Pharmacology & Dosage Calculation
A 71-year-old woman who resides in a long-term nursing home fell while walking down stairs.
The attending nurse arrives to find the patient sitting motionless on the stairs. She is alert and oriented but wishes to rest. While she rests, the nurse reviews the chart and notes that her medication regimen includes metformin, loratadine, warfarin and diclofenac. Which medication is most likely to increase the patient's risk of injury?
Explanation
Core Concept: Medication safety and fall risk assessment in the elderly, specifically regarding anticoagulants.
Clinical Presentation: Mechanical fall in an elderly patient.
Diagnosis: Clinical evaluation for injuries, including a head CT to rule out intracranial hemorrhage.
Management: *Acute:* While all falls are dangerous, *Warfarin* poses the highest immediate risk of severe injury complications (e.g., fatal intracranial or internal hemorrhage) due to impaired coagulation. *Long-term:* Comprehensive fall prevention strategies, medication review, and regular INR monitoring to ensure it remains strictly within the therapeutic range.