MSFinals-6498

A 42-year-old man comes to the emergency department complaining of severe abdominal pain. The pain is concentrated in the epigastric region and is relieved by leaning forward. He has vomited twice, but there was no blood in the vomit.

Upon examination, he appears unwell and sweaty. His heart rate is 90 beats per minute, blood pressure is 100/72 mmHg, respiratory rate is 22 breaths per minute, and temperature is 39.2 ºC.

Given his complex medical history and multiple daily medications, which medication is most likely causing his symptoms?