George is a 76-year-old male who presents to the clinic with complaints of frequ
ID: 59985 • Letter: G
Question
George is a 76-year-old male who presents to the clinic with complaints of frequent nosebleeds (four in the past week) and easy bruising. The patient also complains of a runny nose and cough. He has a history of chronic atrial fibrillation and takes warfarin. About 3 weeks ago, the patient started taking Tagamet over-the-counter (OTC) for heartburn.
What problems with this patient can you identify? What contributes to this patient’s increased blood pressure? What are the mechanisms and ALL interactions associated with this drug regimen?
Medications
Digoxin 0.25 mg QD
Cimetidine OTC BID
Pseudoephedrine SR 120 BID
Warfarin 7 mg QD
Allergies: NKDA
Physical Examination
VS: BP: 180/95, HR 75, irregularly irregular, RR 17, Wt. 95 kg
HEENT: WNL
ABD: + Bowel Sounds
EXT: Bruising on arms and legs
NEURO: Alert & Oriented x 3
GEN: Well developed, well-nourished male.
ECG: atrial fibrillation.
Laboratory
Na 143
K 4.5
Cl 99
CO2 25
BUN 18
SCr 0.9
INR 4.8
Hct 42
Hbg 15
Digoxin 1.6ng/ml
Medications
Digoxin 0.25 mg QD
Cimetidine OTC BID
Pseudoephedrine SR 120 BID
Warfarin 7 mg QD
Allergies: NKDA
Physical Examination
VS: BP: 180/95, HR 75, irregularly irregular, RR 17, Wt. 95 kg
HEENT: WNL
ABD: + Bowel Sounds
EXT: Bruising on arms and legs
NEURO: Alert & Oriented x 3
GEN: Well developed, well-nourished male.
ECG: atrial fibrillation.
Laboratory
Na 143
K 4.5
Cl 99
CO2 25
BUN 18
SCr 0.9
INR 4.8
Hct 42
Hbg 15
Digoxin 1.6ng/ml
Explanation / Answer
The patient is suffering with Chronic atrial fibrillation causing abnormal heart beat or cardiac arrythmia as a result of blood pressure or other heart complications particularly attacking age old persons. It leads to blood clots, heart stroke, heart palpitations.
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