58-year-old with newly confirmed hypertension (average 152/94 on home readings).
Type 2 diabetes with microalbuminuria. eGFR 74. Potassium 4.2.
No other medications; no allergies.
Which first agent fits this patient best?
Therapeutics
Choose the Drug
A patient, a decision, and then the twist: one variable changes, whether renal function, pregnancy, or a new adverse effect. And the question becomes whether your choice survives. That is individualized pharmacotherapy, practised.
Heart failure with reduced ejection fraction
66-year-old with HFrEF (EF 30%), now euvolemic on furosemide.
Current: ramipril (target dose), bisoprolol (titrating).
BP 118/72, HR 68, K 4.4, eGFR 58.
What completes the foundational therapy?
61-year-old, T2DM on metformin at maximal tolerated dose. HbA1c 8.1%.
Background: HFrEF (EF 35%). eGFR 55. BMI 31.
The strongest choice for the second agent?
Anticoagulation in atrial fibrillation
74-year-old, new non-valvular AF. Stroke risk clearly indicates anticoagulation.
Weight 58 kg, creatinine 128 µmol/L, age ≥ 74. On ibuprofen PRN for knees.
Best anticoagulation plan?
29-year-old starting sertraline for moderate depression.
Asks: 'How long until it works, and what should I watch for?'
The most accurate framing?
GERD and acid-related disorders
45-year-old on omeprazole for 14 months after a bout of heartburn.
No alarm features, symptom-free for a year. No NSAIDs, no antiplatelets.
What is the right conversation?