Drug , anticoagulant therapy

Screen the patient s pharmacy profile for potential drug-drug interactions with anticoagulation therapy... 

Deborah DeEugenio, Pharm.D., B.C.P.S., is a 2001 graduate of the Philadelphia College of Pharmacy at the University of the Sciences (Philadelphia). She completed a residency in Pharmacy Practice at Thomas Jefferson University Hospital (Philadelphia). Dr. DeEugenio is a member of the Temple University School of Pharmacy faculty as a Clinical Assistant Professor and a Certified Antithrombotic Provider and a Board Certified Pharmacotherapy Specialist. Her clinical activity takes place at Jefferson Heart Institute as part of the Jefferson Antithrombotics Therapy Service. The ambulatory clinic serves 400 patients on chronic anticoagulation therapy and provides continuous monitoring and education to these patients. The clinic also provides drug information and pharmacy support to the physicians and other health-care providers at the Institute. 

Epidural/Intrathecal- Presence of infection at the injection microinfusion site concomitant anticoagulant therapy uncontrolled bleeding diathesis parenterally administered corticosteroids within a 2-week period, other concomitant drug therapy or medical condition that would contraindicate the technique of epidural or intrathecal analgesia acute bronchial asthma upper airway obstruction. 

Drugs with no significant effect on anticoagulant therapy include ethanol, phenothiazines, benzodiazepines, acetaminophen, opioids, indomethacin, and most antibiotics. 

Approximately 25% of all patients with hypertrophic cardiomyopathy (HCM) have latent left ventricular outflow obstruction with an intraventricular gradient (I). Pathophysiologic features are asymmetric hypertrophy of the septum and a systolic anterior movement of the anterior leaflet. Medical treatment includes betablockers, and calcium antagonists of the verapamil type. Approximately 5— 10% of the patients with outflow obstruction are refractory to such negative inotropic therapy (2). Positive inotropic drugs such as digitalis or sympathomimetics are strictly contraindicated. In the presence of atrial fibrillation, anticoagulation therapy should be started. Since endocarditis is more common in patients with HCM because of turbulence in the left ventricle, prophylactic antibiotics should be administered for periods of potential bacteraemia. 

P-Blockers are the drugs of choice in atrial fibrillation because they decrease heart rate and promote conversion to sinus rhythm. Longterm, low-dose anticoagulant therapy reduces the risk of stroke that Is associated with atriai fibrillation. 

Concurrent administration of other drugs may interfere with the metabolism and alter the effects of corticosteroids. Some of the effects appear to result from increased metabolism of administered steroid. Barbiturates, phenylbutazone, and phenytoin may enhance metabolism and reduce the anti-inflammatory and immunosuppressive potential of systemic steroids. Additionally, the response to anticoagulant therapy may be reduced by simultaneous administration of steroids. 

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