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Apo-Warfarin (CAN)
Coumadin
Gen-Warfarin (CAN)
Drug classification
Oral anticoagulant
Coumarin derivative
Pregnancy Category X
ADULTS
GERIATRIC PATIENTS
Lower doses are usually needed; begin with smaller doses than those
recommended for adults and closely monitor PT ratio or INR.
Therapeutic actions
Warfarin inhibits synthesis of vit K-dependent coagulation factors VII, IX, X and II
and anticoagulant protein C and its cofactor protein S. No effects on established
thrombus but further extension of the clot can be prevented. Secondary embolic
phenomena are avoided.
Indications
Adverse effects
Contraindications
Nursing considerations
Assessment
Interventions
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.
[box type=note]WARNING: 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 23, 34.5 with
mechanical prosthetic valves or recurrent systemic emboli.[/box]
[box type=note] WARNING: Double check all drugs ordered for potential drug interactions;
dosage of both drugs may need to be adjusted.[/box]
Use caution when discontinuing other drugs; warfarin dosage may need to be
adjusted; carefully monitor PT values.
Arrange for frequent follow-up, including blood tests to evaluate drug effects.
[box type=note] WARNING: Evaluate for therapeutic effects: INR within therapeutic range.
[/box]
Teaching points
Many factors may change your bodys response to this drugfever, change of
diet, change of environment, other medications. Your dosage may have to be
changed repeatedly. Write down changes that are prescribed.
Do not start or stop taking any medication without consulting your health care
provider. Other drugs can affect your anticoagulant; starting or stopping another
drug can cause excessive bleeding or interfere with the desired drug effects.
Carry or wear a medical ID tag to alert emergency medical personnel that you are
taking this drug.
Avoid situations in which you could be easily injured (contact sports, shaving with
a straight razor).
Have periodic blood tests to check on the drug action. These tests are important.
You may experience these side effects: Stomach bloating, cramps (transient);
loss of hair, rash; orange-red discoloration to the urine (if upsetting, add vinegar to
your urine and the color should disappear).
Report unusual bleeding (from brushing your teeth, excessive bleeding from
injuries, excessive bruising), black or bloody stools, cloudy or dark urine, sore
throat, fever, chills, severe headaches, dizziness, suspected pregnancy.