input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 55-year-old man presents to the emergency department with complaints of nausea, vomiting, palpitations, and dizziness, which have lasted for the past 3 hours. He was diagnosed with heart failure 1 year ago. During his last visit to his primary care physician, he was doing well and the lab results were normal. He reports that he has been taking low-dose aspirin and digoxin regularly for 1 year, and verapamil was recently added to prevent his frequent migraine headaches. An electrocardiogram is performed urgently and shows paroxysmal atrial tachycardia with block. Suspecting digitalis toxicity, the emergency medicine physician sends blood to the lab for a serum digoxin level, which is 3.7 ng/mL (therapeutic range: 0.8–2 ng/mL). Which of the following mechanisms most likely explains the development of digitalis toxicity in this patient?   (A) Drug-induced hypokalemia   (B) Increased intestinal absorption of digoxin   (C) Inhibition of CYP 3A4 isoenzyme   (D) Inhibition of P-glycoprotein
output: ['(D) Inhibition of P-glycoprotein <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Drug-induced hypokalemia  (B) Increased intestinal absorption of digoxin  (C) Inhibition of CYP 3A4 isoenzyme  (D) Inhibition of P-glycoprotein <> possible answers', '  A 55-year-old man presents to the emergency department with complaints of nausea, vomiting, palpitations, and dizziness, which have lasted for the past 3 hours. He was diagnosed with heart failure 1 year ago. During his last visit to his primary care physician, he was doing well and the lab results were normal. He reports that he has been taking low-dose aspirin and digoxin regularly for 1 year, and verapamil was recently added to prevent his frequent migraine headaches. An electrocardiogram is performed urgently and shows paroxysmal atrial tachycardia with block. Suspecting digitalis toxicity, the emergency medicine physician sends blood to the lab for a serum digoxin level, which is 3.7 ng/mL (therapeutic range: 0.8–2 ng/mL). Which of the following mechanisms most likely explains the development of digitalis toxicity in this patient? <> context']