Recommendations for Medication for Patients with Diabetes

Pharmacology Case Study Scenarios

Scenario 1: Mark Johnson (72 years old, DVT Treatment with Warfarin)

Problem

Mark is on warfarin (5 mg daily) for Deep Vein Thrombosis (DVT) and has a history of hypertension, hyperlipidemia, and osteoarthritis. He is also taking HCTZ (25 mg daily), celecoxib (200 mg daily), fluvastatin (40 mg daily), and Goody\\\\\\\'s Powder (as needed for pain). There are potential drug-drug interactions between warfarin, celecoxib, and Goody\\\\\\\'s Powder (which contains aspirin). Additionally, Mark\\\\\\\'s warfarin dose might need adjustments due to his risk of bleeding, influenced by his concurrent medications and potential CYP2C9 polymorphism (Holail et al., 2022).

Medication Adjustments

1. Warfarin: Continue warfarin but closely monitor INR levels (target INR for DVT: 2-3) (McRae et al., 2021).

· Prescription: Warfarin 5 mg po daily, #30 (30-day supply), 0 refills. Monitor INR in 3-5 days.

2. Celecoxib: Discontinue celecoxib due to its interaction with warfarin, which increases the risk of bleeding.

· Alternative: Acetaminophen 500 mg po q6h prn for pain.

· Prescription: Acetaminophen 500 mg, #60 (15-day supply), no refills. Max 4g/day.

3. Goody\\\\\\\'s Powder: Discontinue due to aspirin\\\\\\\'s interaction with warfarin, increasing the risk of bleeding.

· Alternative: As above, acetaminophen for pain relief.

4. HCTZ and Fluvastatin: Continue both, as they do not have significant interactions with warfarin.

Impact of CYP2C9 Polymorphism