An 82-year-old patient was recently transferred from a long-term care facility and admitted to the telemetry/ medical unit with a diagnosis of recurrent CHF and uncontrolled atrial fibrillation. During the admission assessment interview the nurse notes that the patient's medication history includes: Coreg 12.5mg BID, Digoxin 0.125mg p.o. daily, Enalapril 5mg p.o. BID hold SBP<100mmHg, Lasix 40mg p.o. daily, Imdur 120mg p.o. daily, Lorazepam 0.25mg p.o. daily in a.m., and Lorazepam 1mg at h.s. Upon admission, the patient's daily dose of Digoxin was increased to 0.25mg to better control her atrial fibrillation.