Discussion Part One\u00a0\t\u00a0\tElliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. The patient is also complaining of a runny nose, cough, and head\/chest congestion. He has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. Approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing.\u00a0 Below is a list of the patient’s medications, his physical examination, and his laboratory findings:\t\u00a0\tMedications\tDigoxin 0.25 mg QD Cimetidine OTC BID\tPseudoephedrine SR 120 BID Warfarin 7 mg QD\tAllergies: NKDA \tPhysical Examination\tVS: BP: 180\/95, HR 75, irregularly irregular, RR 17\tWeight: 95 kg\t\u00a0\tHEENT: WNL\tABD: + Bowel Sounds EXT: Bruising on arms and legs\tNEURO: Alert & Oriented x 3 GEN: Well developed, well-nourished male\tECG: atrial fibrillation \tLaboratory\tNa 143 mEq\/L K 4.5 mEq\/L\tCl 99 mmol\/L CO2 25 mEq\/L\tBUN 18 mg\/dL SCr 0.9 mg\/dL\tINR 4.8 Hct 42%\tHbg 15 mg\/dL Digoxin 3.8 ng\/ml\tWhat problems should be identified in this patient?\tWhat are the precise mechanisms of action of each drug?\tWhat do you think is contributing to the patient’s hypertension?\tAre there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?\tWhat is the clinical significance of these interactions?\tDiscussion Part Two\t\u00a0\tYou have decided to have him stop the pseudoephedrine related to his hypertension, as well as the cimetidine related to its interaction with warfarin. The patient returns for his monthly follow-up appointment, and it is noticed that his blood pressure (195\/80) has not come under control. You decide to start him on hydrochlorothiazide.\t\u00a0\tIs there a better medication than a thiazide, and if so what dose should you initiate this medication?\tHow would you proceed, and how you would monitor for efficacy and toxicity?\t\u00a0\tDiscussion Part Three\t\u00a0\tHe returns a month later complaining of increased fatigue, visual disturbances, weakness, and nausea; however, his ECG is normal.\t\u00a0\tBased on this information, what is occurring in this patient? Include precise mechanism(s) of how it is occurring.\t\u00a0\tAdditionally, please include any drug interactions associated with any new medications initiated keeping in mind the current regimen.<\/p>\n","protected":false},"excerpt":{"rendered":"
Discussion Part One\u00a0 \u00a0 Elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. The patient is also complaining of Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-230075","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230075","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=230075"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230075\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=230075"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=230075"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=230075"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}