MSFinals-1104

A 60-year-old man with a 10-year history of type 2 diabetes comes in for his annual check-up. He is currently taking ramipril, pioglitazone, metformin, simvastatin, and acarbose. During previous examinations, he has been found to have microalbuminuria and a decreasing eGFR. His most recent eGFR measurement was 29 ml/minute/1.73 m2. He has an average build and height.

Which medication should be discontinued?