TDMPrep

Mixed Practice 34

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Case 1 of 9Communication and ProfessionalismCounselling and education (e.g., medication adherence)

A 76-year-old woman with atrial fibrillation and moderate rheumatic mitral stenosis is seen for follow-up 3 weeks after discharge for an ischemic stroke. She was discharged on warfarin, atorvastatin, ramipril and metoprolol. She lives alone and has poor vision from age-related macular degeneration. She says she cannot tell her color-coded warfarin tablets apart, sometimes skips doses because the regimen is confusing, and has been delaying refills because of cost. Her INR is 1.5 (2.0-3.0), and it was 4.1 two weeks ago. On examination her pulse is irregularly irregular and there are no new neurological deficits.

Heart rate78/min, irregularly irregular
Respiratory rate16/min
Temperature36.8 °C
O2 saturation97%, room air
Blood pressure152/88 mm Hg

Question 1 of 28

Which one of the following is the most appropriate way to address her difficulty identifying her tablets?

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