Ans: B. Smoking(Ref Goodman Gilman 12/e p1259; Katzung I 3/e p736-737, 12/e p75)Smoking does not increase lactic acidosis risk in patients taking metformin.Lactic acidosis & metformin:Metformin use in patients with concurrent conditions with poor tissue perfusion (sepsis, myocardial infarction, CHF & enal failure).Decreased GFR - Increases plasma metformin levels - By reducing drug clearance from circulation.Metformin - ContraindicationsSevere pulmonary disease.Decompensated hea failure.Severe liver diseaseChronic alcohol abuse.Renal disease.Conditions predisposing to tissue anoxia (e.g., chronic cardiopulmonary dysfunction) - Due to increased lactic acidosis risk.
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