Question

PSR is an 85-year-old man (66.22 kg, 65 in) who suffers from urinary incontinence, gout, hypertension, hypothyroidism, DVT (Deep Vein Thrombosis), seizure, atrial fibrilation, parkinson,osteopenia, constipation.. PRS is treated at an anticoagulation clinic as it uses Warfarin chronically for atrial fibrillation and DVT episode. The patient uses Carbidopa/Levodopa, Donepezil, Prhyidone, Levothyroxine, Metoprolol Tartrate, Simvastatin and Warfarin. At the patient's routine visit to the anticoagulation clinic on 0 9/10/2019,questions are asked about their diet, new medications, missed doses, signs and symptoms of bleeding and whether something has changed since their last visit. PSR indicates that Warfarin is being taken every day and that you had an appointment with your doctor on 08/01/2019 in which you were   reduced the dose of Prhyme from 100 mg to 50 mg. Their diet remains the same and has not had bleeding s/sx.

Warfarin dosage 10mg every day except Monday and Wednesday taking 7.5mg

INR 9/10/19 05:32   4.78

7/30/19 05:25 2.23

6/20/19 05:25 2.22

5/28/19 05:20 2.40

What is the INR target range for this patient?

What factors would you consider when evaluating this patient? What drug-drug interactions are present, what is their possible effect on INR? Why?

What recommendation would you make at this time?

Answer 1

Q1 Answer:

The normal INR for a healthy person can be 1.1 sec or less. But for the patient who are taking wafarin treatment should be maintain the INR of 2.5 second or range between 2.0 to 3.0 second.

Q2 Answer :

The factors that should considered while evaluating this patient includes

- wafarin dose

- any drug interaction

- any vitamin k consumption

- disease condition of any bleeding disorder

Q3

Answer: carbidopa taking along with wafarin may leads to decrease the effect to reduce INR by induction of metaolism . Primidine also interact with the wafarin and it reduce the effectivenss of wafarin drug. It is because primidine leads to fast metabolism of wafarin. Hence both drug will makes the INR increase due to reduce of effectiveness of wafarin.

Q4

Answer: The best recommendation is to inform to the consult doctor to prevent further complication. The consult doctor may increase the amoubt of wafarin or may stop the medications that are drug interaction.