetic medications).

Precautions and Contraindications

Precautions:
- Mild Heart Failure - Use with caution.
- Premenopausal Women - Use with caution due to the risk of unintended pregnancy.
- Elevated LDL Cholesterol - Use with caution as thiazolidinediones may elevate LDL levels.
- Hypoglycemia - Use with caution in patients prone to hypoglycemia.
Contraindications:
- Severe Heart Failure - Contraindicated.
- History of Bladder Cancer - Contraindicated.

Drug Interactions

Insulin: Combining thiazolidinediones with insulin increases the risk of heart failure due to fluid retention.
CYP2C8 Inhibitors (atorvastatin or ketoconazole): Thiazolidinediones are metabolized by the CYP2C8 enzyme in the liver. Drugs inhibiting CYP2C8 can increase thiazolidinedione levels, potentially necessitating a dosage reduction.
CYP2C8 Inducers (rifampin or cimetidine): Drugs that induce CYP2C8 can decrease thiazolidinedione levels, potentially requiring a dosage increase.

Dosing, Administration, and Patient Education

Dosing: Dosing varies based on the condition, severity, and patient response. Consult individual drug dosing guidelines for tailored dosing.
- Oral administration (PO) once daily.
Administration: Oral (PO).
Patient Education:
- Blood Glucose Monitoring: Patients should closely monitor their blood glucose levels to avoid hypoglycemia.
- Hypoglycemia Recognition and Management: Patients should be educated on recognizing signs and symptoms of hypoglycemia and how to manage it if it occurs.
- Contraception for Premenopausal Women: Educate premenopausal women about the importance of using contraception to avoid unintended pregnancy.
- Adverse Effects: Educate patients about potential adverse effects, including the signs and symptoms of heart and liver failure.

Labs to Monitor

Liver Function Tests (LFTs): Baseline and periodic monitoring of LFTs is recommended throughout therapy.
Lipid Profiles: Thiazolidinediones can elevate LDL blood levels, necessitating monitoring in certain patients.
Hemoglobin A1c: Monitoring hemoglobin A1c is crucial to assess the efficacy of the treatment regimen.

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Description

Explore the important aspects of thiazolidinediones, a class of medications used to treat type 2 diabetes. This quiz details their mechanism of action, therapeutic uses, specific examples like pioglitazone, and potential adverse effects. Understand how these drugs can impact insulin sensitivity and patient care strategies.