A nurse is caring for a patient who has been prescribed warfarin for atrial fibrillation and simvastatin for hyperlipidaemia.

Question

A nurse is caring for a patient who has been prescribed warfarin for atrial fibrillation and simvastatin for hyperlipidemia. During medication reconciliation, the nurse notes that the patient has also been taking over-the-counter (OTC) omeprazole for heartburn. The nurse should:



1. Continue administering the medications as prescribed.
2. Hold the omeprazole and inform the physician.
3. Hold the simvastatin temporarily and inform the physician.
4. Advise the patient to take omeprazole at a different time than warfarin.

Answer 1

Hold the Simvastatin and contact the physician, notifying him of the three medications the patient is taking.

Answer 2

The nurse should hold the simvastatin and notify the physician. When simvastatin and warfarin are given together it increases the warfarin PT/INR lab values and coagulating abilities, which puts the patient at an increased risk of bleeding. some studies that show patients who have been taking omeprazole have an increase in thromboembolism incidents. This also puts patients at a further increased risk of bleeding. When Simvastatin and Warfarin are taken together, they can increase the patient's coagulating abilities, which in turn increases the Warfarin PT/INR lab values. This can put the patient at a higher risk of bleeding. Studies have shown that patients who have been taking omeprazole may have an increased risk of thromboembolism episodes, which further increases their risk of bleeding.

Answer 3

Correct answer: 3. Hold the simvastatin temporarily and inform the physician.

Rationale: This question tests the nurse's understanding of drug-drug interactions and the implications of combining certain medications. Omeprazole, a proton pump inhibitor, can increase the plasma concentrations of simvastatin due to its effect on cytochrome P450 enzymes, specifically CYP3A4, which metabolizes simvastatin. Elevated levels of simvastatin increase the risk of serious side effects, such as myopathy and rhabdomyolysis. Although it's important to manage the patient's heartburn symptoms, the immediate risk of combining simvastatin with omeprazole without adjustments poses a greater risk.



1. Option 1 (Continue administering the medications as prescribed) is not advisable due to the interaction between omeprazole and simvastatin.
2. Option 2 (Hold the omeprazole and inform the physician) addresses the interaction but may not be necessary as omeprazole does not significantly interact with warfarin to the same dangerous extent; it is the combination with simvastatin that is more concerning.
3. Option 4 (Advise the patient to take omeprazole at a different time than warfarin) does not address the more critical interaction with simvastatin and is thus not the best course of action.