Elevated International Normalized Ratio associated with concurrent use of ophthalmic erythromycinand warfarin. Parker DL1 DL1 !offmann "# "ucker $% $% &erschutz &P &P $alone P$. P$. %uthor information. information. 'anuary 1 ()1) %*+"R%," P-RP+E/ "he case of a patient whose International Normalized Ratio 0INR increased with concurrent use of ophthalmicerythromycin and warfarin is reported. +-$$%R2/ % 334year4old ,aucasian woman 5e6an therapy with warfarin for throm5oem5olism prophyla7is secondary to atrial fi5rillation 0tar6et INR (48. 9a 9arfarin rfarin was prescri5ed 5y her cardiolo6ist and care was esta5lished with clinical pharmacists in an anticoa6ulation clinic. +he was receivin6 a weekly maintenance dosa6e of 1: m6. +he had a history of atrial fi5rillation hyperlipidemia osteoarthritis hypothyroidism coronary artery disease myocardial infarction con6estive heart failure and 5reast cancer. In addition to warfarin the patient had 5een receivin6 alprazolam carvedilol carvedilol furosemide furosemide levothyro7i levothyro7ine ne sodium sodium lisinopril lisinopril nitro6lycer nitro6lycerin in potassium potassium chloride chloride propo7yphene hydrochloride4acetaminophen simvastatin and trazodone. %fter receivin6 warfarinat the same weekly dosa6e for over four months the patient;s ophthalmolo6ist prescri5ed erythromycin ophthalmic ointment for chronic 5acterial con
. % total of four warfarin doses were withheld and her weekly maintenance dosa6e of warfarin was su5se?uently decreased to 1( m6. @ive weeks later her INR was 1.> and it was determined that the erythromycin ophthalmic ointment had 5een discontinued five days prior. !er weekly maintenance dosa6e ofwarfarin was increased to 1A m6. Rechallen6e with erythromycin five days 5efore her ne7t INR measurement resulted in an INR of :.(. % new weekly maintenance dosa6e of 18 m6 was esta5lished and her su5se?uent INRs were within normal ran6e. ,N,L-+IN/ %n increase in INR values was reported after initiation of ophthalmic erythromycin in a patient receivin6 warfarin and recurred upon rechallen6e recha llen6e with ophthalmic erythromycin.
PENINGKATAN INTERNATIONAL NORMALIZED RATIO TERKAIT DENGAN PENGGUNAAN BERSAMAAN ERITROMISIN MATA DAN WARFARIN. Parker DL1, Hoffma TK, T!"ker MA, Ger#"$!%& GP, Ma'oe PM. ABSTRAK TU(UAN) Ka#!# *a#+e a- I%era%+oa' Norma'+&e Ra%+o /INR0 me+-ka% e-a *e--!aa er#ama er+%rom+#+ ma%a a 2arfar+ +'a*orka. RINGKASAN)
+eoran6 wanita #aukasia 33 tahun mulai terapi den6an warfarin untuk profilaksis trom5oem5oli sekunder untuk fi5rilasi atrium 0tar6et INR (48. 9arfarin diresepkan oleh dokter ahli . +e5anyak empat dosis warfarin yan6 dirahasiakan dan dosis pemeliharaan min66uan dari warfarin kemudian menurun men dan itu ditentukan 5ahwa salep mata eritromisin telah dihentikan lima hari se5elumnya. dosis pemeliharaan min66uan dari warfarin menin6kat men
INTERA3TIONS BETWEEN 4OUR SELE3TED DRUGS MA(OR WARFARIN ER4THROM43IN
%pplies to/ warfarin Erythrocin 0erythromycin -sin6 warfarin to6ether with erythromycin may cause you to 5leed more easily. 2ou may need a dose ad
INTERA3TIONS BETWEEN 4OUR SELE3TED DRUGS AND FOOD MODERATE WARFARIN FOOD APPLIES TO) WARFARIN
Nutrition and diet can affect your treatment with warfarin. "herefore it is important to keep your vitamin supplement and food intake steady throu6hout treatment. @or e7ample increasin6 vitamin # levels in the 5ody can promote clottin6 and reduce the effectiveness of warfarin. 9hile there is no need to avoid products that contain vitamin # you should maintain a consistent level of consumption of these products. @oods rich in vitamin # include 5eef liver 5roccoli *russels sprouts ca55a6e collard 6reens endive kale lettuce mustard 6reens parsley soy 5eans spinach +wiss chard turnip 6reens watercress and other 6reen leafy ve6eta5les. $oderate to hi6h levels of vitamin # are also found in other foods such as aspara6us avocados dill pickles 6reen peas 6reen tea canola oil mar6arine mayonnaise olive oil and soy5ean oil. !owever even foods that do not contain much vitamin # may occasionally affect the action of warfarin. "here are reports of patients who e7perienced 5leedin6 complications and increased INR or 5leedin6 times after consumin6 lar6e ?uantities of cran5erry
pome6ranate
Diet nutrisi dapat mempen6aruhi pen6o5atan den6an warfarin. leh karena itu pentin6 untuk men
Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke.
Schrock JW 1, Glasenapp M, Drogell K. Author information February, 12, 212 Abstract !"#E$%&'E( Dehydration may impair cerebral oxygen delivery and orsen clinical o!tcome in patients ith ac!te ischemic stroke "#$S%. We eval!ated i& elevated blood !rea nitrogen to creatinine ratio "'()*+r% as a marker o& dehydration as associated ith poor clinical o!tcome in emergency department "D% patients presenting ith #$S. )E%*!+( We cond!cted a prospective cohort st!dy !sing a stroke registry enrolling all D patients ith #$S &rom 1-*--/ thro!gh 0*--. 2oor clinical o!tcome as de&ined as death, placement in a n!rsing home &or p!rposes other than rehabilitation, or hospice ithin 3- days o& D presentation. # '()*+r ratio o& 415 as considered elevated. "$67%. 8ogistic regression as per&ormed ad9!sted &or age :0; years, )$#, and coma at presentation reporting odds ratios ith 5? con&idence intervals. -E%( 3; patients had a &inal diagnosis o& #$S. 103 "5-?% ere &emale, 1 "0?% d ied, ;; "1;?% received t@2#, and = "/?% had a poor clinical o!tcome. Ahe median )$
Urea darah rasio nitrogen / kreatinin meningkat dikaitkan dengan hasil yang buruk pada pasien dengan stroke iskemik. Schrock JW1, Glasenapp M, Drogell . in!ormasi penulis "bstrak #UJU"$% Dehidrasi dapat mengganggu pengiriman oksigen otak dan memperburuk hasil klinis pada pasien dengan stroke iskemik akut &"'S(. ami menge)aluasi *ika peningkatan nitrogen urea darah untuk rasio kreatinin &+U$ / r( sebagai penanda dehidrasi dikaitkan dengan hasil klinis yang buruk di ga-at darurat &D( pasien dengan "'S. M#D% ami melakukan studi kohort prospekti! menggunakan registry stroke yang menda!tarkan semua pasien D dengan "'S dari 10/002 melalui 3/004. hasil klinis yang buruk dide5nisikan sebagai kematian, penempatan di sebuah panti *ompo untuk tu*uan selain rehabilitasi, atau rumah sakit dalam -aktu 60 hari dari D presentasi. 7asio +U$ / r dari 819 dianggap tinggi. &':7(. regresi logistik dilakukan disesuaikan dengan usia; 3< tahun, $'=SS; >, diabetes, ?" sebelumnya, dan koma pada presentasi odds pelaporan rasio dengan inter)al kepercayaan 49@. ="S'A% 6< pasien memiliki diagnosis akhir dari "'S. 136 &90@( adalah perempuan, 14 &3@( meninggal, << &1<@( menerima tBC", dan >4 &2@( memiliki hasil klinis yang buruk. Median $'=SS, +U$ dan r adalah < &':7 1B4(, 1< mg / dA &':7 11B1(, dan 1,0 mg / dA &':7 0,>2B1,2( masingBmasing. Median +U$ / r adalah 16,4 &':7 10,3B1>,9(. ?ariabel terkait dengan hasil klinis yang buruk adalah% $'=SS tinggi 7 3,9 &6,3B11,>(, usia; 3< tahun 7 ,2 &1,9B 9,0(, dan +U$ / r rasio 819 7 , &1,B<,0(. S'MCUA"$% 7asio +U$ / r meningkat pada pasien dengan "'S dikaitkan dengan hasil yang buruk pada 60 hari. Cenelitian lebih lan*ut diperlukan untuk melihat apakah mengatasi akut status hidrasi pada pasien D dengan "'S dapat mengubah hasil.
$oderate erythromycin food %pplies to/ Erythrocin 0erythromycin @ood decreases the levels of erythromycin in your 5ody. "ake erythromycin on an empty stomach at least 8) minutes 5efore or ( hours after a meal. "his will make it easier for your 5ody to a5sor5 the medication. !owever some erythromycin products may 5e taken without re6ard to meals. %sk your healthcare provider a5out your particular prescription if you are uncertain of how to take it. &rapefruits and 6rapefruit
+wit $akanan menurunkan kadar eritromisin dalam tu5uh %nda . $en6am5il eritromisin pada perut koson6 minimal 8) menit se5elum atau (
