American Board of Family Medicine (ABFM) Practice Exam

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In managing a patient on warfarin, which condition can lead to a decreased response and higher dosage requirement?

Acute kidney injury
Heart failure
Hypothyroidism
Progressive nonalcoholic cirrhosis

The correct answer is: Hypothyroidism

The management of a patient on warfarin can be complex due to the various factors that influence its metabolism and effectiveness. In the context of the question, hypothyroidism plays a significant role in warfarin response. Hypothyroidism is associated with a decreased metabolic rate, which can lead to alterations in the pharmacokinetics of medications, including warfarin. This reduction in metabolic activity can result in a lower rate of clearance of the drug from the body. Consequently, patients suffering from hypothyroidism may require a higher dosage of warfarin to achieve the same anticoagulation effect compared to those with normal thyroid function. In contrast, acute kidney injury, heart failure, and progressive nonalcoholic cirrhosis can lead to increased sensitivity to warfarin and may require lower doses due to impaired clearance and altered drug distribution. Therefore, understanding the impact of thyroid function on warfarin metabolism provides crucial insights for clinicians to adjust dosing effectively for optimal anticoagulation management.