Problem: Z.G. is a 61-year-old man with AF, HTN, and hypercholesterolemia. His medications include digoxin 0.125 mg/day, warfarin 5 mg/day, amlodipine 10 mg/day, and pravastatin 20 mg every night. He comes to the clinic today with no complaints except for palpitations and shortness of breath when doing yard work. His vital signs include BP 138/80 mm Hg and HR 100 beats/minute. All laboratory results are within normal limits; his international normalized ratio (INR) is 2.4, and his digoxin concentration is 1.1 ng/dL (nl 0.8-2ng/dl). Which is the best option to help with Z.G.'s symptoms?
Add metoprolol succinate 50 mg/day.
Increase digoxin to 0.25 mg/day.
Continue the current regimen; advise the patient to avoid activities that cause symptoms.
Add verapamil 240 mg/day.