Mr. Martini
Mr. Martini is a 75-year-old man who has arrived in your ED for urinary frequency and dysuria with no systemic symptoms. He is on the following medications:
- Warfarin
- ASA
- Ramipril
- Metoprolol
- HCTZ
- Amiodarone
- Metformin
- Alendronate
- Vitamins
- Calcium
He is started on trimethoprim-sulfamethoxazole with no advice about monitoring.
Four days later he’s back with an exsanguinating nosebleed, an INR of 7, requiring Prothrombin Complex Concentrate, and transfusion.
- What do you think happened?
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Important Note
Of all medications, anti-coagulants are the most frequently involved in management problems. Have a heightened awareness whenever you see warfarin on a medication list. Be attentive when adding or changing any medication in the anti-coagulated older patient.
Discussion: Mr. Martini
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ok
ok
THE SAME
common problem in all ed’s
en el paciente anticoasgulado con warfarin siempre al añadir nuevo medicamento valorar la interacción para con este
Creo que el mejor de los recordatorios sobre interacciones es este antibiótico, ya que frecuentemente lo usamos en sepsis de tejidos blandos sin importar si el paciente está anticoagulado o no
Good reminder to check drug interactions when prescribing Abx
Med education very important
okay
ok
should always ensure follow up and discuss s/e with warfarin of new medications
inform the patient of possible side effects and complications and ask to be vigilant about certain signs and symptoms.
warfarin and bactrim interaction
Not working
communication
ok
ideally choice of antibiotics should be with caution when the patient is specifically on Warfarin due to drug-drug interactions
–
found out
Yes
BACTRIM NOT A GOOD CHOICE IN ELDERLY PT THAT IS ANTICOAGULATED.
[
great
medications
.
When given warfarin and other meds a close eye must be taken on those patients
yes
Using Bactrim with coumadin increases the risk of bleeding. With no monitoring of coumadin his INR got way to high and he bled.
Something to be mindful of.
Ok
ok
ok
education is so important
yes
run med check for interactions
good explanation.
yes
noted
ok
warfarin is bad
run meds check
Med interactions are sometimes difficult to predict
bactrim displaced protein bound coumadin
Interesting.
great
over anticoagulated
.
Drug interaction
drug-drug interaction
.
Must be aware of drug drug interactions
always easier to check drug and drug interactions especially for ongoing warfarin therapy
agree wrong antibiotic. Not even a good fit for our antibiogram.
very good point
Always remember to monitor the INR if patient is on Warfarin and you anticipate possible interactions.
Wrong meds. INR needs to be monitored carefully as it may interfere with Warfarin
drug interaction
good info,
Easier to remember a list of meds that don’t interact with coumadin
Drug interactions
coumadin plus bactrim is bad idea
Know what meds cause major interactions w/coumadin
Avoid Bactrim when patient on Coumadin.
Good
Check meds
When rx septra you can ask pt to skip a day’s dose and/or also check the INR on day2/3 of the abx
check meds
Can’t stress enough to look at whole picture when it comes to medications.
all good points to consider
really check med lists especially for warfarin
warfarin, definitely watch for interactions
gotta check abx on coumadin puts
important to check drug interactions with warfarin.
warfarin interactions
Sulphamethoxazole increases effects of warfarin by decreasing metabolism and plasma protein biding competition raising INR and risk of bleeding.
This Abx Potentiates anticoagulants
Good advice. Must consider implications of age + impaired liver function equals medication metabolism nightmares. Remember to check INR more closely when adding new medications and be sure to double check for any precautions or drug interactions, particularly with patients on warfarin.
also a great reminder
Bactrim increased his bleeding. He is already on warfarin and asa
The patient should have been started on another antibiotic, to help avoid this potentiation of warfarin’s action.
Metabolism of warfarin can be altered with changes in other meds, increasing bioavailability.
.
ASA compounded by Warfarin, compounded by sulfamethoxazole = a clotting ability of water
.
–
the thinner the hair, the more fine a comb to manage
warfarin OD
evil warfarin….very naughty indeed….I recommend the benylin formula….9/10 doctors agree
warfarin in the drug list BE CAREFUL
important to check drug interactions with warfarin
that damn warfarin, lol
educate patients and interactions of comlicaciones
education is important
Important to evaluate drug interaction
🙂
Anoxil would have been safer
over anticoagulated
Watch for INR carefully when Rx with drugs may interfere with warfarin.
He was put on the wrong antibiotic in the first place. A pharmacist should have picked this up.
When rx septra you can ask pt to skip a day’s dose and/or also check the INR on day2/3 of the abx