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August 16th, 2024A 50-year-old man comes to the emergency department with a 4-day history of fever, cough, rhinorrhea and sore throat. His medical history includes ongoing pulmonary tuberculosis, arterial hypertension, and obstructive sleep apnea. Drug history includes rifampin, isoniazid, pyrazinamide, losartan and pantoprazole. His temperature is 38.4 °C (101.12 °F), pulse is 95/min, respiratory rate is 19/min, blood pressure is 120/90 mm, SpO2 is 96% in room air. Physical examination shows no distress and lungs are clear to auscultation. Once the patient's diagnosis with a test for SARS CoV-2 is confirmed, the emergency department physician decides for outpatient management with antivirals and prescribes ritonavir-boosted nirmatrelvir. However, in a few days, shortness of breath, worsening of the cough, and decreased SpO2 occur. Which of the following drugs was most likely to contribute to clinical deterioration?