A-fib, Warfarin therapy Flashcards
___ is the most common arrythmia
A-fib
If not tx, A-fib can l/d:
thromboembolic event (stroke), worsened CHF, reduced exercise tolerance, angina
Goal of A-fib tx:
block AV node, restore NSR, prevent thromboembolism, improve exercise
A-fib medications include:
digoxin, BB, CCB, antiarrythmics (amiodarone)
Digoxin has ___ onset, whereas CCB’s and BB’s have a ___ onset.
slow, rapid
___ have effect of bradycardia and impotence, so must educate.
BB’s
Risks of anticoagulants include:
Benefits of anticoagulants include:
bleeding, hemorrhagic stroke
preventing ischemic stroke and embolism
CHADS in deciding whether to start on anticoagulant therapy includes:
CHF HTN Age > 75 yrs Diabetes Stroke/TIA
Warfarin works to deplete ___ in the body, which is responsible for clotting factors inside the body. Therefore, it is known as a vitamin K ___.
vitamin K, antagonist
Warfarin has a ___ therapeutic index
narrow
Takes ___-___ days for warfarin to reach maximum effect. So start pt on warfarin, wait ___-___ days and recheck ___/___.
3-5, 3-5, PT/INR
Do we give loading doses of warfarin?
NO
These clotting factors need to be cleared from the system in order for warfarin to have its full effect:
Protein C, Protein S, II, VII, IX, and X
Adverse effects of warfarin include:
bleeding, skin necrosis, purple toes syndrome
Warfarin is contraindicated in ___ bc it is category X, ___, ___, and high ___ risk.
pregnancy, senility, alcoholism, bleeding
Must monitor ___ while on warfarin therapy. Normal range is ___-___ for normal pts and ___-___ for mechanical valve pts.
INR, 2.0-3.0, 2.5-3.5
What is the initial dose of warfarin therapy?
start on 5 mg
What is the antidote for warfarin? Give if pt has elevated INR.
Vitamin K
Monitor INR ___ weekly until you have ___ consecutive INR’s in range, then monitor every ___ weeks as stable.
twice, 2, 4
Instruct pt to call if black tarry stools, excessive bruising, hematuria while on ___.
warfarin
Educate pt not to take any ___ or ___ while on warfarin. Educate to be consistent w/vit K foods.
OTC’s, herbs
The antiarrhythmic medication, ___ increases INR while on warfarin, so pt’s on this med must reduce warfarin in half.
amiodarone
OTC’s like ASA and NSAIDS ___ warfarin effects. Chronic alcoholism will ___ INR. Foods high in Vitamin K will ___ INR. Herbals may ___ INR.
increase, decrease, decrease, increase
Increase warfarin weekly dose by ___-___% for 2 days a week. Try to use one tablet strength, so pt is not confused.
5-20
