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 {"dropdown-group-1":"B"}

Explanation

A. Minutes: This is too short a timeframe for warfarin's effect. It takes longer for the body's existing clotting factors to be depleted.

B. Days: This medication works by inhibiting the production of vitamin K-dependent clotting factors in the liver. As existing clotting factors are used up and new ones aren't produced as efficiently, it takes time for the anticoagulant effect to become significant.

C. Weeks: While the full effect might take some time (around 3-5 days), several weeks is an overestimation for most patients.

D. Hours: A few hours might show some initial effect, but it's not enough time for a substantial anticoagulant effect. It usually takes at least a day or two.

A. Vitamin K B. Deferoxamine C. Acetylcysteine D. Protamine sulfate

Correct Answer is D

Explanation

A. Vitamin K: Vitamin K is the antidote for warfarin, not heparin. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. Therefore, vitamin K is used to reverse the effects of warfarin in cases of over-anticoagulation. It does not reverse the effects of heparin.

B. Deferoxamine: Deferoxamine is a chelating agent used to treat iron toxicity and aluminum overload. It is not indicated for reversing the effects of heparin.

C. Acetylcysteine: Acetylcysteine is used as an antidote for acetaminophen (paracetamol) overdose. It is not indicated for reversing the effects of heparin.

D. Protamine sulfate: This is the correct answer. Protamine sulfate is the antidote for heparin. It works by binding to heparin to form a stable complex, thereby neutralizing its anticoagulant effects. Protamine sulfate is commonly used in clinical practice to reverse the effects of heparin in situations such as hemorrhage or when rapid reversal of anticoagulation is needed, such as before surgery.

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Unlike heparin, the anticoagulant activity of warfarin can take several to reach its maximum effect.

Correct Answer is {"dropdown-group-1":"B"}

Explanation

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Correct Answer is D

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