Thank you, Nell!
Tuesday, September 15, 2015
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Thank you, Nell!
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Okay, medical and pharmacy students. Get out your #2 pencils and tell me what's wrong with this medication list from an internist:
Thank you, Nell!
A Blog detailing the insanity of my medical practice and the stupidity of everyday life.
Thank you, Nell!
Welcome to my whining!
This blog is entirely for entertainment purposes. All posts about patients, or my everyday life, or anything else may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate. I could be making all this up. I may not even be a doctor. The only true statement on here is that I probably drink more Diet Coke than you do. A lot more.
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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.
Cast of Characters:
Annie: My Phenomenal MA
Mary: My Awesome Secretary
Ed: The office fish
Dr. Pissy: The guy I share an office with
Mrs. Grumpy: My Boss (also the world's greatest school nurse)
Frank, Craig, and Marie: The Grumpy Tribe
Garlic and Riley: The Grumpy Dogs
Questions? Comments? Biting sarcasm? Write to: pagingdrgrumpy [at] gmail [dot] com
Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.
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19 comments:
I'm no medical or pharmacy student but I'm guessing Warfarin and Vitamin K.
I think I know why he needs a fairly high dose of warfarin. :-)
Dig toxicity
Let's see:
-None of the medications list how frequently they are taken or how much is taken at a time
-The patient is taking both warfarin and vitamin K
-Form and dose of vitamin K are also missing
-The only thing Google can tell me about "vits" is that "Vitamin S" is slang for sex, which probably belongs somewhere else in the chart.
According to wikipedia, Vitamin K is used to treat Warfarin overdoses
seems like someone entered the patient's copy of their own med list verbatim into the record...instead of applying common sense!
crap entered into the computer becomes data....
kinda scary, isn't it?
(not sure there is an FDA approved testosterone 20% cream, either....sounds like an" internet pharmacy" item, perhaps)
When you are old enough for warfarin you are too old for testosterone cream.
Gees, you medical people are so dense sometimes.
I'm not in medicine either, but I'll agree with everyone here and say he shouldn't be taking warfarin and vit K together.
Is it bad that the general public knows that and the internist doesn't?
Is testosterone cream even available in 20%?
Leaving aside the warfarin/vitamin K interaction.
testosterone increases prothrombin time.. hence the bleeds and vitamin K.. the 20% is a flat out typo.
considering is warfarin dosing is being maintained horribly, we can assume his labs are few and far between... and can extrapolate that assumption to his dig monitoring as well. we can safely say he still has a pulse..
also that list would be mighty helpful if it contained the sig.. and dates...
A reported med list is just that.
It is not an endorsement.
There are some reports of the benefits of low-dose vitamin K administration to help maintain stable INRs in compliant patients who cannot achieve control for unknown reasons.
Source: http://www.ncbi.nlm.nih.gov/pubmed/18695375
There are reports of the benefits of low-dose vitamin K supplementation to help achieve stable INRs in compliant patients who have consisten out-of-range INRs for unknown reasons.
Source: http://www.ncbi.nlm.nih.gov/pubmed/18695375
I'm a vet tech and when we get a Warfarin toxicity dog in (usually mouse/rat bait ingestion), we give vit K to re-complete the clotting cascade. I know humans and animals are different critters but I'm gonna go ahead and say that Vit K is undoing any Warfarin effects. Would help to know doses and frequencies but knowing how Warfarin and Vit K work, I don't see why the two would be given together.
Digoxin = positive inotrope
Diltiazem = negative inotrope
Then vitamin K with warfarin. What in the world
There are no directions for how to take the stuff. Considering all the interactions involved someone probably should be monitoring levels, effects, and doses with a little fine-tuning specification so the patient isn't titrating his own heart rate with the dig and diltiazem, and his INR with Vit K from bleeding effects resulting from several drug interactions.
I'm sure there's something else other than the lack of directions, etc. wrong w/ this picture.
I know many are saying the Vit. K and Warafin but I know that Vit. K is the "antidote" for Warafin toxicity or an INR that's too high. However, I'm not sure the two should be taken together regularly?
Be sure to tell us the answer, Ibee?
Shana Tova!
182 cm, 100 kg, 75 yom (retired doc who adjusts his own doses of medications). Has Afib (and his wife says 'low-T'). No underlying renal dysfunction?
Several problems- First 2 heart meds starting with D. Always throw in a vowel or at least don't use the same letter twice. Next I would never recommend anything less than 50% Testosterone cream just in case the neighbor's dogs is low T also. Finally, if you Vit K dose is not specified- I recommend 1000 IU q12 hours for a-fib patients, q2 hours for entitled, narcissistic patients and q2 years for homeopaths.
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