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Pharmacology Spring 2021: Set 2 > Hematologic: Oral Anticoagulants > Flashcards

Hematologic: Oral Anticoagulants Flashcards

1
Q

What is the generic and brand name of oral anticoagulants?

A

Warfarin [Coumadin]

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2
Q

How fast is warfarin absorbed?

A

Rapid

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3
Q

How long does it take to see effects of warfarin?

A

36 to 48 hours

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4
Q

When do full effects of warfarin occur?

A

3 to 4 days

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5
Q

Why does it take so long to to see effects of warfarin?

A
  1. Warfarin antagonizes the production of vitamin K–
    dependent clotting factors.
  2. Before warfarin can exhibit its full effect,
    the circulating vitamin K clotting factors must be exhausted.
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6
Q

What does warfarin bind to?

A

Plasma albumin

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7
Q

Where is warfarin metabolized?

A

Liver

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8
Q

Where is warfarin excreted?

A

Urine

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9
Q

Because warfarin is highly protein

bound and metabolized in the liver what can occur?

A
  1. Using other drugs at the same time
    may alter the amount of warfarin in the body.
  2. This may increase the risk of bleeding and clotting
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10
Q

Detailed Pharmacodynamics of warfarin

A

Oral anticoagulants alter the ability of the liver to synthesize vitamin K–dependent clotting factors, including factors II (prothrombin), VII, IX, and X. However, clotting factors already in the bloodstream
continue to coagulate blood until they become depleted, so anticoagulation doesn’t begin immediately.

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11
Q

What is warfarin used to treat?

A
  1. Thromboembolism
  2. Can be started while a patient is still receiving heparin
  3. Prevention of PE caused by DVT, MI, rheumatic
    fever, prosthetic heart valves, or chronic atrial fibrillation
  4. Combined with an antiplatelet drugs to decrease the risk of arterial clotting.
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12
Q

Action of warfarin

A

Inhibits vitamin K–dependent activation of clotting factors II(prothrombin), VII, IX, and X formed in the liver

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13
Q

Adverse reactions of warfarin

A
  1. hemorrhage
  2. prolonged clotting time
  3. rash
  4. fever
  5. diarrhea
  6. hepatitis
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14
Q

What to monitor for in patient receiving warfarin

A
  1. Bleeding gums
  2. bruises
  3. petechiae
  4. epistaxis
  5. tarry stools
  6. hematuria
  7. hematemesis
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15
Q

What can cause warfarin to become ineffective?

A

vitamin K

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16
Q

What labs to monitor in patients receiving warfarin

A
  1. HGB and HCT
  2. Platelet count
  3. PT
  4. INR
  5. PTT
17
Q

what drugs are warfarin combined with decrease the risk of arterial clotting?

A

Antiplatelet drugs such as:

  1. Aspirin
  2. Clopidogrel
  3. Dipyridamole
18
Q

REACTION when taken with Warfarin:

acetaminophen, allopurinol, amiodarone,
cephalosporins, cimetidine, ciprofloxacin, clofibrate, danazol, diazoxide, disulfiram, erythromycin, fluoroquinolones, glucagon, heparin, ibuprofen, isoniazid, ketoprofen, metronidazole, miconazole, neomycin, propafenone, propylthiouracil, quinidine,
streptokinase, sulfonamides, tamoxifen, tetracyclines, thiazides, thyroid drugs, tricyclic antidepressants, urokinase, and vitamin E

A
  1. These are highly protein-bound medications
  2. Increase the effects of warfarin
  3. Resulting in an increased risk of bleeding.
19
Q

REACTION when taken with Warfarin:

barbiturates, carbamazepine, corticosteroids, corticotropin, mercaptopurine, nafcillin, hormonal contraceptives containing estrogen, rifampin,
spironolactone, sucralfate, and trazodone

A

Drugs metabolized by the liver may increase or decrease the

effectiveness

20
Q

REACTION when taken with Warfarin:

diet high in vitamin K

A

reduces the effectiveness

21
Q

REACTION when taken with Warfarin:

phenytoin

A
  1. Risk of phenytoin toxicity increases

2. Increase or decrease the effects of

22
Q

REACTION when taken with Warfarin:

Vitamin K and fresh frozen plasma

A

reduce the effects of warfarin

23
Q

What else can effect the response of warfain?

A

alcohol abuse increases the risk of clotting

24
Q

The primary adverse reaction to oral anticoagulant

A

minor

bleeding

25
Q

Severe bleeding can occur, however, with the most common site being…

A

GI tract

26
Q

Bleeding into _____ may be fatal.

A

the brain

27
Q

______ may form at arterial puncture sites.

A

hematomas

28
Q

____ or _____ of the skin and other tissue can occur.

A
  1. Neurosis

2. Gangrene

29
Q

Is warfarin contraindicated during pregnancy?

A

Yes

30
Q

The effects of oral anticoagulants can be reversed with _____.

A

phytonadione (vitamin K1).

31
Q

At what time should warfarin doses occur?

A

the same time each day

32
Q

Patient educations point

A
  1. Don’t increase intake of green, leafy vegetables or other foods or multivitamins that contain vitamin K
  2. Because vitamin K may antagonize the anticoagulant effects of the drug.

Pharmacology Spring 2021: Set 2 (14 decks)

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