A 56-year-old female patient has a diagnosis of GERD, mild hypertension, hyperthyroidism, hypercholesterolemia, and Type II diabetes of 5 years duration. Medications include metformin, glyburide, propylthiouracil, lansoprazole, atorvastatin, and hydrochlorothiazide. Recent labs report an A1c of 9.8%, TSH of 2.7, Hgb of 12.2 and total cholesterol of 130mg/dL. A physical exam reveals a blood pressure of 128/76 and a resting heart rate of 98. The patient is complaining of muscle cramps, fatigue, and thirst. Which of the following medications may need adjustment?
  1. Metformin and glyburide
  2. Propylthiouracil
  3. Atorvastatin
  4. Metformin, glyburide, and atorvastatin
Explanation
Answer - D - The patient is showing signs and symptoms of uncontrolled diabetes (A1c increased thirst) and an adverse effect of statin use (muscle cramps, fatigue). Thyroid tests are within normal limits. The hypoglycemics and statin dosages should be adjusted.
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