QuestionSBA
QuestionChoice
Acute illness can exaggerate the effect of warfarin and indicate a need to reduce dosage. Given this man has had a recent COVID-19 infection and his INR is out of therapeutic range for warfarin he will likely need his warfarin dose reducing.
50344
a
His warfarin does should be reduced
QuestionChoice
Renal function is not routinely monitored in patients using warfarin.
50348
e
He is likely to need renal monitoring if his warfarin dose needs changing
QuestionChoice
There are no interactions between ramipril and warfarin, it therefore does not need to be changed.
50347
d
He should switch his ramipril to amlodipine due to potential interactions between ramipril and warfarin
QuestionChoice
Nausea is a rare/very rare side effect of warfarin so he is unlikely to experience it with a dose change.
50345
b
He is likely to experience nausea if his warfarin dose needs changing
QuestionChoice
This is incorrect, concurrent illness can exaggerate the effect of warfarin which requires a reduction in dosage. This doesn't mean that you should completely stop this patients warfarin.
50346
c
He needs to stop his warfarin immediately
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3652
Warfarin requires increased monitoring in patients with liver disease/intercurrent illness
Topic
74
Elderly Care
10123
Case presentation: A 74-year-old man attends warfarin clinic to have his INR checked. He has recently had COVID-19.



**PH**
Atrial fibrillation, hypertension, hypercholesterolaemia

**DH**
7.5mg warfarin PO OD, ramipril 5mg PO OD, atorvastatin 20mg PO OD

**Investigations** INR 3.8 (2.0-3.0)

Question: Select the most important information that should be provided for this patient.
a