Warfarin Drug Study

In making a Drug Study, the following elements must be present:

Generic Name and the Brand name (not all brands, just the brand
used by the patient), Action, Indication, Pregnancy Category, Drug
Classification, and Contraindication, Adverse Effect, Drug
interaction and Nursing Consideration/Intervention. Most clinical
instructors preferred this to be in a long bond paper in printed or
handwritten with paper in landscape.
Warfarin sodium
Brand Name: Coumadin, Warfilone (CAN)
Pregnancy Category X
Drug classes: Oral anticoagulant, Coumarin derivative
Therapeutic actions
Interferes with the hepatic synthesis of vitamin K-dependent clotting factors
(factors II-prothrombin, VII, IX, and X), resulting in their eventual depletion
and prolongation of clotting times.
Indications
Venous thrombosis and its extension, treatment, and prophylaxis
Treatment of thromboembolic complications of atrial fibrillation with
embolization, and cardiac valve replacement
Pulmonary embolism, treatment, and prophylaxis
Prophylaxis of systemic embolization after acute MI
Unlabeld uses: prevention of recurrent TIAs, prevention of recurrent MI,
adjunct to therapy in small-cell carcinoma of the lung
Contraindications

 Contraindicated with allergy to warfarin; SBE; hemorrhagic disorders; TB;

hepatic diseases; GI ulcers; renal disease; indwelling catheters, spinal
puncture; aneurysm; diabetes; visceral carcinoma; uncontrolled
hypertension; severe trauma (including recent or contemplated CNS, eye
surgery; recent placement of IUD); threatened abortion, menometrorrhagia;
pregnancy (fetal damage and death); lactation (suggest using heparin if
anticoagulation is required).
Adverse effects
Hemorrhage; GI or urinary tract bleeding (hematuria, dark stools; paralytic
ileus, intestinal obstruction from hemorrhage into GI tract); petechiae and
purpura, bleeding from mucous membranes; hemorrhagic infarction,
vasculitis, skin necrosis of female breast; adrenal hemorrhage and resultant
adrenal insufficiency; compressive neuropathy secondary to hemorrhage
near a nerve, Alopecia, urticaria, dermatitis, Nausea, vomiting, anorexia,
abdominal cramping, diarrhea, retroperitoneal hematoma, hepatitis,
jaundice, mouth ulcers, Priapism, nephropathy, red-orange urine,
Granulocytosis, leukopenia, eosinophilia, Fever, "purple toes" syndrome
Drug Interactions:
Increased bleeding tendencies with salicylates, chloral hydrate,
phenylbutazone, clofibrate, disulfiram, chloramphenicol, metronidazole,
cimetidine, ranitidine, co-trimoxazole, sulfinpyrazone, quinidine, quinine,
oxyphenbutazone, thyroid drugs, glucagon, danazol, erythromycin,
androgens, amiodarone, cefamandole, cefoperazone, cefotetan, moxalactam,
cefazolin, cefoxitin, ceftriaxone, meclofenamate, mefenamic acid,
famotidine, nizatidine, nalidixic acid
Decreased anticoagulation effect may occur with barbiturates, griseofulvin,
rifampin, phenytoin, glutethimide, carbamazepine, vitamin K, vitamin E,
cholestyramine, aminoglutethimide, ethchlorvynol
Altered effects with methimazole, propylthiouracil
Increased activity and toxicity of phenytoin when taken with oral
anticoagulants
Nursing considerations
Do not use drug if patient is pregnant (heparin is anticoagulant of choice);
advise patient to use contraceptives.

 Monitor PT ratio or INR regularly to adjust dosage.

Administer IV form to patients stabilized on Coumadin who are not able to
take oral drug. Dosages are the same. Return to oral form as soon as
feasible.
Do not change brand names once stabilized; bioavailability problems exist.
Evaluate patient regularly for signs of blood loss (petechiae, bleeding gums,
bruises, dark stools, dark urine). Maintain PT ratio of 1.31.5, 1.52 with
mechanical prosthetic valves or recurrent systemic embolism; INR ratio of 2
3, 34.5 with mechanical prosthetic valves or recurrent systemic emboli.
Do not give patient any IM injections.
Double check all drugs ordered for potential drugdrug interaction; dosage
of both drugs may need to be adjusted.
Use caution when discontinuing other medications; warfarin dosage may
need to be adjusted; carefully monitor PT values.
Maintain vitamin K on standby in case of overdose.
Arrange for frequent follow-up, including blood tests to evaluate drug
effects.
Evaluate for therapeutic effects: PT 1.52.5 times the control value; PT
ratio, INR within therapeutic range.