Scenario Description | Warning/Message |
Warfarin order in setting of most-recent INR of >3 |
WARNING—BLEEDING RISK --
INR is ——. Current INR is high. Reduce WARFARIN dose and/or monitor closely. |
Warfarin interaction with trimethoprim/sulfamethoxazole, amoxicillin/clavulanate |
WARNING—BLEEDING RISK -- This drug can interact profoundly with WARFARIN. Consider an alternative antibiotic or monitor very closely. Repeat the INR in 3 days and consider reducing warfarin dose. |
Warfarin-antibiotic interaction |
WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Repeat the INR in 3 days. Consider reducing warfarin dose. |
Warfarin-nonantibiotic interaction (e.g., amiodarone) |
WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days. |
Warfarin-antiplatelet drug or NSAID interaction |
WARNING—BLEEDING RISK -- The use of WARFARIN with NSAIDs and/or ANTIPLATELET AGENTS increases bleeding risk. Reevaluate need for concomitant therapy. |
Warfarin-nonantibiotic interaction (e.g., amiodarone) |
WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days. |
Antiplatelet drug—NSAID interaction |
WARNING—BLEEDING RISK -- The use of ANTIPLATELET AGENTS with NSAIDs increases bleeding risk. Evaluate need for concomitant therapy. |
Any use of NSAIDs, ACE inhibitors, diuretics in resident with BUN and/or creatinine above certain threshold level |
WARNING—RENAL INSUFFICIENCY RISK -- Current BUN=——, Creatinine=——. Worsening renal insufficiency can result from ACE inhibitors, angiotensin receptor blockers (e.g., losartan), diuretics, and NSAIDs. Evaluate medication regimen and monitor BUN and CREATININE closely. |
Any drug therapy that can increase potassium level (ACE inhibitors, potassium-sparing diuretics, potassium supplements, NSAIDs) |
WARNING—HYPERKALEMIA RISK -- Most recent POTASSIUM is —. HYPERKALEMIA can result from therapy with any of the following: ACE inhibitors, angiotensin receptor blockers (e.g., losartan), potassium-sparing diuretics, NSAIDs, and mineralocorticoids. Reevaluate medication regimen and monitor POTASSIUM level closely. |
Any new prescription for thiazide or loop diuretic therapy |
WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring. |