Answers:
Rivoroxaban is a NOAC and is absolutely contra-indicated in this case, as the patient has an acute intracerebral bleed that was most likely caused by this drug. Prophylactic dalteparin should not be prescribed automatically for this patient by the FY1. Mechanical prophylaxis with alternating compression stockings may be considered. Use of anticoagulation in a patient like this would be a consultant decision. Prescription of her other routine medications is acceptable, provided that her fluid intake, BM, renal function and blood pressure are being reviewed on a regular basis. For reference and acknowledgement the CT scan came from this website: Case courtesy of Dr Frank Gaillard, <a href="http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/2764">rID: 2764</a>
2 Comments
Kat
12/5/2016 09:45:47 pm
How would you prescribe oral meds in a case like this i.e: metformin/ antihypertensive? would you simply convert them to IV?
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MC
13/5/2016 06:52:43 pm
Thanks for you comments Kat. She has passed her dysphagia screen so I suppose you can just give her her usual tablets for other conditions. If not then you need to decide....do we need to continue them, is there an NG or IV alternative? I would be tempted to withhold ramipril unless grossly hypertensive, likewise it is probably safter to omit the metformin and potentially change to a iv insulin regime if the lady can't swallow.
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AboutIn order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE. ![]()
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