The problems that were identified in Mr. Elliot were his runny nose, cough, head, and chest congestion, frequent nose bleeds and multiple bruises to his arms and legs. He also had an elevated blood pressure of 180/90, chronic atrial fibrillation, elevated INR of 4.8, and elevated digoxin level 3.8. Mr. Elliot has chronic atrial fibrillation and is being treated with Warfarin. Warfarin is a Vitamin K antagonist, a blood thinner that is used to treat and reduce the chance of blood clots forming, such as a thromboembolism which can develop because of atrial fibrillation (Varim et al., 2016). Mr. Elliot has an elevated INR, which is possibly due to one of his medications causing a drug-to-drug interaction by exacerbating the effect of his current
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When taken together it may increase the risk of cardiac arrhythmias and elevate blood pressure (Epocrates, 2017). Due to digoxin narrow therapeutic margin, when taken with a drug, such as Pseudoephedrine, which can interfere with metabolizing or excreting, it can alter the drug efficacy or lead to potentially severe adverse effects that may result from an overdose. The clinical significance of Cimetidine and Warfarin interaction is it may contribute to an increase in bleeding such as what seen in Mr. Elliot (Micromedex, 2017). Mr. Elliot recently has frequent nose bleeds and multiple severe bruising which can all be contributed to his him taking cimetidine and warfarin together. The clinical symptoms seen with taking digoxin and pseudoephedrine is his elevated blood pressure and possibly worsening of his atrial fibrillation. Educating Mr. Elliot about dietary restrictions and medication interactions are pertinent to his well-being. Mr. Elliot must be encouraged to consult his provider prior to starting a new medicine or taking any over the counter medications. Since Mr. Elliot was already taking both Digoxin and Pseudoephedrine he should be monitor regularly for complications. Digoxin levels need to be monitored as well as an EKG. The goal is to educate Mr. Elliot and help him to be proactive in his care and avoid unnecessary
When taken together it may increase the risk of cardiac arrhythmias and elevate blood pressure (Epocrates, 2017). Due to digoxin narrow therapeutic margin, when taken with a drug, such as Pseudoephedrine, which can interfere with metabolizing or excreting, it can alter the drug efficacy or lead to potentially severe adverse effects that may result from an overdose. The clinical significance of Cimetidine and Warfarin interaction is it may contribute to an increase in bleeding such as what seen in Mr. Elliot (Micromedex, 2017). Mr. Elliot recently has frequent nose bleeds and multiple severe bruising which can all be contributed to his him taking cimetidine and warfarin together. The clinical symptoms seen with taking digoxin and pseudoephedrine is his elevated blood pressure and possibly worsening of his atrial fibrillation. Educating Mr. Elliot about dietary restrictions and medication interactions are pertinent to his well-being. Mr. Elliot must be encouraged to consult his provider prior to starting a new medicine or taking any over the counter medications. Since Mr. Elliot was already taking both Digoxin and Pseudoephedrine he should be monitor regularly for complications. Digoxin levels need to be monitored as well as an EKG. The goal is to educate Mr. Elliot and help him to be proactive in his care and avoid unnecessary