An 80-year-old patient who has persistent AF takes warfarin ...

[LCritchfi]

An 80-year-old patient who has persistent AF takes warfarin (Coumadin) for anticoagulation therapy. The patient has an INR of 3.5 . The primary care NP should consider:
 
  a. lowering the dose of warfarin.
  b. rechecking the INR in 1 week.
  c. omitting a dose and resuming at a lower dose.
  d. omitting a dose and administering 1 mg of vitamin K.

Question 2

A man who has benign prostatic hypertrophy (BPH), in whom prostate carcinoma has been ruled out, asks the primary care nurse practitioner (NP) about beginning drug therapy to treat his symptoms.
 
  The NP notes that he consistently has blood pressure readings around 145/90 mm Hg. The NP should prescribe: a. tadalafil (Cialis).
  b. doxazosin (Cardura).
  c. tamsulosin (Flomax).
  d. finasteride (Proscar).

[Silverbeard98]

Answer to Question 1

B
This patient's INR is only minimally prolonged, so no dose reduction is required. The NP should recheck the INR periodically. If the INR becomes more prolonged, lowering the dose of warfarin is recommended. If the INR approaches 5, omitting a dose and resuming at a lower dose is recommended. Vitamin K is used for an INR of 9 or greater.

Answer to Question 2

B
Doxazosin is a nonspecific B-blocker, which also lowers blood pressure and should be considered to treat BPH in patients who also have hypertension. Tadalafil is used to treat erectile dysfunction. Tamsulosin is a specific -blocker and is first-line treatment for patients with BPH who do not have hypertension. Finasteride is a 5B-reductase inhibitor, which is not a first-line medication.

[LCritchfi]

TYSM

[Viet Thy]

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