Practice Test 6

A 52-year-old man (95 kg) with type 2 diabetes and established atherosclerotic cardiovascular disease (prior MI) presents for medication optimization. Current medications: metformin 1000 mg PO BID, glipizide ER 10 mg PO daily, atorvastatin 80 mg PO daily, aspirin 81 mg PO daily, lisinopril 20 mg PO daily. Labs: A1c 8.6%, SCr 1.0 mg/dL (eGFR 85 mL/min/1.73 m$^2$), AST/ALT normal; allergies: none. Based on current ADA Standards of Care, which add-on medication is recommended to improve glycemic control and provide cardiovascular benefit?

A 58-year-old man (weight 92 kg) presents to urgent care with dysuria and urinary frequency for 2 days and is diagnosed with acute uncomplicated cystitis; he has type 2 diabetes (A1c 7.8%), hypertension, and hyperlipidemia. Current medications: metformin ER 1000 mg PO twice daily, lisinopril 20 mg PO daily, atorvastatin 40 mg PO nightly. Allergies: trimethoprim-sulfamethoxazole (rash). Labs: serum creatinine 1.6 mg/dL (high; ref 0.7–1.3), estimated creatinine clearance 48 mL/min; aspartate aminotransferase 22 U/L, alanine aminotransferase 24 U/L. Based on current IDSA guidance and tertiary dosing references for renal impairment, which medication is recommended for empiric treatment in this patient?