This gentleman is suffering from an AKI and is relatively hypotensive compared to his normal blood pressure. The diagnosis is not difficult and stopping drugs likely to cause an AKI is important.
However he has recently had a drug-eluting stent inserted and so requires dual antiplatelet therapy for one year. This should not be stopped without the say-so of the cardiologist. There may be alternative anticoagulant strategies that they would consider but leave them going pending this discussion. The meds required are therefore on the chart below.
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.