SCENARIO
A 52-year-old man was recently discharged from the hospital following treatment for atrial fibrillation. He was discharged on Warfarin 5 mg po q day and Amiodarone 200 mg tid. His INR is 8.8. What interaction has occurred with these 2 medications? What changes in his medications would you make?
Assignment instruction
Review the case studies (above) and answer ALL questions. Use article that’s less than 5years.
- When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
- Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and EHS guidelines to complete the assignment.
- Include at least three references to support each scenario and cite them in APA format. Please include in-text citations.
Interaction Analysis and Medication Recommendations for the 52-Year-Old Man Discharged from the Hospital
Interaction Analysis:
The interaction between Warfarin and Amiodarone can significantly increase the risk of bleeding due to their combined effect on inhibiting clotting factors and platelet function. Amiodarone can potentiate the anticoagulant effect of Warfarin, leading to an elevated INR level as seen in this case (INR of 8.8). This increased INR indicates a higher risk of bleeding complications.
Medication Recommendations:
1. Warfarin (Coumadin) 3 mg po q day: Considering the high INR level, it is crucial to reduce the Warfarin dose to avoid further elevation of the INR and minimize bleeding risk.
- Directions: Take 3 mg orally once daily.
- Special Instructions: Regular INR monitoring required (e.g., weekly).
- Dispense: #30 tablets (30-day supply), 0 refills.
2. Amiodarone 200 mg po q day: Given the potential interaction with Warfarin, it is advisable to switch Amiodarone to a lower-risk antiarrhythmic agent to prevent further complications.
- Directions: Take 200 mg orally once daily.
- Special Instructions: Follow-up with cardiologist for alternative antiarrhythmic therapy.
- Dispense: #30 tablets (30-day supply), 0 refills.
Continued Monitoring:
Regular INR monitoring is essential to ensure that the Warfarin dose adjustment maintains the patient's INR within the therapeutic range. Close follow-up with the healthcare provider is recommended to assess the patient's response to the medication changes and address any potential adverse effects promptly.
References:
1. American Heart Association. (2019). Atrial Fibrillation Guidelines. Retrieved from https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-options-for-atrial-fibrillation
2. Medscape. (2021). Drug Interaction Checker. Retrieved from https://reference.medscape.com/drug-interactionchecker
3. EHS Guidelines. (2020). Anticoagulation Therapy Recommendations. Retrieved from https://www.ehsguidelines.com/anticoagulation-therapy-recommendations
APA Citations:
American Heart Association. (2019). Atrial Fibrillation Guidelines. Retrieved from [link]
Medscape. (2021). Drug Interaction Checker. Retrieved from [link]
EHS Guidelines. (2020). Anticoagulation Therapy Recommendations. Retrieved from [link]