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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? 

A 34-year-old man with panic disorder is prescribed alprazolam. After 6 months, he reports escalating doses and withdrawal when he misses a dose. What has occurred? 

A patient on donepezil develops dizziness and a heart rate of 48 bpm. This is most likely due to: 

A 28-year-old woman presents with recurrent migraines. Which is most appropriate for acute attacks? 

A 39-year-old with bipolar disorder is stable on lithium. Labs show creatinine 2.0 mg/dL. What is the most appropriate action? 

Which drug is most associated with first-dose syncope? 

A 32-year-old woman presents for follow-up after being prescribed zolpidem 10 mg nightly for short-term treatment of insomnia. She reports that although the medication helps her fall asleep, she often experiences morning grogginess, impaired concentration at work, and difficulty driving safely the next day. She denies alcohol or other sedative use. Her BMI is 23, and liver and renal function tests are normal. Which pharmacokinetic factor best explains her increased sensitivity to zolpidem?