Warfarin

Just some important points about warfarin:
(image taken from http://www.pharmacy-and-drugs.com/reviews/Warfarin.html and some of the notes supplemented with quotes from http://www.pharmacy-and-drugs.com/reviews/Warfarin.html in addition to my own personal notes)

1. 1mg (brown), 3mg (blue), 5mg (pink) tablets

2.That they inhibit F 10, 9, 7, 2

3.That PE/DVT aim INR 2-3 ; recurrent 3.5
4.That AF : 2-3; or cautious and no risk factors (no stroke/dm/ht/tia/under 65) then 2.5-3.5
5.That prosthetic valves : 3-4.9; higher risk valves (cage and ball;tilting disc/mitral and aortic valves) aim for 4-4.9; lower risk ~3

Monitoring

everyday for first week
every week for next 3 weeks
every month for next 6months
then every 8 weeks?

Vit K regenerating reductase enzyme inhibitor - therefore - state is like vit K deficiency :
patients should avoid VIT K containing foods : LIVER AND GREEN VEGETABLES -- stops anticoagulant effect of Warfarin.

Patient to be aware of menstruation - heavier/longer than normal
Patient to be aware of DENTAL WORK/SURGERIES - to always inform both the doctor, surgeon, dentist.

Pregnant women and breastfeeding women to avoid warfarin -- query first and last tri avoid?
(note also, NSAIDS, aspirin DO NOT GIVE TO PREG LADIES -- paracet only ok)

Always to inform docs about the fact that you are on warfarin --!! very very important, never shy away from that, never forget to inform them. - alters treatment /drug interactions

Remind them of dangers of alchol, binge drinking and they are allowed moderate etoh, but good idea to tell them to stop etoh.

Tell your doctor immediately if you are, or become pregnant, or are
breastfeeding, as Warfarin may cause birth defects.

Also tell your doctor of any other medications you are taking, including vitamins and herbal /supplements, and any medical conditions you may have.

So vitamins - which vits?

Herbal supplements : st.John's wort - interaction -? lessen or worsen anticoag effect?

Medical conditions : note our contraindications - also screening questions

1. have you ever had a stroke or tia
2. are you pregnant or breastfeeding
3. do you have an ulcer?
4. do you have high blood pressure?
5. do you have endocarditis -bacterial endocarditis
6. do you have any bleeding disorders
7. have you ever had any major head trauma or cerebral aneurysms?
8. ???? recent surgery?


NOTE that use with caution in the elderly and in those with past GI bleeds!
Don't ever give warfarin and NSAIDS together!

It is very important that you take this medicine exactly as your
doctor tells you to.

At the same time every evening -- once only in the
evening!!

Do not take more or less medicine than directed, and
never stop taking Warfarin without discussing it with your doctor first.

If you miss a
dose of this medicine, take it as soon as you remember, unless
it is almost time for your next
dose. Do NOT double doses.

Recall warfarin drug interactions (to be added later):

LIVER ENZYME INHIBITORS FECKIN COB(inging on alcohol) SCAM
So in this case they would potentiate/increase the effect of warfarin - ie more prone to bleeding, increase the INR, because the available warfarin is increased and not being broken down due to inhibited liver enzymes.

liver enzyme inducers CRAP GPS (chronic alcohol)
The opposite is the case here, where the individual is more likely to form clots, the anticoagulant effect of warfarin is decreased, less warfarin is available in the body because is has been eliminated or is being eliminated faster by the liver enzymes of the body induced by the respective drug.

check with doctor if :

Check with your doctor immediately if any of the following symptoms occur:
bleeding from gums when brushing teeth; blood in urine; nosebleeds; pinpoint red
spots on skin; unusual bleeding or bruising; unusually heavy bleeding or oozing
from cuts or wounds; unusually heavy or unexpected menstrual bleeding; abdominal
or stomach pain or swelling; back pain or backaches; black, tarry stools;
bleeding in eye; blood in stools; blood in vomit or vomit that looks like coffee
grounds; blood in urine; blurred vision; chest pain; confusion; constipation;
coughing up blood; severe diarrhea; dizziness or fainting; joint pain,
stiffness, or swelling; loss of appetite; continuing nausea and vomiting;
nervousness; numbness or tingling of hands, feet, or face; paralysis; shortness
of breath; or sudden weakness.