A patient who has taken warfarin Coumadin for a year begins ...

[abern]

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.

Question 2

A patient who takes warfarin Coumadin is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal.
 
  The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione).
  b. protamine sulfate.
  c. a PTT.
  d. a PT and an INR.

[abro1885]

Answer to Question 1

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 carba-mazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.

Answer to Question 2

D
This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematomas or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.

[abern]

TY

[abro1885]

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