NRNP 6566 Knowledge Check Week 3

NRNP 6566 Knowledge Check Week 3 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 individual's risk of stroke exceeds the risk of bleeding. The 12-lead EKG shows an inferolateral wall MI. Leads II, II, aVF, V5, and V6 shows ST-elevation Myocardial Infarction (STEMI). Treatment for a STEMI includes the following (MONA): 1. Aspirin 162 - 325 mg PO, chew and swallow – If the patient has allergies to Aspirin, clopidogrel may be substituted. 2. Nitroglycerin sublingual 0.4 mg given 1 every 5 minutes 3. Morphine for pain (0.1 mg/kg) IV 2-4 mg. to relieve chest pain and anxiety, may repeat 208 mg every 5 - 15 min until pain relief is achieved. 4. Supplemental oxygen would be indicated (2-4 L/min via nasal cannula) in hypoxia 5. PCI 6. Fibrinolytic/thrombolytic therapy for STEMI (if PCI is no available within 90 mins)