Name: _Warfarin__________________
CLASSIFICATION: _Anticoagulant____________________________________
GENERIC: _warfarin (Rx)_______________________________TRADE:_Coumadin_____________________
________________
MECHANISM of ACTION:
Interferes with blood clotting by indirect means; depresses
hepatic synthesis of vit K–dependent coagulation factors (II,
VII, IX, X)
THERAPEUTIC USES:
Antiphospholipid antibody syndrome, arterial thromboembolism
prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, thrombosis
prophylaxis, pulmonary embolism
SIDE EFFECTS: CNS: Fever, dizziness, fatigue, headache, lethargyDOSAGE & ROUTE: • Adult: PO 2 mg/day × 2-4 days, then titrated to INR/PT
CV: Angina, chest pain, edema, hypotension, syncope
• Adolescent/child/infant: PO 0.2 mg/kg/day × 2 days titrated to INR
GI: Diarrhea, nausea,
vomiting,
anorexia,
stomatitis, Available forms: Tabs 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg
cramps, hepatitis, cholestatic jaundice
GU: Hematuria
HEMA: Hemorrhage,
agranulocytosis,
leukopenia,
eosinophilia, anemia, ecchymosis, petechiae
INTEG: Rash, dermatitis, urticaria, alopecia, pruritus
MISC: Epistaxis, hemoptysis, mouth ulcers, taste disturbances, CONTRAINDICATIONS/INTERACTIONS: Pregnancy, breastfeeding,
priapism, dyspnea
hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease,
MS: Bone fractures
thrombocytopenic purpura, hepatic disease (severe), malignant hypertension,
SYST: Anaphylaxis, coma, cholesterol, microembolism, exfoliative subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia,
dermatitis, purple toe syndrome
preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with
large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke,
aneurysms, pericardial effusion, spinal puncture, major regional/lumbar block
anesthesia
Black Box Warning: Bleeding
Precautions: Geriatric patients, alcoholism, HF, debilitated patients, trauma,
indwelling catheters, severe hypertension, active infections, protein C deficiency,
polycythemia vera, vasculitis, severe diabetes,
Asian patients (CYP2C9),
protein C, S deficiency.
Increase: warfarin action—allopurinol, amiodarone, chloral hydrate,
chloramphenicol, cimetidine, clofibrate, cotrimoxazole, COX-2 selective
inhibitors, dextrothyroxine, diflunisal, disulfiram, erythromycin, ethacrynic
acids, furosemide, glucagon, heparin, HMG-CoA reductase inhibitors,
indomethacin, isoniazid, mefenamic acid, metroNIDAZOLE, miFEPRIStone,
NSAIDs, oxyphenbutazone, penicillins, phenylbutazone, quiNIDine,
quinolone antiinfectives, RU-486, salicylates, sulfinpyrazone, sulfonamides,
sulindac, SSRIs, steroids, thrombolytics, thyroid, tricyclics
Increase/decrease: effectiveness—assess for use of products that may
increase or decrease effect
Increase: toxicity—oral sulfonylureas, phenytoin
Decrease: warfarin action—aprepitant, azaTHIOprine, barbiturates, bile acid
sequestrants,
bosentan,
carBAMazepine,
dicloxacillin,
estrogens,
ethchlorvynol, factor IX/VIIa, griseofulvin, nafcillin, oral contraceptives,
phenytoin, rifAMPin, sucralfate, sulfaSALAzine, thyroid, vit K, vit K foods
Name: _Warfarin__________________
NURSING INTERVENTIONS : • Pregnancy/breastfeeding: do CLIENT TEACHING: • To avoid OTC preparations that may cause serious
not use in pregnancy; use effective contraception during and
product interactions unless directed by prescriber; to avoid alcohol, herbs,
for 1 mo after final dose; cautious use in breastfeeding
supplements
Black Box Warning: Blood studies (Hct, PT, platelets, occult• To carry emergency ID identifying product taken
blood in stools) q3mo; INR: in hospital daily after 2nd or 3rd• About the importance of compliance with exams and doses
dose; when in therapeutic range (2-3) for 2 consecutive days, Black Box Warning: Bleeding: to report any signs of bleeding: gums,
monitor 2-3× wk for 1-2 wk, then less frequently, depending on nosebleed, under skin, urine, stools; to use soft-bristle toothbrush to avoid
stability of INR results; Outpatient: monitor every few days bleeding gums; to use electric razor
until stable dose, then periodically thereafter, depending on
• To avoid hazardous activities (e.g., football, hockey, skiing), dangerous work
stability of INR results, usually at least monthly
• To inform all health care providers of anticoagulant intake
Black Box Warning: Bleeding: Bleeding gums, petechiae,• To take exactly as prescribed; dosage changes are common for desired effect
ecchymosis, black tarry stools, hematuria, occult bleeding• To eat a diet that is not varied; several foods contain vitamin K and can alter
(cerebral, intraabdominal; fatal hemorrhage can occur, do not warfarin effect
use in uncontrolled bleeding
• To report to prescriber fever, rash, trouble breathing
• Fever, skin rash, urticaria
CLASSIFICATION__________________________________________
GENERIC:_______________________________________TRADE:_____________________________________________
MECHANISM of ACTION:
THERAPEUTIC USES:
SIDE EFFECTS:
DOSAGE & ROUTE:
CONTRAINDICATIONS/INTERACTIONS:
NURSING INTERVENTIONS:
CLIENT TEACHING: