NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

 Title: NURS 6521 Week 1: Basic Pharmacotherapeutic Concepts

I had a family member with a history of CAD, and IDDM, who was in need of an aortic valve replacement.  The TAVR procedure was completed successfully and was sent home on a regimen of Coumadin/Warfarin for anticoagulant therapy.  This person had other underlying health problems (one of which was a herniated disc) of which he was unaware which resulted in weakness and frequent falling.  His falls resulted in multiple skin tears and bruising, bleeding was always present and he related that to the warfarin.  Upon speaking to him one day when he had a question about his meds, I noticed a bottle of Ibuprofen with his prescriptions.  He stated he had been taking Ibuprofen for the pain in his back.  I did explain that the Ibuprofen affected his Coumadin/Warfarin, and to speak with his PCP about an alternative.

Pharmacokinetics /Pharmacodynamics

In a study completed by Juel, Pedersen, Langfrits & Jensen, 2013, it was determined that there is a pharmacokinetic interaction between Coumadin/Warfarin and Ibuprofen which causes and inhibition of Coumadin/Warfarin metabolism.  The level of anticoagulation with warfarin is usually monitored with international normalized ratio (INR), every one-point increase, increases bleeding risk by 54% (Choi, Kim, Son, Kim, Kim, Ahn, & Lee, 2010). According to Choi et al., 2010, and Juel, et al., 2013 both medications are metabolized by cytochrome P450.

Personalized Plan of Care

For initial Coumadin/warfarin therapy the INR must be checked routinely and monitored closely, as this was not the case with my family member.  Perhaps an alternate anticoagulant should have been introduced.  There are many other oral anticoagulants that are utilized, which would have been more beneficial to this individual.  According to Arcangelo, Peterson, Wilbur & Reinhold (2017), direct-acting oral coagulants (DOACs) have a faster onset of action, have fewer drug-drug interactions, and have a predictable anticoagulant response.  Along with any anticoagulant therapy, patient teaching explaining the effects of OTC medication. This family member was unaware at the time, that he also had pancreatic cancer, which would have also affected the pharmaceutical plan.

 

References:

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins

Choi, K. H., Kim, A. J., Son, I. J., Kim, K. H., Kim, K. B., Ahn, H., & Lee, E. B. (2010). Risk factors of drug interaction between warfarin and nonsteroidal anti-inflammatory drugs in practical setting. Journal of Korean medical science, 25(3), 337-41.

Juel, J., Pedersen, T., Langfrits, C., & Jensen, S. (2013). Administration of tramadol or ibuprofen increases the INR level in patients on warfarin. European Journal of Clinical Pharmacology, 69(2), 291–292. https://doi-org.ezp.waldenulibrary.org/10.1007/s00228-012-1325-3