Question

1. Mr. Smith stops by the pharmacy to pick refills on his prescriptions. He reports that he has a headache and wants to purchase a bottle of Excedrin Extra Strength. Here is his medication profile: John Smith. d.o.b. 4-29-1943 Medication Profile: 7/24/19 RX 345811 - Warfarin 5mg po qday. #30. Dr. John Keegan 7/24/19. RX 345810 - Furosemide 40mg po qday. #30. Dr. John Keegan 6/30/19. RX 345781 - Atorvastatin 40mg po qpm. #30. Dr. Erica Stiles How would you counsel Mr. Smith? (2pt)

Answer 1

Mr. Smith has gone to the pharmacy to pick refills on his prescription. He is on the following medicines:

Date of birth: 4-29-1943 (V)

Medication profile

7/24/19 RX 345811- Warfarin 5 mg PO qday. #30. Dr. John Keegan

7/24/19 RX 345810- Furosemide 40mg PO qday. #30. Dr. John Keegan

6/30/19. RX345781 – Atorvastatin 40mg PO qpm. #30. Dr. Erica Stiles

He complains of headache and wants to purchase a bottle of Excedrin extra strength

Counsel the patient by letting him understand the following points, help the patient understand the effects of the drugs and the precautions he must take while taking that medicine:

Warfarin

• Warfarin tablet is an anticoagulant which prevents the formation of clots in the body. This medicine may have some side effects like bleeding gums, fever, cramps, nausea, vomiting, etc.
• Ask the patient to seek immediate medical assistance if he develops:
  • Severe bleeding
  • Coughing of blood
  • Dizziness
  • Severe headache
  • Black stool
  • Red or brown stool
  • Joint pain or swelling in joints.
• Counsel the patient regarding some of the supplements and natural that would interact with this medicine are:
  • Vitamin E, garlic, green tea, ginseng, anise, licorice increase the effects of warfarin and may cause bleeding
  • St. John wort may decrease the effect of warfarin.
  • Ask the Mr. Smith to inform the physician if he is taking any of the above-mentioned products
• Avoid eating large amounts of foods rich in vitamin K( like banana, spinach, parsley, Brussels, sprouts, broccoli, fish, liver, meat, eggs, etc) as it may decrease the effects of the drug.
• Avoid taking IM injections and activities that have high risk of injury
• Ask the patient to soft toothbrush.
• Counsel the patient not to use any over the counter medicines or herbal products that contains aspirin or NSAIDs.
• Inform the physician before starting or stopping any new drug.
• Tell the patient to take the medicine 5mg daily per orally in the morning.

Furosemide

• Counsel the patient that furosemide is an diuretic, which is used the remove the excess amounts of fluids from the body and also helps to decrease blood pressure.
• Counsel the patient regarding the possible side effects of this drug like dry mouth, constipation, diarrhea, nausea, vomiting, muscle cramps, headache, dizziness.
• Ask the patient to get his blood pressured monitored regularly
• Tell the patient that after taking the medicine he may have increased frequency of urination
• To take restrict salt and oil in food
• Take fluids in the amounts prescribed by the physician
• Counsel the patient to take tab Furosemide 40mg daily per orally in the morning.

Atorvastatin

• Tablet Atorvastatin helps to reduce the lipids and cholesterol levels in the body
• Patient may have some possible side-effects like dizziness, fatigue, hot flushes, muscle weakness.
• Also this drug may increase the effects of warfarin, so counsel the patient to observe for any signs of bleeding and bruising and to seek medical help.
• Ask the patient to seek immediate medical attention if he develops severe muscle cramps, weakness, fever or malaise.
• Ask the patient that he should also reduce high fats I diet as this medicine should be taken in conjunction with direct restrictions.
• Inform the patient to take tab Atorvastatin 40mg per orally daily at night.

Counseling regarding headache and Bottle of Excedrin extra strength

• Counsel the patient that he cannot take over the counter medicines when he is on the above-mentioned drugs.( warfarin, furosemide, atorvastatin)
• Excedrin contains Acetaminophen, aspirin, and caffeine. All these three substances interact with warfarin tablets and may increase its effects leading to a higher risk of bleeding.
• Ask the patient to use nonpharmacological measures to reduce headaches like head massage, watching movies, listening to soft music, using relaxation techniques, sleep for a minimum 7 hours a day.
• If the headache does not decrease ask the patient to seek physician appointment.