George is a 76-year-old male who presents to the clinic with complaints of frequent nosebleeds

George is a 76-year-old male who presents to the clinic with complaints of frequent nosebleeds (four in the past week) and easy bruising. The patient also complains of a runny nose and cough. He has a history of chronic atrial fibrillation and takes warfarin. About 3 weeks ago, the patient started taking Tagamet over-the-counter (OTC) for heartburn.What problems with this patient can you identify? What contributes to this patient’s increased blood pressure?MedicationsDigoxin 0.25 mg QDCimetidine OTC BIDPseudoephedrine SR 120 BIDWarfarin 7 mg QDAllergies: NKDAPhysical ExaminationVS: BP: 180/95, HR 75, irregularly irregular, RR 17, Wt. 95 kgHEENT: WNLABD: + Bowel SoundsEXT: Bruising on arms and legsNEURO: Alert & Oriented x 3GEN: Well developed, well-nourished male.ECG: atrial fibrillation.LaboratoryNa 143K 4.5Cl 99CO2 25BUN 18SCr 0.9INR 4.8Hct 42Hbg 15Digoxin 1.6ng/ml

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