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
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Ferrous sulfate: This is an iron supplement and wouldn't be used to reverse warfarin's anticoagulant effect.
B. Prednisone: This is a steroid medication used for various inflammatory conditions and wouldn't be used to address excessive blood thinning.
C. Vitamin K: Vitamin K is the antidote for warfarin poisoning or excessive anticoagulation. By providing vitamin K, the body can resume producing clotting factors, counteracting warfarin's effect.
D. Heparin: This is another blood thinner medication. While it can be used in specific situations, it wouldn't be the first choice to reverse warfarin's effect because it adds another layer of anticoagulation, which could be risky.
Correct Answer is A
Explanation
A. "This medication will not break down clots but will make it less likely that the clot will get larger." Warfarin (Coumadin) is an anticoagulant medication that works by inhibiting the synthesis of certain clotting factors in the liver. It does not directly break down existing clots but prevents the formation of new clots and the extension of existing ones. This response provides accurate information about the mechanism of action of warfarin.
B. "It will break down the clot within 8 to 12 hours of administration." This statement is incorrect. Warfarin does not have an immediate effect on existing clots. Its action is primarily preventive, reducing the risk of further clot formation and allowing the body's natural processes to gradually break down existing clots over time.
C. "It will take 7 to 10 days for the clot to break down." While the body's natural processes may start breaking down the clot within this timeframe, warfarin itself does not directly cause the dissolution of clots. This response is partially accurate in terms of the timeline for the body's natural clot resolution but does not specify that warfarin itself is not responsible for clot breakdown.
D. "You will need to be on this medication for a long time before it will break down the clot." This statement is misleading. Warfarin's role is to prevent the formation of new clots and further extension of existing ones rather than directly breaking down clots. Additionally, the duration of warfarin therapy is typically determined based on the individual's risk factors for clot formation, and it may not necessarily correlate with the time it takes for existing clots to resolve.
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