Pharmacogenetics Case Study
Ms. Jessup is 75-year-old Chinese women who has recently been diagnosed with atrial fibrillation. Her PMH includes stress incontinence and Parkinson disease. Her CHAD II score is 3. She has been started on Coumadin 5 mg daily with INR check in 3 days. Her son calls your practice and notifies you that his mother has been admitted to the hospital with a life-threatening GI bleed and her INR was 20 on admission.
A.
1. Why did this happen? Apply and explain pharmacogenetics.
2. Diagnosis and differentials (Use VINDICATE) on why this may have happened and relate your rationale to pharmacology therapy.
3. Treatment
B. Now think about if this medication was changed to Eliqus or Xaralto and you were told that Mrs Jessup fell, hit her head and has a life-threatening sub arachnoid hemorrhage.
1. How would you treat her?
2. What would you order? What testing?
3. Why would you order this? Be specific
4. Think about how these two situations that are causing life threatening injuries in these patients could have been avoided or mitigated. Be specific, think about treatment for atrial fibrillation, how do you decide if anticoagulants should be used in a certain patient? Use medical calculators. Is there an alternative treatment?
C. Now think about this same patient who presents to the PCP day 5 after Coumadin start of therapy with c/o general fatigue, weakness, fever in which she quickly decompensates and is sent to the ED with the following skin changes: see picture
