A patient is receiving warfarin (Coumadin), which is 98% bound to plasma proteins. The antidepressant paroxetine (Paxil), which is 95% bound to plasma proteins, is added to the patient's daily medication. If the paroxetine displaces warfarin from its protein binding sites, which of the following will most likely to occur?

Diminished effect from warfarin

Diminished effect from paroxetine

Increased effect, and toxicity from paroxetine

Increased effect, and toxicity from warfarin

Answer and Explanation

The Correct Answer is D

A. Diminished effect from warfarin: This is unlikely because displacement of warfarin from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased anticoagulant effects and toxicity.

B. Diminished effect from paroxetine: This is also unlikely because displacement of paroxetine from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased pharmacological effects and toxicity.

C. Increased effect, and toxicity from paroxetine: If paroxetine displaces warfarin from protein binding sites, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.

D. Increased effect, and toxicity from warfarin: Correct. If warfarin is displaced from protein binding sites by paroxetine, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.

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Correct Answer is D

Explanation

A. Trombin (Evithrom): Incorrect: Thrombin (also known as factor IIa) is not typically used as a hemostatic drug. It is involved in the final step of the coagulation cascade, converting fibrinogen to fibrin to form a stable clot. However, it is not administered directly as a medication.

B. Aminocaproic acid (Amicar): Aminocaproic acid is an antifibrinolytic agent commonly used to control bleeding. It works by inhibiting the breakdown of fibrin clots, thus promoting hemostasis. It is particularly useful in situations where excessive bleeding occurs due to impaired clot dissolution. However, tranexamic acid is generally considered more potent and has a longer-lasting effect, making it the preferred choice in many situations.

C. Aspirin: Incorrect: Aspirin is an antiplatelet medication that inhibits platelet aggregation. While it can reduce the risk of clot formation, it is not primarily used for controlling postoperative bleeding.

D. Tranexamic acid (Cyklokapron): Correct: Tranexamic acid is another antifibrinolytic agent that helps prevent excessive bleeding. It works by blocking the breakdown of fibrin clots. Tranexamic acid is commonly used in surgical settings to manage bleeding during and after procedures.

A. "Drink a glass of water after each dose of your new drug." B. "Avoid taking other medications that can cause bleeding, such as NSAIDS like ibuprofen." C. "Follow up with the prescribed laboratory testing needed to monitor your clotting values." D. "Eat foods high in Vitamin K and calcium to help prevent clotting." E. "Continue to take your newly prescribed medications until your prescriber tells you not to do so." F. “Report any unexpected bleeding to your primary health provider."

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

Essential

1. "Avoid taking other medications that can cause bleeding, such as NSAIDs like ibuprofen." Both aspirin and clopidogrel increase the risk of bleeding. NSAIDs like ibuprofen can further increase this risk, so it is crucial to avoid them unless advised otherwise by a healthcare provider.

2. "Continue to take your newly prescribed medications until your prescriber tells you not to do so." Discontinuing aspirin and clopidogrel without medical advice can increase the risk of stent thrombosis and other complications. It is essential to follow the prescribed regimen strictly.

3. “Report any unexpected bleeding to your primary health provider." Monitoring for signs of bleeding (such as bruising, blood in the stool or urine, or unusual bleeding) is important due to the increased bleeding risk associated with these medications. Prompt reporting can help manage and mitigate serious complications.

Unrelated

1. "Drink a glass of water after each dose of your new drug." While staying hydrated is generally good advice, it is not specifically relevant to the efficacy or safety of aspirin and clopidogrel.

2. "Follow up with the prescribed laboratory testing needed to monitor your clotting values." Routine clotting tests (such as INR, PT, or aPTT) are not typically required for monitoring the effects of aspirin and clopidogrel, as these medications do not usually require lab monitoring like warfarin does.

3. "Eat foods high in Vitamin K and calcium to help prevent clotting." This advice is unrelated because Vitamin K can counteract the effects of anticoagulants like warfarin but does not affect the action of antiplatelet drugs like aspirin and clopidogrel. Calcium intake is also unrelated to the management of these medications.

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Naxlex Comprehensive Predictor Exams

The healthcare provider has ordered that a patient be placed on a hemostatic drug to control postoperative bleeding. Which of the following medications will most likely be given in this situation?

Correct Answer is D

Explanation

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}

Explanation

Patients often use herbal therapies for which of the following reasons?

The patient is to be started on warfarin (Coumadin) therapy. It is important for the nurse to check for the use of which herbs? (Select All that Apply.)

It is important for the nurse to assess for the use of complementary and alternative medicine (CAM) because:

The nurse responds to the client's questions about CAM therapies and explains that some have been popular for centuries in treating conditions of the body and mind including which of the following? (Select All that Apply.)

A nurse is preparing to administer digoxin 0.25 mg PO to a client. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer to the client? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Why is it important for the nurse to collect information from the patient about the use of complementary and alternative medicine (CAM)?

A nurse is preparing to administer amoxicillin 350 mg PO. Available is amoxicillin 250 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number.)