Case study: Marie L. is a 65 yr old woman with a history of rate-controlled atrial fibrillation (AF), HTN, Type 2 DM, and UTIs. She has had AF for the last 8 years, has tried 2 cardioversions (CVs) and after each CV she returned to AF. She has considered ablation therapy in the past but has decided that rate control works for her. Her medications include: metroprolol (ER) 100mg Qday, ASA 81mg Qday, Warfarin 5mg Mon, Wed, Fri and 2.5 mg all other days, and multivitamin. When she was first diagnosed with DM ( 4 yrs ago) she began a weight loss and exercise program and has been able to maintain her hgbA1C at appropriate levels so far without medications. This was the first year of Marie’s retirement and so she and her huband were able to winter in Arizona. During her stay in Arizona she was able to get her INRs monitored at a local cardiologist’s office and they were always therapeutic, but slightly on the high end (2.8-3.1). 2 days before coming back to Minnesota, Marie felt a UTI coming on. She was able to pick up some Ciprofloxacin 250mg in Mexico and started taking it. She has been taking Cipro for the last 7 days and is now in your office with frequent nosebleeds that take a long time to stop. Her INR is 4.8. In your own words discuss: The Cytochrome P450 system (how it works, how warfarin is metabolized, etc) What is Ciprofloxacin doing within the system (induction/inhibition) How this induction or inhibition affects warfarin A better choice of antibiotic for UTI for this patient and why Submit this paper in publication-quality APA format (6th edition). You must use at least 2 peer-reviewed references other than your textbook(s). Up-To-Date, WebbMD, -websites ending in .com, and other such collections are not allowed. Additionally, please remember that Advanced Practice Nurses do not quote Wikipedia, Wikepedia quotes us. If you have a question about the quality of your reference, please contact the instructor prior to using it in your paper.
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