General Medicine Rotation Essay

Warfarin requires the blood be checked regularly to monitor how effective the drug is, i.e. is the blood becoming too 'thin', which could cause an internal bleed or if the Warfarin dose is not effective enough leaving the patient at risk of blood clots.

many different medicines are used to treat coronary heart disease. Usually they aim to reduce blood pressure or widen your arteries. For example antiplatelet are a type of medicine that can help reducing the risk of a heart attack by thinning your blood and preventing it from clotting. However there are also side effects after taking the medication like dizziness, diarrioah, nose bleeds and abdominal pain.

If on the leaflet (which should ALWAYS be kept near the drugs) it says that a medical professional should be contacted if some reactions occur (i.e. bleeding) then follow the instructions. Some reactions may occur but no further medical help is required unless it becomes very bad (like the possible constipation with pain killers such as co codamol, paracetamol etc.)

The evidence based practice process gives more evidence of young patients with few risk factors and no structural heart defect, the benefits of anticoagulation may be outweighed by the risks of haemorrhage (bleeding). High quality guidelines and the systematic searches used for the topic in this portfolio were beneficial. Use of a rigorous and transparent process in this portfolio for identifying, appraising and adopting/ adapting guidelines are crucial to help for the decision making. A major factor that stops the usage of the new drug is unfortunately, there are no specific antidotes to reverse the coagulant effects of the direct thrombin or factor Xa

Aspirin – this is medication that is used to help prevent inflammation in your body and also helps prevent blood clots. This medication is important to prevent another blockage in your heart that can cause another heart

Other outcomes were myocardial infarction, ischemic stroke, systemic thrombosis, venous thrombosis in other areas of the body besides the legs, and even death. The patients underwent assessment either in the clinic or by telephone at days 30, 90, 180, 270, and 360. This study was consistent with other studies in the fact that the use of rivaroxaban reduced the risk of recurrent venous thromboembolism by about 70%. Rivaroxaban was found to be more effective than aspirin for the prevention of recurrent venous thromboembolism and was associated with a smaller risk of bleeding. The primary outcome occurred in 17 out of the 1,107 individuals who received 20 mg of rivaroxaban and in 13 out of the 1,127 individuals who received 10 mg of rivaroxaban. This was compared to 50 out of the 1,131 individuals who received aspirin once a day. Rates of bleeding were 0.5% in individuals who received 20 mg of rivaroxaban, 0.4% in individuals who received 10 mg of rivaroxaban, and 0.3% in individuals who received aspirin. For patients with venous thromboembolism who continued anticoagulation the risk of a repetitive event was lower with rivaroxaban at both 20 mg and 10 mg of treatment doses rather than with

Some inhibitors suppress new blood vessel formation, causing the blood pressure to rise dramatically, increasing the chance of blood clots forming and heart

Starting a new clinical rotation is always an exiting moment for me. Since the first clinical rotation, every new one is a surprise, you never know what you going to encounter, learn and experience. For the psychiatric clinical rotation, I am thinking that it is going to be the most different experience I am going to encounter in my nursing school. Different, I mean, taking care of people that is not in their full state of mind, is going to give me new knowledge to be able to understand people with mental disabilities.

Clopidogrel is a second-generation thienopyridine antiplatelet agent used in humans and other species including cats to reduce the risk of thromboembolic diseases secondary to cardiovascular diseases and other systemic diseases. Once it’s converted to clopidogrel active metabolite by Cytochrome P450 isoenzymes, clopidogrel irreversibly inhibits one of the platelet ADP receptors leading to an inhibition of platelet activation and aggregation. Several large clinical trials revealed that clopidogrel administration in human patients significantly reduced the platelet activation and aggregation in vivo, and decreased the frequency of developing thromboembolic events (Sabatine MS et al. JAMA 2005, Yusuf S et al. NEJM 2001, Chen ZM et al. Lancet 2005).

Atrial fibrillation is the most frequent cardiac arrhythmia. There has always associated risk of clot formation and embolization that can lead to ischemic stroke. A large number of these ischemic events could be prevented by timely anticoagulation. Warfarin has been used for decades for this purpose, but there are many problems for the patients due to warfarin therapy like there is continuous need of INR monitoring, many food and drug interactions of the drug, late onset of action and risk of major bleeding. Anticoagulation with the Novel oral anticoagulants e.g. Dabigatran, rivaroxaban, apixaban, endoxaban led to similar or even lower rates of ischemic stroke and major bleeding compared to an adjusted dose of warfarin (INR 2-3) in patients

For many year’s patients with atrial fibrillation have been treated with anticoagulants such as Warfarin to prevent strokes and embolisms. Unfortunately, Warfarin must be closely monitored and that is an irritant for some patients. In October 2010, the FDA approved a new generational anticoagulant drug called Dabigatran (Pradaxa). This alternate medication gives patients the benefit of no dietary restrictions since dabigatran is not affected by certain foods. Another benefit of taking dabigatran is a monthly blood test is not required to measure its effectiveness, so for this particular reason many patients switch from taking other anticoagulants to dabigatran (Talati & White, 2011). Since this medication does not require close monitoring, some wonder if is it truly a better option or can more harm than good come from taking it. While the benefits of using dabigatran have shown significant improvement over warfarin, there are still risks associated with using dabigatran.

The period entered for the search was from January 2002 to August 2015. The Search terms were: “dual antiplatelet therapy”, “shortened DAPT”,”, “clopidogrel”, “early discontinuation”, “Drug-eluting stenting in diabetes mellitus AND Dual Antiplatelet Therapy”, “extended DAPT”, “prolonged DAPT”, “gastroenteritis AND clopidogrel”, “Delayed eosinophilic gastroenteritis and gastroenteritis”, “thienopyridine”, “P2Y12”, “premature cessation “drug eluting stents AND diabetes” , “duration of dual antiplatelet therapy”. The search had to be modified to include patient’s co-morbidities, medications and medical condition. The search initially started with optimal duration of dual antiplatelet therapy in patients after drug-eluting stent revascularization, and then the search was broadened to include diabetic patients with drug-eluting stent. Lastly I included gastroenteritis to unearth any relation between clopidogrel and Mrs GL’s hospital admittance.

Clopidogrel can be prescribed prophylactically to high-risk patients or to those who have experienced atherothrombotic events such as strokes, acute coronary syndrome, peripheral arterial diseases or any other thrombi-producing illnesses (Cheek, 2013). Clopidogrel works by inhibiting the binding of adenosine diphosphate to platelet receptors, thus, disrupting the process of platelet formation and preventing platelet aggregation and thrombi formation. However, in order to inhibit the binding of ADP, clopidogrel has to be converted to its active form by the enzyme CYP2C19*1. Unfortunately, some people have lost the ability to produce enzyme CYP2C19*1 and instead produce a variant form known as CYP2C19*2. CYP2C19*2 cannot convert clopidogrel to its active form, making clopidogrel useless in patients who carry gene CYP2C19*2. Providentially, pharmacogenomics can identify variant genes with DNA sequencing prior to prescribing medications in order to assure the effectiveness of pharmacologic therapy. This also helps health care providers to prescribe alternate medications when appropriate.

Warfarin is a prescription medicinal drug used to save you harmful blood clots from forming or developing large. useful blood clots prevent or prevent bleeding, but dangerous blood clots can reason a stroke, coronary heart attack, deep vein thrombosis, or pulmonary embolism. because warfarin interferes with the formation of blood clots, it's far referred to as an anticoagulant. Many humans check with anticoagulants as “blood thinners”; but, warfarin does now not thin the blood but rather reasons the blood to take longer to form a clot. Warfarin decreases the body’s capability to form blood clots through blocking the formation of diet k–established clotting elements. diet okay is needed to make clotting elements and prevent bleeding. therefore,

We will obtain 6 milliliters and 5 milliliters of blood samples following verification of a diagnosis of HCM and after approximately 14 days of clopidogrel administration, respectively. The blood samples will be obtained from all cats from femoral or cephalic venipuncture using a 21 to 23-gauge needle or butterfly needle. The blood sample will be stored into red-top serum, EDTA, and sodium citrate tubes. The serum sample will be used to evaluate the biochemistry panel. The EDTA whole blood sample will be used to extract genomic DNA and the plasma to measure clopidogrel active metabolite/clopidogrel acid concentrations. The citrated whole blood will be used to perform platelet aggregometry and flow cytometry analyses of platelet function.