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MMI Scenario 26


Daisy visits your INR clinic for the first time. She has been prescribed a 3mg dose of warfarin on one day and 5mg the next day recently and informs you that she understands that she should take one blue tablet on one day, then one blue and one brown tablet the next day. She is due for a crown replacement at a local dentist soon and wanted to ask you if she can drink alcohol to calm her nerves the night before as she dislikes dentists. What steps would you take to manage this situation.
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Example Answer
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INR Understanding: Ascertain Daisy’s knowledge of her condition and her understanding of why it is important to keep her INR in range. It would also be useful to explain the warfarin colour chart to Daisy and ensure she understands the colour of the tablets she needs to take daily, to avoid any future dosage errors.

Warfarin Interactions: Counsel the patient on how different factors may affect her INR, including the effect that alcohol may have on her INR.

Anticoagulation & Procedures: Explain how the dental procedure may affect her and explain how many days/hours before the procedure she needs to come in for her INR check. 
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