INDEX Generic Name warfarin Trade Name Coumadin

NURS 2236 Clinical Form 3: Clinical Medications Worksheet (You will need to made additional copies of these forms) Classification Dose Route Time/Frequency 2.5-10mg PO Daily for 2-4 days then adjust daily dose by results anticoagulants of prothrombin time.

Peak Onset 5-7 days 36-72 hours Why is your patient taking this medication?

Duration 2-5 days

For IV meds, compatability with IV drips and/or solutions

Mechanism of action and indications Prophylaxis and treatment of Venous thrombosis, pulmonary embolism, atrial fibrilation with embolization, Management of MI's (decreases risk of death, decreases risk of subsequent MI, and decreases risk of future thromboembolic events.) Prevention of thrombus formation and embolization after prosthetic valve placement. Prevention of thromboembolic events Interactions with other patient drugs, OTC, or herbal medicines (ask patient specifically) Abciximab, androgens, capecitabine, cefoperazone, cefotetan, chloral hydrate, chloramphenicol, clopidogrel, disulfiram, fluconazole, fluoroquinolones, itraconazole, metronidazole, thrombolytics, eptifibatid, tirofiban, ticlopidine, sulfonamides, quinidine, quinine, NSAID's, valproates, aspirin, acetaminophen, alcohol, barbiturates, hormonal contraceptives, Nursing Process - Assessment (Pre-administration assessment) Signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stool; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools, urine, or nasogastric aspirate. vital signs

Nursing Implications (what to focus on) Contraindications/warnings/interactions Uncontrolled bleeding, open wounds, active ulcer disease, recent brain, eye, or spinal cord injury, or surgery, severe liver or kidney disease, uncontrolled hypertension, preganancy Use cautiously in: malignancy, patients with history of ulcer or liver disease, history of poor compliance, and women with childbearing potential. Common side effects Cramps, nausea, dermal necrosis, bleeding and fever

Lab value alterations caused by medicine

Be sure to teach the patient the following about this medication Limit intake of Vitamin K foods, avoid IM injections, or activities leading to injury, use soft toothbrush, don't floss, shave with electric razor, venipunctures and injection sites require pressure to prevent bleeding or hematoma formation. Report and sign of bleeding or bruising; Don't dring alcohol or take OTC, especially those containing aspirin; frequent lab test to monitor. Assessment Evaluation Why would you hold or not give Check after giving this med? Prolonged PT (1.3-2.0 times the control; may PT is excessively prolonged or if minor vary with indication) or INR of 2-4.5 without bleeding occurs. signs of hemorrhage.