# Chapter 15 (5th ed) Drugs Affecting the Hematologic System

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Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendationis:
1.Ibuprofen 400 mg three times a day
2.Acetaminophen, not to exceed 4 grams per day
3.Prescribe acetaminophen with codeine
4.Aspirin 640 mg three times a day
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Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response isto:
1.Contact the hospitalist as this is not the normal guideline for prescribing these twomedications and she may have had a more complicated case.
2.Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness
3.Encourage the patient to contact the Customer Service department at the hospitalas this was most likely a medication error during her admission.
4.Draw anticoagulation studies to make sure she does not have dangerously highbleeding times.
Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting "a shot" to prevent blood clots like his friend Ralph did before international travel. The correct respond wouldbe:
1.Administer one dose of low-molecular weight heparin 24 hours before travel.
2.Prescribe one dose of warfarin to be taken the day of travel.
3.Consult with a hematologist regarding a treatment plan for Cecil.
4.Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.
Robert, age 51 years, has been told byhis primary care provider (PCP) to take an aspirin a day. Why would this be recommended?
1.He has arthritis and this will help with the inflammation and pain.
2.Aspirin has anti-platelet activity and prevents clots that cause heart attacks.
3.Aspirin acidifies the urine and he needs this for prostrate health.
4.He has a history of GI bleed, and one aspirin a day is a safe dosage
Patient education when prescribing clopidogrel includes:
1.Do not take any herbal products without discussing it with the provider.
2.Monitor urine output closely and contact the provider if it decreases.
3.Clopidogrel can be constipating, use a stool softener if needed.
4.The patient will need regular anticoagulant studies while on clopidogrel
Patients receiving heparin therapy require monitoring of:
1.Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy
2.Electrolytes for elevated potassium levels in the first 24 hours of therapy
3.INR throughout therapy to stay within the range of 2.0
4.Blood pressure for hypertension that may occur in the first 2 days of treatment