RESUMO
Death and dying in America has received limited attention in medical education. The Southern Arizona VA Health Care System and the University of Arizona have collaborated with three nonprofit community hospice programs to develop an end-of-life care curriculum. This formal and comprehensive program is offered as a one-month elective to senior medical students, residents and fellows. The goal of the program is to improve clinical skills in caring for the dying patient and foster research in palliative and supportive care.
Assuntos
Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/organização & administração , Internato e Residência/organização & administração , Assistência Terminal , Competência Clínica/normas , Comportamento Cooperativo , Relações Interinstitucionais , Modelos Educacionais , Modelos Organizacionais , Objetivos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , PesquisaRESUMO
The purpose of this study was to assess the effect of fluoxetine on the hypoprothrombinemic response of warfarin in patients chronically anticoagulated. Patients receiving low-intensity anticoagulation with warfarin were recruited. All patients were taking stable dosages of warfarin and had two baseline prothrombin times (PTs) within 10% of each other. Each patient received fluoxetine (20 mg daily) for 21 days. PTs were measured on days 2, 5, 8, 12, 15, 19, and 22 of fluoxetine administration. Six patients completed the study. There was no significant difference in mean PTs before and during fluoxetine administration. Fluoxetine at the dosage studied does not predictably effect the hypoprothrombinemic response of warfarin.
Assuntos
Anticoagulantes/farmacocinética , Fluoxetina/farmacocinética , Tempo de Protrombina , Inibidores Seletivos de Recaptação de Serotonina/farmacocinética , Varfarina/farmacocinética , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Interações Medicamentosas , Humanos , Hipoprotrombinemias/induzido quimicamente , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Fluconazole has been reported to interact with many medications. This study examined the effect of low-dose fluconazole therapy on the hypoprothrombinemic response of warfarin sodium in patients. METHODS: Patients receiving low-intensity anticoagulation therapy with warfarin were recruited. All patients were taking stable doses of warfarin and had two baseline prothrombin times (PTs) within 10% of each other. Each patient received 100 mg of fluconazole daily for 7 days. Prothrombin times were measured on days 2, 5, and 8 during fluconazole administration. RESULTS: All patients had a progressive increase in PTs. Mean (+/- SD) of PTs increased from 15.8 +/- 1 seconds before the administration of fluconazole to 18.9 +/- 1.9 seconds on day 5 and 21.9 +/- 2.2 seconds on day 8. Fluconazole therapy was stopped early in the three patients due to high PTs. The largest change in PT was 9.7 seconds. No bleeding was noted during the study. CONCLUSION: Fluconazole predictably potentiates the hypoprothrombinemic response of warfarin. Prothrombin times must be monitored when fluconazole is administered to patients taking warfarin.
