The nurse is caring for a client taking both gemfibrozil (Lopid) and warfarin (Coumadin). To maintain safety relative to the interaction of these drugs, the nurse should monitor the client closely for which clinical manifestation?

Question

1. Myolysis
2. Clot formation
3. Bleeding
4. Hyperlipidemia

Answer 1

Correct Answer: 3
Rationale 1: There would be an increased risk of myolysis if the drug interaction increased the serum concentration of gemfibrozil.
Rationale 2: Clot formation would be a risk if the therapeutic anticoagulant effect of warfarin were reduced by its interaction with gemfibrozil.
Rationale 3: The client is at increased risk for bleeding because gemfibrozil competes with warfarin for plasma protein receptors, with the consequence of increasing the anticoagulant effect of an increased amount of free warfarin.
Rationale 4: Hyperlipidemia would be a consequence if the serum concentration of gemfibrozil were decreased as a consequence of the drug interaction.
Global Rationale: The client is at increased risk for bleeding because gemfibrozil competes with warfarin for plasma protein receptors, with the consequence of increasing the anticoagulant effect of an increased amount of free warfarin. There would be an increased risk of myolysis if the drug interaction increased the serum concentration of gemfibrozil. Clot formation would be a risk if the therapeutic anticoagulant effect of warfarin were reduced by its interaction with gemfibrozil. Hyperlipidemia would be a consequence if the serum concentration of gemfibrozil were decreased as a consequence of the drug interaction.