Final: Warfarin Flashcards

1
Q

Warfarin exhibits an ______ model.

A

Irreversible.

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2
Q

Warfarin PK:
1. Warfarin exhibits _____ bioavailability.
2. The Tmax for warfarin is _____, with a Vd of _____.
3. Warfarin is _______ protein bound.
4. The _____ isomer of warfarin has higher Cl.

A
  1. good (90%)
  2. 1-2 hours, 0.08-0.12 L/kg
  3. Highly (99%)
  4. S-isomer.
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3
Q

Which phase of warfarin disposition has a steep curve? What dosage sees this primarily?

A

Distribution—> Low doses.

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4
Q

Warfarin pK is initially _____ on day 1, but become _____ by day 7.

A

Nonlinear
Linear

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5
Q

Warfarin is a _____ extraction ratio drug.

A

Low Extraction Ratio

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6
Q

______ is metabolized by CYP2C9, while _____ is metabolized by many enzymes.

A

S-isomer of Warfarin
R-Isomer of Warfarin.

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7
Q

What is the mechanism of warfarin?

A

Inhibits the interconversion of Vitamin K, slowing the production of the following clotting factors.
—> II, VII, IX, X
—> Protein C and S

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8
Q

What Pharmacodynamic Response Model does Warfarin Follow?

A

The Indirect Pharmacodynamic Response Model—> Meaning there i s a delayed effect and the maximum response after a dose is not observed for at least 2 days.

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9
Q

T or F: Traditional TDM methods for warfarin monitoring are more than effective for managing warfarin patients.

A

F: These have limited value.

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10
Q

What is the INR goal for patients on warfarin?

A

2-3

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11
Q

What are some factors influencing warfarin PK?

A
  1. Age (decreased CL)
  2. Genetic Polymorphisms (CYP2C9 and CKORC1)
  3. Body Weight (obese = decreased initial response)
  4. Sex
  5. Drug Interactions
  6. Disease States
  7. Adherence
  8. Vitamin K intake
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12
Q

What genetic polymorphisms may influence the PKPD of warfarin?

A
  1. CYP2C9 and VKORC1
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13
Q

What is the new focus of managed warfarin patients?

A

Population PK/PD coupled with feedback measurements using Bayesian methods to improve individualization of warfarin.

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