CG is a 72-year-old African American female who is visiting you today at your Ambulatory Care clinic. She is here today

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CG is a 72-year-old African American female who is visiting you
today at your Ambulatory Care clinic. She is here today for chronic
disease management. Her past medical history is significant for
chronic kidney disease, diabetes, peripheral neuropathy,
hypertension, heart failure with reduced ejection fraction and
dyslipidemia. She also had an episode of a heart attack back in
2008. Her medications are listed below.
Objective Data
Height: 5’6”; Weight: 90 kg
BP: 142/81 mmHg; HR: 70 beats/min
Labs (today):
SCr: 1.8 mg/dL (baseline: 1.7 mg/dL)
A1c: 6.1%
BUN: 28 mg/dL
Albumin: 3.7 g/dL
Medication List
1. Based on the patient case above and drugs identified to
require an adjustment based on renal function, list the recommended
change(s) to be made. Be specific and list a complete sig (drug
name, dose, route and frequency).
Example:
My patient's eGFR is 30 mL/min/1.73
m2 administering saxagliptin 5 mg PO daily.
Answer: Instead of saxagliptine 5 mg PO daily, I would recommend
a change to saxagliptin 2.5 mg PO daily.
2. Which of CG's medications listed above
would require a renal dose adjustment (either for CrCl or
eGFR)?