Sheila B. age 30 presents to the clinic with complaint of cl…

Sheila B. age 30 presents to the clinic with complaint of classic migraine headache, which she describes as moderately severe. She first developed migraines in her teen years and they have worsened as she has gotten older. She has been using ibuprofen, aspirin, acetaminophen and aspirin plus caffeine 2 to 3 times per week for the treatment of her headaches, but continues to experience them despite increasing therapy. The best course-of-action from the list below to manage Sheila’s headaches is:

Use the following case study to answer questions 17 and 18. …

Use the following case study to answer questions 17 and 18.  Lois, age 54, is taking warfarin (Vitamin K antagonist, an anticoagulant) 4 mg p.o. each day following a deep vein thrombosis. Her INRs have been well-maintained at 2.0 – 2.3. Today, however, her INR is 4.8. On review of her history, you note that she has been taking Advil Cold (Ibuprofen, an NSAID + phenylephrine, a decongestant), an over-the-counter cold remedy regularly for the past 3 days.  Other daily medications include atorvastatin (statin) 20mg  and lisinopril (ACE-I) 10mg. She has been on these daily medications and dosages  for several years. A careful history, physical exam, and diagnostic testing reveal no evidence of active bleeding. Given what you know about drug-drug interactions with warfarin (Vitamin K antagonist) and management of elevated INRs, identify appropriate actions to take with this patient.  (Choose as many of the following options as apply).