A patient is receiving warfarin (Coumadin), which is 98% bound to plasma proteins. The antidepressant paroxetine (Paxil), which is 95% bound to plasma proteins, is added to the patient's daily medication. If the paroxetine displaces warfarin from its protein binding sites, which of the following will most likely to occur?

Diminished effect from warfarin

Diminished effect from paroxetine

Increased effect, and toxicity from paroxetine

Increased effect, and toxicity from warfarin

Answer and Explanation

The Correct Answer is D

A. Diminished effect from warfarin: This is unlikely because displacement of warfarin from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased anticoagulant effects and toxicity.

B. Diminished effect from paroxetine: This is also unlikely because displacement of paroxetine from protein binding sites would increase its concentration in the bloodstream, potentially leading to increased pharmacological effects and toxicity.

C. Increased effect, and toxicity from paroxetine: If paroxetine displaces warfarin from protein binding sites, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.

D. Increased effect, and toxicity from warfarin: Correct. If warfarin is displaced from protein binding sites by paroxetine, it can increase the concentration of free warfarin in the bloodstream, leading to increased anticoagulant effects and potential toxicity.

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Correct Answer is D

Explanation

A. Vitamin K: Vitamin K is the antidote for warfarin, not heparin. Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. Therefore, vitamin K is used to reverse the effects of warfarin in cases of over-anticoagulation. It does not reverse the effects of heparin.

B. Deferoxamine: Deferoxamine is a chelating agent used to treat iron toxicity and aluminum overload. It is not indicated for reversing the effects of heparin.

C. Acetylcysteine: Acetylcysteine is used as an antidote for acetaminophen (paracetamol) overdose. It is not indicated for reversing the effects of heparin.

D. Protamine sulfate: This is the correct answer. Protamine sulfate is the antidote for heparin. It works by binding to heparin to form a stable complex, thereby neutralizing its anticoagulant effects. Protamine sulfate is commonly used in clinical practice to reverse the effects of heparin in situations such as hemorrhage or when rapid reversal of anticoagulation is needed, such as before surgery.

A. Labeling is not always reliable and herbal products should be used with caution. B. Herbal products are approved under strict FDA regulations. C. There are so few side effects, and they can be purchased without a prescription. D. The manufacturer has repeatedly demonstrated effectiveness.

Correct Answer is A

Explanation

A. Labeling is not always reliable and herbal products should be used with caution. Herbal products are not subject to the same rigorous regulations and testing as pharmaceutical drugs. Therefore, their labeling may not always be accurate or comprehensive. Patients need to be aware of potential risks, interactions, and variations in potency associated with herbal products. Education helps patients make informed decisions and use these products safely.

B. Herbal products are approved under strict FDA regulations. This statement is false. Unlike pharmaceutical drugs, herbal products are regulated as dietary supplements in the United States and are not subject to the same level of scrutiny and approval processes by the FDA. While the FDA regulates the manufacturing and labeling of dietary supplements, including herbal products, the standards are not as strict as those for prescription or over-the-counter medications.

C. There are so few side effects, and they can be purchased without a prescription. This statement is misleading and potentially dangerous. Herbal products can indeed have side effects and interactions with medications, and their safety profiles vary widely. Additionally, the availability of herbal products without a prescription does not necessarily imply safety. Patients need education to understand potential risks and benefits associated with herbal product use.

D. The manufacturer has repeatedly demonstrated effectiveness. This statement is unsubstantiated and may not be true for all herbal products. Unlike pharmaceutical drugs, herbal products often lack extensive scientific evidence supporting their effectiveness for specific indications. While some manufacturers may conduct studies to support their products' efficacy, the evidence may be limited or inconclusive. Patients need education to critically evaluate claims of effectiveness and make informed decisions about herbal product use.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Correct Answer is D

Explanation

It is important that nurses ensure that their patients receive education regarding herbal products because:

Correct Answer is A

Explanation

is the stopping of blood flow, an essential mechanism protecting the body from both external and internal injury.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following is an appropriate action by the nurse?

The patient has been started on warfarin (Coumadin) for deep vein thrombosis. The patient asks when the medication will break up the clots. The nurse's best response would be:

Complementary and alternative medicine focuses on treating the person using natural products and mind-body therapies.

A nurse is reinforcing teaching with a client who is to start subcutaneous heparin. Which of the following information should the nurse include in the teaching?

When asked if there are any regulatory controls on herbal or dietary supplements, the nurse responds to the client by informing him that herbal and dietary supplements are regulated by the:

Unlike heparin, the anticoagulant activity of warfarin can take several to reach its maximum effect.

A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?