3. A 67 year old woman has a 10 year history of type 2 diabetes, hypertension and hyperlipidaemia. She is obese and weighs 89kg (BMI = 31kg/m2) and has significant osteoarthritis of the knees. Her GP has advised her to lose weight, or she may have to commence on insulin soon. She would like to do this, but says that her knee pain is stopping her from walking enough to lose weight (she has a dog, so walking may be a good option for her). Her current list of medications is as follows:
Aspirin 100mg each morning
Atenolol 50mg each morning
Irbesartan 150mg each morning
Paracetamol 665mg 2 three times daily when required (takes these approximately once a day)
Simvastatin 40mg at night
Sitagliptin 50mg/Metformin 500mg (Janumet) 1 twice daily
Current blood pressure is 140/85mmHg. Laboratory tests from 3 months ago are as shown below:
Total Cholesterol 3.9 mmol/L
Triglycerides 2.2 mmol/L
HDL Cholesterol 1.1 mmol/L
LDL Cholesterol 1.8 mmol/L
HbA1c 8.8 % (73mmol/mol)
There are a number of potential medication related problems in this case. Which of the following problems would have the highest priority in this lady?