Digoxin Case Study

750 Words 3 Pages
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 …show more content…
Elliot is taking Digoxin, Pseudoephedrine SR, Warfarin, and Cimetidine OTC. The mechanism of action for Digoxin is it inhibits sodium-potassium ATPase that causes an increase in intracellular sodium concentration, prompting an increase in intracellular calcium concentration (Micromedex, 2017). It slows the electrical conduction between the atria and the ventricle of the heart to treat atrial fibrillation (Ambrosy et al., 2014). Pseudoephedrine is a phenethylamine and a dextro-isomer of ephedrine, the mechanism of action is as Adrenergic alpha-agonist’s, which acts as a decongestant that stimulates the alpha-adrenergic receptors of vascular smooth muscle (National Center for Biotechnology Information [NCBI], 2017). Cimetidine is an H2 blocker that inhibits histamine action at the H2 receptors of the parietal cells (Micromedex, 2017). It decreases day and nighttime amount of acid in the stomach (Micromedex, 2017). Warfarin is a vitamin K antagonist. It “prevents vitamin K epoxide enzyme complex which blocks the regeneration of vitamin K epoxide and inhibits the synthesis of vitamin K-dependent clotting factors two, seven, nine and ten and the anticoagulation proteins C and S” (Micromedex, …show more content…
Mr. Elliot INR is elevated, possibly due to him taking Cimetidine an OTC medicine for his heartburn. Cimetidine OTC is a liver enzyme inhibitor. It decreases Warfarin clearance and can increase INR by augmenting the anticoagulant effect of Vitamin K antagonist (Ageno, et al., (2012). Cimetidine can cause drug-drug interactions when taken with agents that are metabolized by microsomal enzymes (National Library of Medicine, 2014). By taking the OTC Cimetidine plus his prescribed Warfarin, Mr. Elliot may have caused an increase in his plasma warfarin concentration (Ageno, et al., 2012). Digoxin and Pseudoephedrine interaction is another interaction that can cause adverse effects. 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

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