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Age: 39 years Gender: Female Diagnosis: DVT with Arrythmia Rx Warfarin Tab 1 mg , one...

Age: 39 years

Gender: Female

Diagnosis: DVT with Arrythmia

Rx

Warfarin Tab 1 mg , one od

Warfarin Tab 5 mg , 1.5 tab od

Furosemide tabs 40 mg , 1.5 od

Aspirin Tab 75 mg, one od

Ketoprofen gel prn

Amiodaron 200 mg od

Note: what are the new anticoagulants? differentiate between them and warfarin?

according to this prescription find the mistakes, the interaction, dose for adult and Paediatric , the toxicity level , antidotes , follow up,  the counselling and what the suitable medication for this patient ?

Solutions

Expert Solution

NEW ANTI-COAGULANTS

In 2019, FDA approved three new oral anti-coagulant drugs. They are,

  • T. Pradaxa ( Dabigatran).
  • T. Xarelto ( rivaroxaban).
  • T. Eliquis( apixaban).

DIFFERENCE BETWEEN NEW ANTI-COAGULANTS AND WARFARIN

T. Pradaxa : This drug is better for preventing stroke and bleeding is lower as compare with warfarin. But stomach and bowel bleeding is usually higher than warfarin.

T. Xarelto: Cerebral hemorrhage rate is lower than warfarin. So this drug is safe.

T. Eliquis: This drug is shorter acting than warfarin.

MISTAKE OF THIS PRESCRIPTION

Here warfarin prescribed twice with different dose. First is T. warfarin 1mg OD and second, T. Warfarin 5mg (1.5 tab) OD. Warfarin and Aspirin cause bleeding . So its better to give one drug at a time.

INTERACTION

Warfarin : Warfarin prevent blood clotting by stopping the production of blood clotting factors from liver such as factor two, seven, nine and anti-coagulant factors protein C and S.

Furosemide: It prevent absorption of sodium, chloride and water from kidney because it cause inceresed urine output.

Aspirin: Decrese the process of making blood clots.

Ketoprofen: This medicine is NSAID reduce pain, swelling and stiffness.

Amilodaron :This drug prevents reappreance od ventricular arrthymias.

PEDIATRIC DOSAGE

T. warfarin: 0.2 mg/kg orally .

T. furosemide : 2mg/kg/ single dose.

T. Aspirin : 10 to 20 mg /kg dose every 4 to 6 hours.

T. Amilodaron : 5mg/kg single dose every 8hours.

TOXICITY .

Warfarin : Hemorrhage, necrosis, calcification of valve and arteries, purple toe syndrome

Furosemide : Blurred vision, dizziness, headache, vertigo, hypoension, excessive urination, anorexia, dry mouth.

Aspirin : Bleeding, irritability, double vision, vomiting and hallucination.

Amilodaron: Tinnitus, tremor, ataxia, ocular neuritis, bradycardia.

ANTIDOTES

Warfarin : Vitamin K

Furosemide : No specific antidote

Aspirin : Sodium bicarbonate

Amilodaron : No specific antidote

FOLLOW-UP AND COUNSELLING

  • Treatment may be upto 3months.
  • Long term treatment if no risk for bleeding.
  • Aviod intake Vit K containing foods because it interfere with warfarin.
  • Regular follow-up visit.
  • Take medicine as prescribed.
  • Avoid smoking and alcohol
  • Wear compress stockings
  • Eat healthy.
  • Investigate for the possibility of cancer.
  • Lift foot end.

SUITABLE MEDICINE FOR THE PATIENT

Blood thinners

Heparin

Aspirin

Warfarin

Rivaroxaban

Apixaban

Anti -arrthymias drugs

Amilodaron

Nightingale answered 2 years ago
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