George's Multiple-Warfarin Study

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The patient George is 76 year old who has the subjective complaints of frequent nosebleeds, ecchymosis, runny nose, and cough. His history reveal atrial fibrillation. He is taking medications that include digoxin, warfarin, cimetidine, and pseudoephedrine. There are four problems identified for the patient. First, based on this complaints of frequent nosebleeds, it is noted that the patient is taking cimetidine and warfarin. There is an interaction with his cimetidine and warfarin. This is a contraindication as cimetidine increases the level of the warfarin which causes bleeding. It is noted that his hematocrit is 42% which is outside the accepted range of 45% to 52 %. Second, the patient complains about easy bruising. The objective data reveal ecchymosis on the arms and legs. When a patient is on warfarin, there is a need to ensure the best possible health care status for the …show more content…
(2012). Evaluation of methods for achieving stable INR in healthy subjects during a multiple-dose warfarin study. European Journal of Clinical Pharmacology, 68(3), 239-247. doi:10.1007/s00228-011-1114-4
Elshershari, H. (2010). Pseudoephedrine-Induced tachycardia and hypertension in an infant misdiagnosed as supraventricular tachycardia: A case report. Journal of Medicine & Biomedical Sciences, 2(1), 42-45.
Jamula, E., Woods, K., Verhovsek, M., & Douketis, J. D. (2009). Comparison of pain and ecchymosis with low-molecular-weight heparin vs. unfractionated heparin in patients requiring bridging anticoagulation after warfarin interruption: A randomized trial. Journal of Thrombosis and Thrombolysis, (3), 266-270. doi:10.1007/s11239-009-0389-0
Niemeijer, M. N., van den Berg, M. E., Deckers, J. W., Aarnoudse, A. L., Hofman. A., Franco, O. H., … Stricker, B. H.(2015). ABCB1 gene variants, digoxin and risk of sudden cardiac death in a general population. Heart, 30, 307-319. doi:

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