NURS 6521 Week 1 Assignment

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NURS 6521, Week 1 Assignment Template

 For each of the scenarios below, answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.

 

  1. 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?
  1. A 44-year-old women is currently taking Glipizide and Phenytoin.She has a new prescription for Ceftriaxone. All three medications are known to be highly protein bound.What effect does protein binding have on drug availability?How would you manage this patient’s medication?

 

  1. Name two drugs that are highly affected by the first pass effect.As a prescriber, what actions would you take in prescribing these drugs to counter the first pass effect?
  2. James is a 49-year-old male that was prescribed atenolol for his high blood pressure.James states that he only occasionally takes the medication because he does not like the side effects.What information would you provide to the patient at his visit?How would you manage his medication?

Solution:

Problem:  The problem that this patient is experiencing is high level of INR level (8.8) which is above therapeutic range.  The patient is therefore at high risk of bleeding.  The high level can be attributed to interaction between Warfarin and Amiodarone.  Amiodarone inhibit  CYP2C and this enzymes play a role in the metabolism of Warfarin. As such, Amiodarone raises the  plasma concentration of Warfarin.

Management: Reduce the risk of bleeding by temporarily withholding Warfarin dosage.  The INR level should be monitored.  And once the INR stabilizes, Warfarin can be continued but at a lower dosage.

Prescription Changes:

RX: Warfarin 2.5 mg

Sig: Take one tablet PO daily

Disp: #30 tablets

Refill: 0

Signed:

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