A 75-year-old woman is brought to the family medicine clinic by her daughter for 2 weeks of fatigue, dizziness on standing and leg cramps. She has hypertension, type 2 diabetes, hypothyroidism and dyslipidemia, lives alone, needs her daughter's help with shopping, housework and medications, and wants to stay in her own home. Her daughter reports home glucose readings of 3.1 and 3.4 mmol/L before breakfast in the past month. Medications are hydrochlorothiazide 25 mg daily, ramipril 2.5 mg daily, amlodipine 5 mg daily, insulin glargine at bedtime, insulin aspart with meals, levothyroxine 100 mcg daily and atorvastatin 20 mg daily; she has no known allergies. On examination she appears frail, mucous membranes are moist, there is no edema and the lungs are clear. Laboratory results: sodium 128 mmol/L (135-145), potassium 4.8 mmol/L (3.5-5.0), creatinine 164 µmol/L (45-90), eGFR 28 mL/min/1.73 m2 (above 60), TSH 2.3 mIU/L (0.4-4.0), HbA1c 6.4% (4.0-6.0), urine albumin/creatinine ratio 12 mg/mmol (below 2.0).
| Heart rate | 78/min |
| Respiratory rate | 16/min |
| Temperature | 36.8 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 148/80 mm Hg seated, 126/70 mm Hg standing |
Question 1 of 21
Which of the following medication changes are most appropriate at this visit?
Select 2. (0 / 2 selected)
Tip: right-click an answer (or press and hold on a phone) to strike it out. Drag over the question text to highlight it.