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Dynamics Test 4 > Warfarin > Flashcards

Warfarin Flashcards

1
Q

Explain the route of Warfarin in the body

A

oral route—> binds to plasma proteins(albumin)—> excreted in urine and stool

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2
Q

What is warfarin used for

A

recurrence of acute deep vein thrombosis leading to pulmonary embolism even while heparin

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3
Q

What types of surgery should you take warfarin to prevent venous thromboembolism

A

orthopedic and gynecological surgery

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4
Q

What is warfarin used to protect against

A

patients with acute MI, prosthetic heart valves and chronic atrial fibrillation

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5
Q

what does vitamin K epioxide normally do

A

posttranscriptional carboxylation of factors 2, 7, 9, and 10 and the anticoagulant proteins C and S.

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6
Q

What are the side effects of warfarin

A

bleedings, especially internal bleeding
skin lesions and skin necrosis
purple toe syndrome
many drug interactions

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7
Q

How soon after starting warfarin treat can you see skin lesions/ necrosis. How common is it and who develops

A

its rare; usually happens 3-10 days after therapy initiation; primarily women

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8
Q

What is purple toe syndrome

A

its painful, blue tinge discoloration- due to cholesterol emboli breaking from plaques

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9
Q

When purple syndrome does occur, how soon after treatment does it occur

A

it happens 3-8 after therapy begins

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10
Q

explain how Warfarin interacts with aspirin and phenylbutazone

A

aspirin and phenylbutazone (NSAID) removes warfarin from albumin—increases bleeding and decreases platelet aggregation

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11
Q

How do antibiotics and warfarin interact with each other

A

decrease microbial vitamin K production–no competition and doesn’t stop Warfarin from working

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12
Q

How do oral contraceptives and warfarin interacts together

A

oral contraceptives decrease warfarin effectiveness by increasing plasma clotting factors and decreasing antithrombin III–no point

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13
Q

How do barbiturates and rifampin interact with warfarin

A

it induces microsomal P450 system and breaks down Warfarin faster

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14
Q

What is the half life of warfarin

A

its about 40 hours but varies (kind of like heparin) but its variable among individuals

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15
Q

Can Warfarin be given to pregnant women

A

NO

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16
Q

What effect will warfarin have on pregnant women; what dose should be given

A

Warfarin crosses the placenta and causes fetal hemorrhage and malformation; TEROGENIC
don’t give any time of dose…instead give heparin or lmwh

17
Q

What is the half life of factor 7

A

6 hours

18
Q

What is the half life of factor 9

A

24 hours

19
Q

What is the half life of factor 10

A

40 hours

20
Q

What is the half life of factor 2 (prothrombin)

A

60 hours

21
Q

What does time Warfarin action depend on

A

it depends on the disappearance of factors 2, 7, 9, 10

22
Q

How fast does Warfarin work

A

anticoagulant effects can usually be seen in 24 hours but peak may take 72-96 hours (3-5 days) because pool of clotting factors have to decrease

23
Q

Which drugs can interact and decrease anticoagulant effects of warfarin

A
  1. estrogen-increases clotting factors
  2. phenytoin-increases metabolism
  3. rifampin -increase metabolism
  4. baribiturates
  5. vitamin K-completes with warfarin
24
Q

What drugs increase the bleeding tendencies of Warfarin

A
  1. cephalosporins-decrease vitamin K
  2. salicyclates-
  3. adrenal corticosteroids
  4. NSAIDS-remove warfarin from albumin
25
Q

What enhances the anticoagulant effects of warfarin

A
  1. oral antibiotics
  2. salicylates
  3. alcohol sulfonamides
  4. cimetidine
  5. amiodarone
26
Q

What do you tell patient on Warfarin about food rich in vitamin K example green leafy vegetables?

A

be consistent

27
Q

What test can be used to monitor warfarin

A

prothrombin time- it measure the extrinsic system

28
Q

What standard was used to monitor warfarin concentrations

A

the international normalized ration adopted in the 1990 to monitor warfarin concentration—it corrects for variations that would occur with different thromboplastin reagents b/w hospitals, or when a single hospital gets a new lot reagents

29
Q

what is the equation of monitoring parameters INR

A

the equation is INR= (patient thrombin time/ reference prothrombin time) to the power of international sensitivity time

30
Q

What is the goal of therapy for INR

A

the goal of therapy is an INR of 2.0-3.0 for most indications

31
Q

Why would a patients INR be 2.5-3.5

A

because the person has mechanical heart valves
after myocardial infaraction
antiphopholipid syndrome thrombosis

32
Q

A what point would you discontinue warfarin

A

if the INR is below 5 and you can some modest anticoagulant activity w/o too much bleeding

33
Q

What should be done if the INR is higher than 5

A

administer large amounts of vitamin K (phytonatoide) because too much anticoagulation and bleeding is occuring

34
Q

If INR is equal or to 20, what should the doctor do

A

the anticoagulation is way too high, give the patient vitamin K, factor 9 concentrates, and fresh frozen plasma-to replace clotting factors

Dynamics Test 4 (29 decks)

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