NR 508 Week 3 TD and Quiz

NR 508 Week 3 TD and Quiz PART 1: 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 (increased INR). 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 (Tagamet, H2 antagonist) for heartburn he was experiencing. Below is a list of the patient’s medications, his physical examination, and his laboratory findings: Medications Digoxin 0.25 mg QD Cimetidine OTC BID Pseudoephedrine SR 120 BID Warfarin 7 mg QD Allergies: NKDA Physical Examination VS: BP: 180/95, HR 75, irregularly irregular, RR 17 Weight: 95 kg (209 lbs) HEENT: WNL ABD: + Bowel Sounds EXT: Bruising on arms and legs NEURO: Alert & Oriented x 3 GEN: Well developed, well-nourished male ECG: atrial fibrillation Laboratory Na 143 mEq/L N K 4.5 mEq/L N Cl 99 mmol/L (95-105) N CO2 25 mEq/L (23-29) N BUN 18 mg/dL (8-21) N SCr 0.9 mg/dL (0.8-1.3) N INR 4.8 (2-3) H Hct 42% (40-52% m) N Hbg 15 mg/dL (13-17 m) N Digoxin 3.8 ng/ml (0.5-2) H • What problems should be identified in this patient? HTN possibly r/t Pseudoephedrine intake and/or afib, chronic Afib, high INR reason for bruising, digoxin overdose, possible Viral URI d/c pseudoepi and start on zyrtec OTC and Tylenol prn , GERD, drug-drug interaction between cimetidine and warfarin , flu swab to r/o flu, check for H. Pylori, make sure pt’s diet hasn’t changed. • What are the precise mechanisms of action of each drug? • What do you think is contributing to the patient’s hypertension? Pseudoephedrine intake, however we must consider he could have HTN unrelated to this med