A 67 year old male with a known history of heart failure visits his primary care physician for his yearly examination. During the check-up, his blood pressure is measured at 170/100 mmHg. He is currently taking furosemide and aspirin. Which medication would be the most suitable to include?
A 68-year-old man with chronic heart failure due to ischaemic heart disease complains of knee pain. An x-ray has revealed osteoarthritis. What medication should be avoided if feasible?
You see a 50-year-old type one diabetic patient who has come to see you regarding his erectile dysfunction. He reports a gradual decline in his ability to achieve and maintain erections over the past 6 months. After reviewing his medications and discussing treatment options, you suggest he try a phosphodiesterase (PDE-5) inhibitor and prescribe him sildenafil.
What advice should you give this patient regarding taking a PDE-5 inhibitor?
Which of the following is the least acknowledged side effect of sildenafil?
A 56-year-old man collapses after complaining of palpitations and is admitted to the Emergency Department (ED). He is found to be in ventricular tachycardia and is successfully cardioverted. Further investigations reveal an underlying long QT syndrome, and an implantable cardioverter-defibrillator (ICD) is inserted. The man works as an HGV driver. What advice should be given regarding his ability to drive HGV vehicles?
A 70-year-old man with a history of hypertension only complains of worsening breathlessness and swollen ankles for the past 3 months. You plan to conduct a BNP test. What could cause a falsely low BNP result in this patient?
You assess a 65-year-old man who has just begun taking a beta-blocker for heart failure. What is the most probable side effect that can be attributed to his new medication?
A 75-year-old man with a history of type 2 diabetes mellitus and hypertension is seen in clinic. There is no evidence of diabetic retinopathy, chronic kidney disease or cardiovascular disease in his records.
He is currently taking the following medications:
simvastatin 20 mg once daily
ramipril 10 mg once daily
amlodipine 5mg once daily
metformin 1g twice daily
Recent blood results are as follows:
Na+ 142 mmol/l
K+ 4.4 mmol/l
Urea 7.2 mmol/l
Creatinine 86 µmol/l
HbA1c 45 mmol/mol (6.3%)
The urine dipstick shows no proteinuria. His blood pressure in clinic today is 134/76 mmHg.
What is the most appropriate course of action?
You receive a call from a nursing home about a 90-year-old male resident. The staff are worried about his increasing unsteadiness on his feet in the past few months, which has led to several near-falls. They are also concerned that his DOAC medication puts him at risk of a bleed if he falls and hits his head.
His current medications include amlodipine, ramipril, edoxaban, and alendronic acid.
What steps should be taken in this situation?
A 65-year-old male on long-term warfarin for atrial fibrillation visits the anticoagulation clinic. Despite maintaining a stable INR for the past 3 years on the same dose of warfarin, his INR is found to be 5.4. What is the most probable cause of this sudden change?