Chronic conditions

Question 1

65 yo male
Known with stable angina, HPT, T2DM
Rx: Isosorbide dinitrate 10mg dly, Carvedilol 5mg BD, ASA 81mg dly, Metformin 750mg BD, HCTZ 25mg dly, Naproxen 500mg dly.
Latest bloods: eGFR 45, ACR 3,5 (3 different occasions), HbA1C 8,7 and FBS 7,1.

1. What medication adjustment would you make to his treatment?
   - Name class and medication
   - Rationale
2. Lab tests and frequency of tests for above medication
3. Side effects of above medication

After 6 months patient follows up. New lab tests: 
Na = 135
K = 6,6 
HbA1c = 7,8
FBG = 6,9
eGFR = 29 

4. What changes would you make to his medication?

Answer 1

1. Add Angiotensin Converting Enzyme Inhibitor - Enalapril

Proteinuria / Nephropathy

2. Potassium & Serum Creatinine
   @ baseline and repeat in 2 weeks, then every 6 months

3.

• Dry cough
• Angiooedema
• Renal failure
• Hyperkalemia
• Altered taste

4. Stop HCTZ
   Stop Metformin
   Stop ACEI - change to loop diuretic