Elliot complaints on his body

Elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. The patient is also complaining of a runny nose, cough, and head/chest congestion. He has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. Approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing.  Below is a list of the patient’s medications, his physical examination, and his laboratory findings:Medications                                                                  Digoxin 0.25 mg QDCimetidine OTC BIDPseudoephedrine SR 120 BIDWarfarin 7 mg QDAllergies: NKDAPhysical ExaminationVS: BP: 180/95, HR 75, irregularly irregular, RR 17Weight: 95 kgHEENT: WNLABD: + Bowel SoundsEXT: Bruising on arms and legsNEURO: Alert & Oriented x 3GEN: Well developed, well-nourished maleECG: atrial fibrillationLaboratoryNa 143 mEq/L                           SCr 0.9mg/dlK 4.5 mEq/L                               INR 4.8Cl 99 mmol/L                             Hct 42%CO2 25 mEq/L                           Hbg 15mg/dLBUN 18 mg/dL                          Digoxin 3.8 ng/mlWhat problems should be identified in this patient?What are the precise mechanisms of action of each drug?What do you think is contributing to the patient’s hypertension?Are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?What is the clinical significance of these interactions?