Gunda Siska, PharmD
Gunda Siska, PharmD, has worked in various fields within the pharmaceutical industry as a licensed pharmacist for more than 20 years. She is currently a staff hospital pharmacist assisting nurses and doctors with drug prescribing, administration, and dispensing, as well as independently monitoring and dosing highly toxic and dangerous drugs. For 2 years, she was concurrently a consultant pharmacist for skilled nursing facilities and nursing homes. Dr. Siska is a member of the New Mexico Society of Health-System Pharmacists and the American Academy of Anti-Aging Medicine. Follow her on Twitter @GundaSiska
Today, she needs her discharge medications filled. For the newly diagnosed MAI infection she is getting azithromycin 500mg qd, ethambutol 400mg qd, and rifampin 600mg qd. She also has a new prescription for warfarin 15mg qd.
Mystery: Why did her dose of warfarin increase so drastically? Is the patient stock piling the medications? This dose is unusually high for a small person with cachexia.
Solution: The rifampin is a potent enzyme inducer and has caused her coumadin dose to more than triple. If she were to stop the rifampin, her INR will likey become too high.
Product Information: RIFADIN(R) oral capsules, rifampin oral capsules. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2019.