An asthmatic client has been taking Accolate (zafirlukast) for a number of years. Coumadin is being added to the client's medications because of atrial fibrillation. What concern does the nurse have related to this addition?
1. Warfarin may significantly decrease prothrombin time (PT).
2. The client might experience an increase in BUN and creatinine values.
3. Less warfarin (Coumadin) will be needed to achieve the desired prothrombin time (PT).
4. The client will be at greater risk for stroke because of drug interaction.
Correct Answer: 3
Rationale 1: Warfarin (Coumadin) may significantly increase PT.
Rationale 2: BUN and creatinine are not affected.
Rationale 3: Warfarin (Coumadin) may significantly elevate the PT so that less warfarin (Coumadin) is needed.
Rationale 4: The effects of warfarin (Coumadin) effects would be potentiated. This will elevate the PT so that less Coumadin is needed. This lowers the risk of stroke.
Global Rationale: Zafirlukast is metabolized by CYP450 enzymes and has the potential to interact with substrates of the inhibitors of this enzyme. Use with warfarin may significantly increase prothrombin time (PT). BUN and creatinine are not affected. The increased effect of warfarin lowers risk of stroke.
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