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A 62-year-old man with type 2 diabetes and hypertension is on atorvastatin 80 mg daily. He has no history of ASCVD. Despite good adherence, his LDL-C remains 92 mg/dL. His 10-year ASCVD risk is 26%. He asks whether he should “just try a different cholesterol pill” since the statin hasn’t brought him below 70. Which is the most appropriate next pharmacologic step? 

A 60-year-old woman with diabetes and hyperlipidemia has been on rosuvastatin 40 mg for 8 months. She presents to clinic with severe muscle pain, weakness, and dark urine. Exam shows diffuse muscle tenderness. Which statin-associated adverse effect mandates immediate discontinuation of therapy? 

Which adverse effect is most concerning with benzodiazepines in older adults? 

Sudden withdrawal of beta blockers may precipitate: 

A patient with treatment-resistant schizophrenia is started on clozapine. What is the most important baseline test? 

A 64-year-old man with ischemic cardiomyopathy (LVEF 25%) presents with dyspnea on exertion and peripheral edema. He is initiated on lisinopril, carvedilol, and spironolactone, consistent with guideline-directed medical therapy for HFrEF. Which additional medication would be expected to improve symptoms of volume overload but is not associated with a reduction in mortality? 

A 72-year-old woman with hypertension and osteoarthritis is prescribed digoxin. Her renal function shows eGFR 28 mL/min. What adjustment is most critical? 

Which drug type requires especially close therapeutic monitoring? 

Flumazenil is used in benzodiazepine overdose but should be given cautiously because: 

A patient receiving naloxone infusion for opioid overdose develops severe withdrawal. Which explains this?