A-fib, Warfarin therapy

Question 1

___ is the most common arrythmia

Answer 1

A-fib

Question 2

If not tx, A-fib can l/d:

Answer 2

thromboembolic event (stroke), worsened CHF, reduced exercise tolerance, angina

Question 3

Goal of A-fib tx:

Answer 3

block AV node, restore NSR, prevent thromboembolism, improve exercise

Question 4

A-fib medications include:

Answer 4

digoxin, BB, CCB, antiarrythmics (amiodarone)

Question 5

Digoxin has ___ onset, whereas CCB’s and BB’s have a ___ onset.

Answer 5

slow, rapid

Question 6

___ have effect of bradycardia and impotence, so must educate.

Answer 6

BB’s

Question 7

Risks of anticoagulants include:

Benefits of anticoagulants include:

Answer 7

bleeding, hemorrhagic stroke

preventing ischemic stroke and embolism

Question 8

CHADS in deciding whether to start on anticoagulant therapy includes:

Answer 8

CHF
HTN
Age > 75 yrs
Diabetes
Stroke/TIA

Question 9

Warfarin works to deplete ___ in the body, which is responsible for clotting factors inside the body. Therefore, it is known as a vitamin K ___.

Answer 9

vitamin K, antagonist

Question 10

Warfarin has a ___ therapeutic index

Answer 10

narrow

Question 11

Takes ___-___ days for warfarin to reach maximum effect. So start pt on warfarin, wait ___-___ days and recheck ___/___.

Answer 11

3-5, 3-5, PT/INR

Question 12

Do we give loading doses of warfarin?

Answer 12

NO

Question 13

These clotting factors need to be cleared from the system in order for warfarin to have its full effect:

Answer 13

Protein C, Protein S, II, VII, IX, and X

Question 14

Adverse effects of warfarin include:

Answer 14

bleeding, skin necrosis, purple toes syndrome

Question 15

Warfarin is contraindicated in ___ bc it is category X, ___, ___, and high ___ risk.

Answer 15

pregnancy, senility, alcoholism, bleeding

Question 16

Must monitor ___ while on warfarin therapy. Normal range is ___-___ for normal pts and ___-___ for mechanical valve pts.

Answer 16

INR, 2.0-3.0, 2.5-3.5

Question 17

What is the initial dose of warfarin therapy?

Answer 17

start on 5 mg

Question 18

What is the antidote for warfarin? Give if pt has elevated INR.

Answer 18

Vitamin K

Question 19

Monitor INR ___ weekly until you have ___ consecutive INR’s in range, then monitor every ___ weeks as stable.

Answer 19

twice, 2, 4

Question 20

Instruct pt to call if black tarry stools, excessive bruising, hematuria while on ___.

Answer 20

warfarin

Question 21

Educate pt not to take any ___ or ___ while on warfarin. Educate to be consistent w/vit K foods.

Answer 21

OTC’s, herbs

Question 22

The antiarrhythmic medication, ___ increases INR while on warfarin, so pt’s on this med must reduce warfarin in half.

Answer 22

amiodarone

Question 23

OTC’s like ASA and NSAIDS ___ warfarin effects. Chronic alcoholism will ___ INR. Foods high in Vitamin K will ___ INR. Herbals may ___ INR.

Answer 23

increase, decrease, decrease, increase

Question 24

Increase warfarin weekly dose by ___-___% for 2 days a week. Try to use one tablet strength, so pt is not confused.

Answer 24

5-20

Question 25

Write down on calendar to take 5 mg on ___, ___, and ___. Take 7.5mg on ___ and ___.

Answer 25

mondays, wednesdays, fridays, tuesdays, thursdays.

Question 26

___ is a new anticoagulant that does not require any lab monitoring.

Answer 26

Pradaxa