Case Ana Chandok is a 67-year-old female who suffers from atrial fibrillation.

Case
Ana Chandok is a 67-year-old female who suffers from atrial fibrillation. She is currently prescribed digoxin (Lanoxin) 250 μg daily and dabigatran (Pradaxa) 150 mg twice a day.
Last week Ana felt a bit dizzy on several occasions and when she felt her pulse, she noted that it had become quite fast and irregular. She visited the local GP who decided that her ventricular rate was no longer well controlled and prescribed additional verapamil (Anpec) 80 mg, three times a day, which was dispensed at the local pharmacy.
Today Ana came to the pharmacy and asked for something to treat a large bruise on her left arm. She also said that for the past couple of days when she cleaned her teeth her gums had started to bleed, and she asked if you could recommend a good toothbrush with soft bristles. She also mentioned that the new tablets seemed to be working as her heart rate was now quite slow, but it did seem to be missing a beat every now and again.

Questions:
You must include individual responses to each of the following questions regarding the case descriiption above.
1. What might have caused Ana’s bruising? Explain the mechanism/s which may underlie any suspected adverse drug reaction and/or drug interaction.
2. What might have caused Ana’s bradycardia and missed beats? Explain the mechanism/s which may underlie any suspected adverse drug reaction and/or drug interaction.
3. What advice would you give Ana and her doctor regarding management of her atrial fibrillation?
4. Download and complete the adverse event report form relating to Ana’s bruising, bradycardia and missed beats, include it at the end of questions 1-3.