Warfarin

Question 1

Strengths of warfarin tablets and how to differentiate

Answer 1

0.5mg - white
1mg- brown
3mg- blue
5mg - pink

Question 2

warfarin MHRA warnings

Answer 2

Calciphylaxis- rash in pts with renal impairment

Miconazole

Question 3

Warfarin antidote

Answer 3

Phytomenindione (vitamin K)

Question 4

Food/drink to avoid during warfarin treatment

Answer 4

Cranberry and pomegranate juice- increases INR

Leafy greens (kale, collard greens, broccoli, spinach, cabbage, and lettuce)

Alcohol - decreases INR

Question 5

Is warfarin safe in pregnancy?

Answer 5

No - teratogenic
LMWH/unfractionated preferred

Question 6

INR targets

Answer 6

3.5- mechanical heart valve and recurrent DVT

2.5- the rest (Treatment DVT, AF, Cardioversion, Dilated Cardiomyopathy, MI, acute arterial embolism)

Question 7

What should you do if a Patients INR:
above 8
minor bleeding

Answer 7

Stop warfarin

Vit K (IV) - repeat if still high after 24 hours

restart when INR <5

Question 8

What should you do if a Patients INR:
above 8
no bleeding

Answer 8

Stop warfarin

Vit K IV but ORALLY - repeat if still high after 24 hours

restart when INR <5

Question 9

What should you do if a Patients INR:
5-8
minor bleeding

Answer 9

Stop warfarin

Vit K (IV) - repeat if still high after 24 hours

restart when INR <5

Question 10

What should you do if a Patients INR:
5-8
no bleeding

Answer 10

withhold 1 or 2 doses

reduce subsequent maintenance doses

Question 11

Interactions

Answer 11

Enzyme inducers/inhibitors

anything that will increase the risk of bleeding- SSRIs, NSAIDs etc

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