79   years old male pt 
knonw to have 
DM 
HTN 
DLD 
IHD   with stent   before  15 years 
BPH 

medication 
CO DIOVAN   160/25 
AMARYL  4 MG ONCE 
JUVISTA   50 MG ONCE 
ALLORIL   100 MG ONCE 
  COLCHIIN     ONCE DAILY 
ASA   100 MG ONCE 
LIPITOR  40 MG ONCE 
OMNIC  0.4 MG ONCE 

Presented with   acute worsening creatinine   to  2.8  from   2.4 
he also has  recurnt  uti    with ECOLI 

HE WAS TAKING  TRUFEN 

PLAN 
STOP  TRUFE 
STOP  CODIOVAN 
STPOP   COLCHIN 
ADD  CADEX 
ADD    TAVANIC 
ADD  ZIMICAL 
PARAMOL  EXTRA 
DO  US 
DO LABS  AFTER ONE WEEK