bluestar
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a 58 year old woman had a mitral valve replacement, and was placed on anticoagulants and prophylactic antibiotics following her surgery. five days after the surgery, she developed a sharply demarcated erythematous rash on her left thigh. two days after the rash appreared, large hemorrhagic bullae began to form in the area of the rash. which of the following drug most likely caused the patients rash?
a, aspirin,
b, cefazolin
c, heparin
d, vancomycin
e, warfarin
please also explain your seletion.
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| Idiopathic
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Sounds like warfarin and a patient who is protein C deficient. this is the main problem we see in people who are Protein C deficient when they are given warfarin - hemorrhagic skin necrosis.
Protein C and S are vitamin K-dependent factors that are anti-coagulants and must be activated by K to work. Warfarin knocks out K, which usually isnt a problem because you have both intact, I think. If you are deficient in one, however, you can actually get localized areas of necrosis, due to a paradoxical clot. Am I close?
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| intern_doc
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I think you are CORRECT idio.....I am 100% sure...
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| bluestar
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sorry I don't have the answer for the question. but why did you mention paradoxical clot, idiopathic? :roll:
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| Idiopathic
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Protein C, after activation by vitamin K, will neutralize factor V and help break down clots. Heterozygotic individuals who are deficient in protein C will have the little Protein C that they have knocked off by warfarin before they are fully anticoagulated, and will therefore have a superficial skin necrosis with about 6 hours after beginning warfarin therapy (~3 days to become fuly anticoagulated).
Paradoxical because you give warfarin to avoid a clot, and here you actually cause one with it.
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| bluestar
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you are awsome! aren't you not ready for the exam? to me, you are over-qualified already :P .
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| peekay
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i wonder if antibiotic therapy has something to do with vit-k deficiency and hence the side effects of anticoagulant are augumented.pt should have gone through the coag lab work befor surgery and any deficiency of a factors or the proteins should have been found .
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