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1069105 tn?1256704012

AF & HTN medications

My mom, 72 year old, female, with hypertension for 8 years (with medications, systolic 110-120). In May, while hospitalized due to methyldopa induced cholestasis, she was diagnosed with atrial fibrillation. In 8/09, 14 days into Warfain, she felt & suffered an acute subarachnoid & subdural hemorrhage.

In Dec, she has open cholecystectomy due to acute cholecystitis with pigmented gallstones.  

ECG results:
4/09: Sinus Bradycardia & Atrial Premature Complex
5/09: AF, T abnormalities
8/09: (hospitalized for CNS haemorrhages) Sinus rhythm
10/09: AF, T & ST abnormalities

Current Medications:
30 Amlodipine Besylate: 5 mg
Lisinopril: 40 mg
Atenolol: 50 mg
Omeprazole: 40 mg
Aspirin: 100 mg

She has no other risk, CHADS is "1".

1. Given her near-death bleed out, how safe is it to continue any blood-thinning therapy?

2. Are there any no problematic  drug interactions with her medications?  We are particularly concerned with some of the Atonolol’s side effects (i.e., the potential to develop type 2 diabetes, and unsteadiness when walking leading to more falls.)  Are there safer, just as effective alternatives to Atonolol for her?  We are also concerned with the elevated dosages of Lisinopril & Omeprazole. With these dosages, our mother’s systolic blood pressure has been in the lower end of below 120. Should the dosage be lowered, what should that be ?

Thank you.

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242508 tn?1287427246
The atenolol and the lisinopril should be continued and they are safe at these doses unless she feels lots of lightheadedness.  The omeprazole helps with ASA tolerance.  

As far as the CNS bleeding, she obviously should never be on coumadin.  ASA has a lower risk of bleeding and is probably safe in her case.  I would confirm this with her neurologist or neurosurgeon.  

I would probably keep her regimen the way it is for now.
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