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Originally Posted by jeffradd  67 y.o. man who is presenting for PT |
Physio Therapy?
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after suffering MI weeks ago. His other PMH
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Personal/Previous Medical History?
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include: MI - 2 weeks ago, HTN,
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hypertension
ejection fraction?
Gastro Oesophageal Reflux Disease GORD
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His meds include: ASA 325 mg QD
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aspirin 325mg od
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Metroprolol XL 100 mg QD, lisinopril 40 mg QD, Imdur 30 mg QD, Lipitor 40 mg QD, NTG SL spray PRN
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GTN spray
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Furosemide 40 mg QD, Spironolactone 25 mg QD, Digoxin 125 mcg per day, amiodarone 200 mg QD, Ibuprofen 800 mg TID, Percocet 1-2 tabs Q4h PRN pain
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oxycodone+paracetamol
pantoprazole
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Warfarin 5 mg per day
Which are true?
A. Heart rate will not be a good indicator of exercise exertion in this patient
B. Therapy session should be cancelled if Bob's INR is between 2 and 3
C. Bob should take 1 spray of NTG 15 min before each PT session
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A. Dunno - but maybe I ought to.
B. I thought the target INR was between 2 and 3?
Things that affect our INR [May 2001; 87-5]
which also raises questions about the use of paracetamol prn
C. Probably - depends what PT is though - if Bob is attached to a whole set of wires and you're looking for signs of afib then perhaps not.
Not part of your question but there are concerns about the use of aspirin and ibuprofen at the same time
The FDA said
http://tinyurl.com/3cmoaz
"Health care professionals should consider:
• Counseling patients about the appropriate timing of ibuprofen dosing if they are also taking aspirin for cardioprotective effects.
• With occasional use of ibuprofen, there is likely to be minimal risk from any attenuation of the antiplatelet effect of low dose aspirin, because of the long-lasting effect of aspirin on platelets.
• Patients who use immediate release aspirin (not enteric coated) and take a single dose of ibuprofen 400 mg should dose the ibuprofen at least 30 minutes or longer after aspirin ingestion, or more than 8 hours before aspirin ingestion to avoid attenuation of aspirin’s effect.
• Recommendations about the timing of concomitant use of ibuprofen and enteric-coated low dose aspirin cannot be made based upon available data.
• Other nonselective OTC NSAIDs should be viewed as having the potential to interfere with the antiplatelet effect of low-dose aspirin unless proven otherwise.
• Prescribing analgesics that do not interfere with the antiplatelet effect of low dose aspirin for high risk populations"
The CSM advice is
"The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely."
Regards
Jeff