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Change citalopram to escitalopram
0%
0/157
Change lisinopril to propanolol
4%
6/157
Change lisinopril to amlodipine
5%
8/157
Change atorvastatin to to lovastatin
1%
2/157
Change lisinopril to losartan
87%
137/157
Select Answer to see Preferred Response
This has an angiotensin-converting enzyme (ACE) inhibitor associated cough and should be switched to angiotensin receptor blocker (ARB) such as losartan. Like ACE inhibitors, ARBs inhibit the renin-angiotensin-aldosterone (RAA) system (so are good for treating CHF, hypertension, and diabetic nephropathy), but they do not interfere with breakdown of bradykinin, and therefore, not associated with cough. This patient has type II diabetes and an elevated creatinine, and drugs that target the RAA axis have been shown to delay the progression of diabetic nephropathy. Incorrect Answers: Answer 1: Cough is not a common side effect of SSRIs such as citalopram. Answer 2: Switching this patient to a beta-blocker would be ill-advised given his history of asthma. Answer 3: Switching this patient to amlodipine would not be preferred since first line anti-hypertensives are ACE inhibitors or ARBs in diabetics. Answer 4: Cough is not a common side effect of statins such as atorvastatin.
4.6
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