A patient has been taking warfarin (Coumadin) for atrial ...

[CORALGRILL2014]

A patient has been taking warfarin (Coumadin) for atrial fibrillation. The provider has ordered dabigatran etexilate (Pradaxa) to replace the warfarin. The nurse teaches the patient about the change in drug regimen.
 
  Which statement by the patient indicates understanding of the teaching?
  a. I may need to adjust the dose of dabigatran after weaning off the warfarin.
  b. I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3.
  c. I should stop taking the warfarin 3 days before starting the dabigatran.
  d. I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2.

Question 2

A patient who has taken warfarin (Coumadin) for a year begins taking carbamazepine. The nurse will anticipate an order to:
 
  a. decrease the dose of carbamazepine.
  b. increase the dose of warfarin.
  c. perform more frequent aPTT monitoring.
  d. provide extra dietary vitamin K.

[blakcmamba]

Answer to Question 1

ANS: D
When switching from warfarin to dabigatran, patients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the patient's INR and not on the amount of time that has elapsed.

Answer to Question 2

ANS: B
Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

[CORALGRILL2014]

Gracias!

[peter]

TYSM