When a driver is removed from medication under medical supervision, makes lifestyle changes and establishes a BP less than 140/90, the decision to offer up to 2 years is up to the Medical Examiner.  This does not apply to those with a history of Stage 3 hypertension which are always limited to a 6-month interval.

Both the SPE program and the federal hearing exemption allow a two-year recertification interval.

The Substance Abuse Professional (SAP) is responsible for evaluation and treatment of drivers suspected of drug or alcohol abuse.  If a driver has had a DOT drug or alcohol test violation such as positive DOT drug test, they must be evaluated by a DOT Accredited SAP and successfully complete a treatment program if directed by the SAP.  If the driver did not have a DOT drug or alcohol test violation, the SAP is not required to be DOT Accredited.

The key to answering this question correctly is that they are taking the medication while driving. Diphenhydramine (Benadryl) has a sedative effect and often causes drowsiness. Answer B in conjunction with answer C would be the next best alternative.

Motor Carriers have the right to adopt stricter medical standards.  If the driver meets all of the FMCSA medical standards, but not the additional lifting requirement, the ME issues the driver a medical examiner\'s certificate but informs the company that the driver did not meet their lifting requirement.

Medical Examiners must follow the FMCSA Medical Standards found in 49 CFR 391.41

Must attain heart rate greater than 85% of predicted maximum (unless on beta blocker)

Driver must have their driving log for the last 7 days.

The medication of greatest concern is Zolpidem (Ambien). It is a sleep aid prescribed for insomnia. It has a half-life of 2.5-3 hours. The medical examiner should verify from the prescriber that the condition is stable, and that the driver is not driving within at least 6 hours of taking the medication. Zofran (Ondansetron) is an antinausea medication that often causes drowsiness. Follow-up questions might include why they were prescribed the medication and how often they are taking it. A driver should not be operating a CMV when nauseated or while taking a medication that causes drowsiness. Zoloft (Sertraline) is an SSRI antidepressant with minimal side effects that are unsafe for driving. The concern here is whether the driver has had any severe depressive episodes and if the treatment is effective and the condition is stable. Zithromax (Azithromycin) is an antibiotic most prescribed for respiratory infections.

In the role of the medical examiner, you are examining for medical fitness for duty, not diagnosing or treating personal medical conditions.  However, this does not preclude the ME from diagnosing or treating the driver.

Determination pending allows up to 45 days for the ME to receive the necessary information to determine driving status if the driver is considered safe to drive and meets the two non-discretionary medical standards.

The use of long-wearing contacts is not disqualifying. Monocular vision is disqualifying until they have obtained a completed Vision Evaluation Report. Monovision is disqualifying unless they are using corrective lenses that allow for far vision in both eyes.

"MEs should select the incomplete examination option when the physical examination is not completed for any reason (e.g., driver decides they do not want to continue with the examination and leaves) other than situations outlined under determination pending and should provide the reason on the Medical Examination Report Form, MCSA-5875. Even if the examination has been completed, the physical qualification examination is considered incomplete if the driver refuses to sign the Medical Examiner’s Certificate, Form MCSA-5876."

A positive Babinski reflex is indicative of abnormalities in the motor control pathways leading from the cerebral cortex and is widely used as a diagnostic aide in disorders of the central nervous system. The examiner should obtain clearance from a neurologist prior to reconsidering the driver for certification.

Cataract formation causes diminished visual acuity in all fields, and night glare from headlights is one of the first changes to appear. Near vision may be improved.

To pass the color standard, a driver must differentiate between traffic signal red, green, and amber.  Ishihara charts do not make that determination. The ME should use traffic signal-colored cards or use the colors on a Snellen chart to test color deficiency.

Drivers must have a prescription for narcotics, amphetamine, or any other habit-forming drug. The other medications listed are over-the-counter antihistamines.

Diabetes is the most common cause of retinopathy.  Partial loss of central and obscured vision in other fields possible. Color discrimination can also be affected.

When a driver returns from an illness or injury that interferes with driving ability, the driver must undergo a medical examination even if the medical examiner’s certificate has not expired. Typically, this does not apply to conditions such as the flu or a cold. If there is a question of whether the driver must have a new medical certificate, the decision is determined by the driver and the employer. Given the authority the employer has over the driver, the employer usually gets the final say.

In addition, drivers cannot take a stimulant except for the treatment of ADHD.

To be certified, partial pressure of arterial oxygen (PaO2) must be a minimum of 60mmHg for a driver living at altitudes above 5000 feet and at least 65mmHg for a driver living below 5000 feet.

50% is the value used for disqualification of drivers with pulmonary hypertension.

This is Stage 2 Hypertension, which is defined as 160 – 179 / 100-109.

Stable angina includes pain with exertion, emotion, extremes in weather and sexual activity.

This scenario describes anisocoria. With both Horner’s syndrome and CN3 palsy, the affected pupil does not react normally to light but there still is a reaction. With glaucoma, the pupils are not of different diameters.

In most cases, there is no longer a mandatory waiting period after a stroke. However, if there is a risk for seizure and the driver is placed on an anticonvulsant medication, the seizure guidelines apply.

The driver is certifying that the health history information is complete and true.

Implanted defibrillation devices with or without pacemakers are always disqualifying. There is a federal appeal program for drivers with an implanted defibrillator. However, in order to be considered, the driver would need to show a long history where the defibrillator did not activate, and/or the defibrillator was not needed to treat a cardiovascular condition.

There is no reason not to certify this driver for 2 years, but they should be further evaluated which may include imaging, certain treatment, and/or consult a specialist. An SPE only applies to fixed deformities of the extremities. Also, a ME cannot place any restrictions on a driver that might limit their ability to perform all the duties of a commercial driver.

It is fine for a driver to obtain a second opinion. If the ME believes that a driver has been given the wrong qualification determination, they can perform a new exam and submit the results to FMCSA. The most recently submitted exam always supersedes any previously submitted exam.

Drivers must have a completed and signed copy of the ITDM form from their treating provider.

Furosemide (Lasix) is a diuretic that depletes the body’s potassium. This may cause complications such as muscle weakness and palpitations, cardiac palpitations and arrhythmias, and more. For this reason, a potassium supplement is usually recommended. Diuretics work on the kidneys to help remove excess water from the body. Therefore, creatinine levels are helpful but not the primary concern. Hb and Hct are not affected by furosemide. Protein in the urine can be an indication of kidney disease but there is not a direct correlation between the urinalysis findings and furosemide.

Naltrexone is used for opioid and alcohol dependance. The medical examiner should obtain more information, including clearance from the prescribing provider, prior to certifying the driver. Metformin is used for the treatment of diabetes, Lisinopril is used for hypertension, and Advil is an anti-inflammatory.

If a driver fails the whisper test, audiometric testing must be performed prior to certification.  If the driver is unable to meet the audiometric standard, the driver should be counseled regarding obtaining hearing aids to meet the hearing standard.

MEs should discuss non-compliance of treatment plan and medication use with the driver.

Upon detection of an AAA with high risk of rupture, the ME should provide or initiate immediate emergency care.

Substance Abuse Professionals (SAPs) are licensed or certified professionals that have knowledge not only of the diagnosis and treatment of alcohol and controlled substances related disorders, but also of DOT drug and alcohol testing and return-to-duty processes. A DOT-qualified SAP initially evaluates drivers who have violated DOT drug and alcohol regulations and makes recommendations concerning education, treatment, follow-up testing, and aftercare. Once the education and/or treatment is successfully completed, the SAP reassesses the driver’s condition and, if satisfied with the driver’s compliance, completes a SAP report and prescribes a series of follow-up tests covering a period of one to five years.  It is the responsibility of the driver and/or motor carrier to successfully complete the follow-up testing, treatment, and aftercare.

Drivers with partial or no hearing can apply for the Federal Hearing exemption program.  The hearing standard is a non-discretionary standard and must be followed.

When a referral has been made or advised from another healthcare provider, the ME should wait to certify a driver until after that evaluation has taken place and the driver has been found to be safe and stable. In this instance, the proper specialist to refer to would be a cardiologist.

The MMSE exam result may indicate that a referral to a mental health specialist is required.

The L4 nerve root innervates the patellar tendon. Both plantar flexion of the foot and hip extension would be assessments of the S1 nerve root. Big toe extension is an assessment of the L5 nerve root.

Physician’s contact information, date of onset, limitations, diagnosis, and medications used, including OTC and herbal supplements are required to be listed in the health history.

Driver’s must have a prescription for narcotic use.  Use of medication not prescribed is illegal and is not allowed by the federal drug and alcohol program policy. Drug use is a violation of drug policy and an SAP evaluation is required.

To return to work after CABG the driver should be asymptomatic, their sternum should be fully healed, and they should have clearance from their treating provider. A driver with sustained ventricular tachycardia should never be certified. One of the criteria for a “passing” ETT is achieving 6 METs on an ETT.

A medical history and exam will provide details of the event but may not help to ascertain recovery.  Complete recovery should be confirmed by X-ray.

If the driver can demonstrate sufficient power grasp and prehension, they can be certified to drive without a SPE.

For NRCME testing purposes, the best answer is to temporarily disqualify the driver as it is “best practice” for the driver to wait a year following a stroke. The reasoning is that the risk of having another stroke or other complications is greatest in the first year.

All CDL classifications must meet the same medical guidelines to be medically certified to drive; therefore, there would be no reason to ask whether they have a Class A, B, or C license.  Some drivers that do not have a CDL license must still have a medical certificate.

Shortness of breath with exertion would be considered normal. Indicators for pulmonary testing also include wheezing or coughing, and shortness of breath at rest.

Whenever the ME suspects undiagnosed OSA, the driver should be evaluated by a sleep specialist.  A ME can qualify the driver for 3 months unless they report sleepiness when driving, have a history of an accident associated with falling asleep, or have been observed sleeping behind the wheel.

Diabetic proliferative retinopathy is a disqualifying condition for insulin-treated diabetics. A driver missing one eye may meet the alternate vision standard if they pass in the eye they have. Arcus senilis doesn't affect vision, nor does it require treatment. It is lipid deposits that appear as rings on the outer region of the cornea. They are usually gray or white and are usually opaque. Glaucoma affects peripheral vision which may require more frequent monitoring, but drivers can be certified if they meet the vision standard.

Although most OSA clearance is currently being provided by a pulmonologist or sleep specialist, the guidance is very specific that the sleep specialist be certified.  Keep in mind that this is a discretionary standard.

When taken for chronic pain or a mental health condition, there is less risk for side effects due to lower dosage.

An acute seizure from a systemic metabolic illness does not have a recommended time frame and can be qualified for up to 2 years.

Drivers with a history of childhood febrile seizures can be certified for 2 years without the need for clearance.

When less than full function is lost in the hand or foot, it is up to the medical examiner to determine if the driver can be qualified to drive.  In this case, the driver appears to have sufficient ability to drive.   If the medical examiner determines the driver does not have sufficient prehension and grip strength, the examiner could qualify the driver but require a SPE.

There is a 5-year waiting period for an unprovoked seizure during which time the driver must be seizure free and off anti-seizure medication. However, a driver can apply for the Federal Seizure Exemption program once they have been seizure free for 4 years, with or without the use of an anti-seizure medication. The recertification interval is 1 year.

A driver with well-controlled, non-insulin treated diabetes can be certified for 2 years. However, a driver with hypertension will always receive a maximum of a 1-year certification.

The liver oversees the processing of hemoglobin for use of its iron content. The spleen controls the level of white blood cells, red blood cells and platelets. The pancreas produces enzymes important to digestion. Inguinal nodes help to fight off infection.

The ME must always complete testing on both ears. If one ear passes while performing either the whisper test or an audiometric test, the ME is not required to perform both tests. If the driver fails either the whisper test or an audiometric test in both ears, the other test must be performed before disqualifying the driver. However, the driver must be given the opportunity to apply for the Federal Hearing Exemption, in which case the ME would certify the driver for 2 years with the certificate indicating that it must be accompanied with the Federal Hearing Exemption.

The ME must ask follow-up questions regarding Aphakia, Cataracts, Retinopathy, Glaucoma, and Macular Degeneration. A follow-up question regarding Impaired vision is suggested but not required.

Before certifying a driver with a medical condition that could affect safe driving, the ME should determine the severity and prognosis for that condition.  The ME role does not include diagnosis or treatment of driver medical conditions although it is not prohibited.

TIAs are defined as having complete recovery and low risk of recurrence after a year.

Evaluation of hand function is based on prehension and power grasping (grip strength). There is no specified way this must be measured, and no specific amount of strength or weight lifted. Provided the driver has at least one digit on their hand with which they can meet the functional requirements, the driver can be qualified for 2 years.

Drivers with all of the listed conditions can be considered for a SPE.

Peripheral neuropathy is only disqualifying if it affects safe operation of a CMV. Trulicity is not a type of insulin and therefore does not require a completed Insulin-Treated Diabetes Mellitus Form.

While a blood glucose level of 60mg/dl indicates hypoglycemia, it is not part of the definition of a severe hypoglycemic episode.

A HbA1C of 7% or greater causes end organ damage.  The American Diabetes Association (ADA) considers a HbA1C greater than 9% as uncontrolled. For those with a HbA1C greater than 9%, an ME may consider the ADA guidelines as "best practices" and provide a temporary certification status (up to 90 days) to allow the driver to gain better control of their blood sugar. Provided the driver is making improvements in the management of their diabetes, a ME can give consecutive temporary certifications until they have achieved proper control.  FMCSA suggests that HBA1c is not the only determining factor when considering driver qualification.

A TSH of 7mIU/L is very high as the normal TSH values range between 0.4 to 4.0mIU/L. The other values are all within normal range. Normal ESR is 0-15mm/hr. Normal BUN = 5-20mg/dL.

The ME should also ask regarding insulin treatment, but it is not specifically required to ask whether the driver has been evaluated by a diabetic specialist.

MEs are to evaluate a driver's disability to see if it will affect safe driving.  Because the medical exam is a "fitness for duty" exam, it could affect the status of the driver's disability if a medical certificate is issued.

The condition most likely to cause symptoms that would be unsafe for driving would be bipolar disorder. A mildly elevated blood pressure is not a risk but can have long-term effects. Symptoms of uncontrolled hypothyroidism include fatigue, weight gain, and depression. Benign prostatic hyperplasia (BPH) may cause an increase in urgency and frequency of urination.

A driver may use a stimulant solely for the treatment of ADD or ADHD.

Creatinine and BUN are the main two lab results used to monitor kidney function. They are part of the basic metabolic panel (BMP) lab results. The complete blood count (CBC) does not provide any values for kidney function. It gives levels of various types of both white blood cells and red blood cells, Hbg and Hct, iron, AST and ALT for liver function, and more. Sodium is processed through the kidneys, but the lab result does not provide much value. Urine specific gravity measures the kidneys’ ability to balance water content and excrete waste.

The decision to require pre-employment alcohol testing is up to the motor carrier.

The required 5-panel drug testing includes opiates, amphetamines, PCP, Cocaine, and Marijuana (THC).

If the driver can demonstrate sufficient power and movement even though all digits are missing on the foot, they can be certified to drive without a SPE.

The Intracity zone regulation has not been changed, so the ME could qualify the driver for one year.  However, these drivers could also be certified to drive across state lines if they obtain a signed ITDM indicating they are safe to drive.

The most critical safety issue is the risk for a severe hypoglycemic episode.

The correct answer is B. The only recommendation regarding sleep study results is that a driver with moderate sleep apnea (AHI > 15) should be treated. The other three answers are all requirements for initial recertification after obtaining a sleep study and starting treatment.

A disc herniation at L5-S1 may result in a decreased Achilles reflex and ability to plantar flex the foot on the side of the herniation.  Having the driver demonstrate the ability to toe walk will test any loss of strength that could influence vehicle control.

Coumadin is an anticoagulant and requires monthly INR testing and an INR value of 2-3.  Theo-Dur is an older bronchodilator medication which requires blood level monitoring to maintain safe levels.  Lithium is used for mood disorders and blood level monitoring is required. Pradaxa, used for blood thinning, does not require any lab testing.

The measurement 20/40-1 means that the driver missed one letter on the 20/40 line.  It is acceptable practice for a driver to miss only one letter on a line.  Therefore, 20/40-1 indicates 20/40 vision.  The driver has 20/40 vision in both eyes and should be certified for two years.

This question refers to the long-term overall control of diabetes. Although rotating schedules, stress and lack of sleep can all affect diabetes control, a good diet would be essential in controlling the driver's diabetes mellitus over the long run.

This question is directed toward an immediate or short-term blood sugar level. A missed dose of medication would be expected to have the greatest impact on the immediate blood sugar of a driver with non-insulin dependent diabetes mellitus.  Another issue with a large impact would be a current illness.

The driver's signature is the most important element that all information given is complete and true.  Another important component is verifying driver identity.

The original copy of the exam report form, which is the copy used during the examination, is kept by the medical examiner.  This can be either a paper or electronic copy.

The driver gets the original copy of the Medical Examiner's Certificate.

Proteinuria, hematuria or glycosuria may be an indication for further testing.  When an abnormal urinalysis is indicative of a medical condition that endangers the safety and health of the driver and the public, you should not certify the driver until the etiology is confirmed and treatment safe, effective, and stable.  A UA result of 30 mg/dl for protein is a low result (just above trace) and may be normal or a result of exercise, recent illness, or other factors.  Qualify the driver, inform the driver of the abnormal finding, and recommend a follow-up UA or evaluation from PCP.

For testing purposes, ordering a follow-up test to better determine if the driver’s condition may interfere with safe driving would be the best route to take. In a real-life situation, the ME may rather decide to refer the driver to their PCP for further testing and treatment.  Each of the lab tests listed could provide useful information.

The correct answer would be to complete the physical exam and disqualify the driver.  Have the driver return to your office after Lasik.

Perform a completely new exam on new forms and qualify the driver for up to 2 years.

If there is no pacemaker/defibrillator a referral would be considered if the lump cannot be identified.

This is a difficult question because a slight change in the wording of the question can determine which answer is best.  In young drivers, temporary high protein in the urine can be normal after exercise or illness. Generally, protein detected in the urine would be re-tested in about two weeks and if still present, a test for creatine may be the next step. In an older driver, ordering the creatine test may be the best answer.

FMCSA has stated that the ME should not make a qualification determination based solely on hyperuricemia. The ME should obtain additional lab values to aid in the decision. High glucose in the urine or in the blood is not diagnostic of diabetes but it does warrant further evaluation. A temporary medical certificate would allow the individual to continue driving in the meantime. A driver with possible undiagnosed or uncontrolled diabetes should not be certified for 2 years.

All answers are side effects of Tegretol, but blurred vision and double vision are the most common.

Thrush is caused by an overgrowth of a fungus called candida in the mouth. It causes creamy white lesions, usually on your tongue or inner cheeks but may spread to the roof of the mouth, gums, tonsils, or the back of the throat. It is more likely to occur in people with suppressed immune systems or certain health conditions. Geographic tongue is an inflammatory but harmless condition that results from the loss of the papillae on the tongue's surface. It appears as smooth, red patches of varying shapes and sizes. Gingivitis is simply inflammation of the gums.

Although a drug test is not a usual part of the medical exam, the ME can order a Non-DOT drug test as long as the driver has never had a positive DOT drug test.  The purpose of the test is to ensure the driver is no longer using marijuana.   Marijuana use in the U.S. is usually considered a choice rather than being addictive, although when used in high concentrations, physical dependence can be present.

A positive DOT drug test is considered a violation of FMCSA policy.  When a violation occurs, a driver cannot be returned to driving until they have had an evaluation by a DOT accredited substance abuse professional (SAP) and have successfully completed a treatment program when recommended by the SAP.

Comment: In air conduction testing, the triangle icon stands for the right ear and is usually recorded as a red line on the graph. The square icon is typically recorded as a blue line, represents the left ear.  (Note: A audiogram graph has frequently appeared on the certification test, please review an actual graph, and make sure you know how to determine if the driver meets the hearing standard.)

The driver's medical certificate can be issued for up to 2 years.  Drivers with a medical condition other than the fixed deficit may have a medical certificate issued for less than 2 years.  The deficit must be fixed and not expected to improve.  The deficit is limited to an extremity and does not include movement such as bending or rotation of the spine.

Although it is best to have clothing suitable for access to the systems being examined, the FMCSA minimal clothing allowable is a gown and clothing considered as underwear according to male and female standards. Females generally consider underwear to be underpants and a bra. Therefore, for a female the minimum clothing requirement would be a gown, bra, and underwear.

If the initial blood pressure reading of a driver is equal to or above 140/90, a second reading should be taken later during the exam.

Although the second reading is in the Stage 2 category, the ME should use the lowest reading obtained (145/80) which is in the Stage 1 category. Since the driver has no previous history of hypertension, they can be given a one-year medical certificate.

It is well-documented that drivers with ADHD are more likely to have road rage. This is a reason why it is important to obtain clearance from the treating provider stating that treatment is effective. The use of psychostimulants (Adderall, Ritalin, Modafinil, etc.) is not disqualifying.

Photophobia and retinal exam are not specifically required while pupillary reaction is.

FMCSA guidelines are to certify a person with only mild symptoms of Parkinson’s disease who tolerates their medications without side effects that could affect safe driving. They must have no significant fluctuations in motor response, sometimes referred to as “on-off” effects. They must have satisfactory results on tests assessing key cognitive function and have no cognitive dysfunction. MEs may consider these symptoms to be slightly more than “mild” symptoms and determine this driver to be a medium risk when driving a CMV.

This driver would be considered to have stage 2 Parkinson’s disease which consists of tremor, rigidity and other movement symptoms affecting both sides of the body. Stage 2 also has walking problems and poor posture may be apparent. Stage 1 consists of tremor and other movement symptoms on one side of the body as well as changes in posture, walking, and facial expressions. Stage 3 consists of loss of balance/unsteadiness when turning or pushed. Falls are more common.

Drivers with cancer can be certified but not until after the ME has confirmed that treatment is not causing side effects that are unsafe for driving.

Determination pending exams are not reported a second time on the National Registry. When an exam is placed into determination pending and the exam is completed within 45 days, the ME should select “Medical Examination Report amended”, provide the reason for the amendment, then sign and date. In addition, they should initial and date any changes made on the Medical Examination Report Form.

For exams that expire at 45 days, the ME updates the report form by selecting incomplete examination, specifying the reason, and files the form in the driver’s record their copy of the form and file it away. The ME does not need to submit another CMV Driver Medical Examination Results Form, MCSA-5850, through their National Registry account.

For testing purposes, always choose to order the appropriate lab test rather than referring to the driver’s PCP. The best way to diagnose rhabdomyolysis is to order repeated blood tests for the muscle protein creatine kinase (CK) which will rise when muscle tissue is damaged. A complete metabolic panel (CMP) consists of glucose, calcium, sodium, potassium, carbon dioxide, chloride, albumin, total protein, ALP, ALT, AST, bilirubin, BUN, and creatinine. A complete blood count (CBC) measures the various WBCs, RBC, platelets, Hgb, Hct, MCV, MCH, and MCHC.

Even if a driver meets the vision in both eyes, the ME should refer the driver to an eye specialist if eye pathology is suspected.

The PCP shouldn’t be the one managing the seizures. Also, it’s unlikely that the ME will be able to obtain documentation from 16 years ago. An EEG can detect and monitor changes in brain activity for around 48 hours after the seizure so at this time, the test would not be helpful unless the ME suspects a recent seizure. The seizure exemption does not apply as it has been longer than the required 5 years of being seizure-free and off anticonvulsant medication. To verify that the driver has been off anticonvulsant, the ME should obtain pharmacy records.

These medications are anticoagulants that affect the kidneys. Kidney function is measured by creatinine and Blood Urea Nitrogen (BUN). Frequency of monitoring depends on Creatinine Clearance (CRCL) levels. If the CRCL > 50, creatinine should be checked every 6-12 months. If CRCL < 50, creatinine should be checked every 3 months. Coumadin (warfarin) is measured by monthly INR and therapeutic levels are between 2-3.

Irritability during the medical exam is a concern that the driver has an undetected psychological condition that may result in unsafe or aggressive driving or actions.  Before being certified, the driver should be evaluated by a mental health professional and the cause of the irritability determined (and if recommended) successfully treated and controlled before certification.

To meet the alternate vision standard, at least one eye must meet the vision standard with or without corrective lenses and the driver must have a completed Vision Evaluation Report. Until then, the exam should be completed, and the driver should be disqualified.

Leukocytes are white blood cells, indicating that there is an infection present. Bacteria convert nitrate to nitrite in the urine. Therefore, these findings are suggestive of a urinary tract infection. Sepsis is an infection of the blood. Unless the driver has cancer of the urinary tract system, cancer will not cause these positive values. Dementia is completely unrelated to urinalysis findings.

The driver’s condition and treatment appears to be safe, stable, and not a risk to safe driving.

Eliquis is an anticoagulant most used for treatment and/or prophylactic treatment of stroke, and other thromboembolic events. The medical examiner should verify the condition for which it is prescribed, that the condition is stable, treatment is effective, and the driver is not having any adverse effects that are unsafe for driving. Lisinopril is an anti-hypertensive medication. Allopurinol is for the ongoing prophylactic treatment of gout.