NRNP 6566 Knowledge Check Week 3
QUESTION 1
1.
A 63-year-old female has been successfully cardioverted and is now on amiodarone
for rhythm maintenance. The patient is on the following medications:
Warfarin 10 mg po daily
Lisinopril 20 mg po daily
Amiodarone 400 mg po
daily Prilosec 20 mg po
daily Digoxin 4250 mcg po
daily
What interactions are possible and how would you monitor and adjust for them.
Amiodarone has possible complex interactions with multiple medications. It
has an effect on warfarin metabolism. Amiodarone is a potent inhibitor of
cytochrome P450 enzymes and inhibition of these enzymes will cause an
increased plasma concentration and decreased clearance; thereby
increasing the prothrombin time and INR placing the patient at increased
risk for bleeding complications. Hence, when given
together, warfarin dose should be decreased and frequent INR monitoring
should be done.
Amiodarone also interacts with digoxin. It increases digoxin concentrations
through the inhibition of P-glycoprotein mediated efflux transporter that
facilitates digoxin elimination from the body. Amiodarone increases the
serum drug levels of digoxin. Due to this, when given together, digoxin dose
should be reduced and levels are closely monitored.
QUESTION 2
, What is your interpretation of this 12-lead EKG?
The EKG shows an acute anteroseptal ST-Elevation Myocardial Infarction (STEMI). Leads V1
to 4 (anteroseptal). Q waves are present in v1 and 2 (septal). ST elevations (mild) are seen
in I, aVL, and V5, and reciprocal changes in lead III.
QUESTION 3
Mrs. Franklin is a 68-year-old woman with long-standing, persistent AF being managed
with rhythm control on dofetilide. She also has type 2 diabetes mellitus (T2DM),
hypertension, and a myocardial infarction 3 years ago. She also takes an 81 mg
aspirin every day.
Based on her CHADS2 score and HAS-BLED score, would you recommend starting her on
anticoagulation?
What data would help you explain why this is important preventative step for the patient?
The risks and benefits of oral anticoagulation should be carefully weighed in
a patient's treatment for Afib. Tools such as HAS-BLED determines the risk
for bleeding and CHADS2 identifies the risk for thromboembolic events.
Those scores can assist a provider in their clinical decision for
anticoagulation therapy in Afib patients.
Mrs. Franklin's HAS-BLED score of 3 (age 68, Hypertension, use of ASA). A score
of ≥3 indicates caution is warranted when giving anticoagulation and
regular review is recommended. She has a 5.8% risk of bleeding per year.
Her CHADS2 score is 2 (Hypertension and Type 2DM). The patient has an
intermediate risk of
a thromboembolic event and has a 4% risk of event per year if no coumadin.
It is generally recommended that oral coagulation is given when an
QUESTION 1
1.
A 63-year-old female has been successfully cardioverted and is now on amiodarone
for rhythm maintenance. The patient is on the following medications:
Warfarin 10 mg po daily
Lisinopril 20 mg po daily
Amiodarone 400 mg po
daily Prilosec 20 mg po
daily Digoxin 4250 mcg po
daily
What interactions are possible and how would you monitor and adjust for them.
Amiodarone has possible complex interactions with multiple medications. It
has an effect on warfarin metabolism. Amiodarone is a potent inhibitor of
cytochrome P450 enzymes and inhibition of these enzymes will cause an
increased plasma concentration and decreased clearance; thereby
increasing the prothrombin time and INR placing the patient at increased
risk for bleeding complications. Hence, when given
together, warfarin dose should be decreased and frequent INR monitoring
should be done.
Amiodarone also interacts with digoxin. It increases digoxin concentrations
through the inhibition of P-glycoprotein mediated efflux transporter that
facilitates digoxin elimination from the body. Amiodarone increases the
serum drug levels of digoxin. Due to this, when given together, digoxin dose
should be reduced and levels are closely monitored.
QUESTION 2
, What is your interpretation of this 12-lead EKG?
The EKG shows an acute anteroseptal ST-Elevation Myocardial Infarction (STEMI). Leads V1
to 4 (anteroseptal). Q waves are present in v1 and 2 (septal). ST elevations (mild) are seen
in I, aVL, and V5, and reciprocal changes in lead III.
QUESTION 3
Mrs. Franklin is a 68-year-old woman with long-standing, persistent AF being managed
with rhythm control on dofetilide. She also has type 2 diabetes mellitus (T2DM),
hypertension, and a myocardial infarction 3 years ago. She also takes an 81 mg
aspirin every day.
Based on her CHADS2 score and HAS-BLED score, would you recommend starting her on
anticoagulation?
What data would help you explain why this is important preventative step for the patient?
The risks and benefits of oral anticoagulation should be carefully weighed in
a patient's treatment for Afib. Tools such as HAS-BLED determines the risk
for bleeding and CHADS2 identifies the risk for thromboembolic events.
Those scores can assist a provider in their clinical decision for
anticoagulation therapy in Afib patients.
Mrs. Franklin's HAS-BLED score of 3 (age 68, Hypertension, use of ASA). A score
of ≥3 indicates caution is warranted when giving anticoagulation and
regular review is recommended. She has a 5.8% risk of bleeding per year.
Her CHADS2 score is 2 (Hypertension and Type 2DM). The patient has an
intermediate risk of
a thromboembolic event and has a 4% risk of event per year if no coumadin.
It is generally recommended that oral coagulation is given when an
