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When the NOACs (sometimes referred to as DOACs) first came out they were heavily promoted as having fewer drug interactions compared to warfarin. This is true, but please remember that “fewer drug interactions” doesn’t mean “no drug interactions”! Here’s a scenario of the carbamazepine apixaban interaction and some potential strategies to manage it. A 72-year-old […]
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66 year old female was newly diagnosed with atrial fibrillation. Her other diagnoses included hypertension, diabetes, hyperlipidemia, and GERD. Current medication list included: Aspirin 81 mg daily Simvastatin (Zocor) 40 mg at bedtime Tylenol as needed Protonix 40 mg daily Lisinopril 10 mg daily Metformin 500 mg twice daily With the new diagnosis of atrial fibrillation, […]
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I had a doctor a year or two ago ask for my input (off the record) on a patient that she was struggling with. Coumadin and INR management was the issue. I think I recall the term “roller coaster” when the doc described the case to me. So we sat and chatted for a few […]
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88 y/o with a history of depressive type symptoms was placed on an antidepressant to manage symptoms shortly after admission to a long term care facility. This particular patient was trialed on Zoloft (sertraline) and then transitioned to Cymbalta (duloxetine), neither of which made a significant difference in symptoms. This patient continued to have ongoing […]
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I’ve been asked to discuss the relationship between Digoxin levels and potassium…so I will. Digoxin toxicity was discussed earlier this week, and obviously the kidney plays a big role in both digoxin levels and potassium homeostasis. Individuals with low potassium may be more susceptible to possible digoxin toxicity i.e. they may experience toxicity at digoxin […]
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