PHARM PROCOTORED MED LIST

Prozac

Fluoxetine Antidepressant, SSRI's Indications: depression, bulimia, OCD< Contraindications: known drug allergy and and MAOI therapy Adverse effects: anxiety, dizziness, drowsiness, insomnia, and others Herbal supplement St johns wort can increase effectiveness taken in the morning because it can make some people feel more energized, especially at the beginning of treatment. DO NOT STOP ABRUPTLY

Zidovudine

Retrovir *Zidovudine (Retrovir) for eg is used by pregnant women with HIV to prevent transmission of disease to infant* Tx: HIV in pregnant women Class: antiretroviral AE: paresthesia, N/V, lactic acidosis, bone marrow supression Teaching: monitor hemoglobin

Chemo drug effects

bone marrow supression alopecia <wbc neuropathy

Advair

salmeterol/fluticasone *Long-acting beta agonist (LABA) inhalers* - Long-acting beta2 agonist bronchodilator - NEVER to be used for acute treatment -Used for the maintenance treatment of asthma and COPD and is used in conjunction with an inhaled corticosteroid - *Salmeterol should never be given more than twice daily nor should the maximum daily dose (one puff twice daily) be exceeded* *Advair inhaler, which consists of salmeterol and fluticasone propionate are used for the prevention of bronchospasms* keeps the air moving, contains corticosteroids to decrease inflammation. Long term maintainence/not for rescue keep the albuterol handy for acute bronchospasms

Antidotes

succinylcholine- anticholinesterase such as neostigmine Opioid - Narcan and Revia Acetaminophen (Tylenol) - acetylcyseine regimen (mucomyst) Anesthesia - dantrolene (skeletal muscle relaxant) Benzodiazepines (CNS Depressant) - flumazenil Barbiturates (CNS depressant) - activated charcoal

NSAIDS

Nonsteroidal anti-inflammatory drugs. Contraindications: Conditions that place the patient at risk for bleeding: Vitamin K deficiency Peptic ulcer disease Bleeding disorders Watch out with children who have had a virus - chicken pox/flu = Reyes syndrome NSAIDs are also used for the relief of: Mild to moderate headaches Myalgia - muscle pain Neuralgia - nerve pain Arthralgia - joint pain The pain associated with arthritic disorders, Treatment of gout and hyperuricemia Ibuprofen = Motrin, Advil Naproxen =Aleve and Naprosyn Ketoorolac = Toradol - short-term use (up to 5 days) to manage moderate to severe acute pain Adverse effects: renal impairment, edema, GI pain, dyspepsia, and nausea -Patient should not be on med for more than 5 days = kidney damage celecoxib (Celebrex) meloxicam (Mobic) (all share - antipyretic, analgesic, antiflammatory) AE: *GI: heartburn to severe GI bleeding* (give Cytotec to tx/prevent bleed) *Hepatotoxicity* *Tinnitus, hearing loss* indomethacin (Indocin) - Uses: RA, OA, acute bursitis or tendonitis, ankylosing spondylitis, acute gouty arthritis, PDA, *and treatment of preterm labor*

Flexeril

(Cyclobenzaprine) Muscle relaxant Antidote - flumazenil

Aricept

donepezil; Alzheimer's disease/dementia; Alzheimer's disease

Lithium

drug used to treat mania * Therapeutic serum level range 0.6-1.2 mEq/L* *levels exceeding 1.5-2.5 mEq/L being to produce toxicity* -toxic effects: gastrointestinal (GI) discomfort, tremor, confusion, somnolence, seizures, and *possibly death*. -monitor sodium levels: normal range (135 to 145 mEq/L) helps to maintain therapeutic lithium levels. adverse effects: *cardiac dysrhythmia* long term use may cause *hypothyroidism*

Lovenox

enoxaparin Anticoagulant Can be given post op Ensure that subcutaneous doses are given subcutaneously, not intramuscularly. Subcutaneous doses should be given in areas of deep subcutaneous fat and sites rotated. Do not give subcutaneous doses within 2 inches of: The umbilicus, abdominal incisions, open wounds, scars, drainage tubes, or stomas Do not aspirate subcutaneous injections or massage the injection site. Rotate injection sites May cause hematoma formation do not aspirate Protamine sulfate can be given as an antidote in case of excessive anticoagulation. Contraindications: in patients w/ indwelling epidural catheters risk of epidural hematoma

Main med for parkinsons

*Carbidopa-Levodopa (sinemet)* - cotraindications in cases of patients with open/angle closure glaucoma. - best taken on an empty stomach -adverse effect : discoloration of urination As PD progresses, it becomes more difficult to control it with levodopa (5-10 years) -Taking levodopa with MAOIs may result in hypertensive crisis - benztropine (Cogentin) Tx: Parkinson's and extrapyramidal symptoms Class: anticholinergic *can cause hyperthermia* AE: TACHYCARDIA, urinary retention, blurred vision, dry throat - take at night and stay hydrated

Dilantin

-Phenytoin (Dilantin) has been used as a first-line drug for many years and is the prototypical drug. TX: seizure disorder/status epilepticus -Adverse effects: gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis *encourage good oral hygiene* -Therapeutic drug levels are usually 10 to 20 mcg/mL. *Good albumin levels are necessary to prevent toxicity* Administration : given via *SLOW IV infusion* large 20 gauge (it is irritating to veins) - *diluted in normal saline* - used w/ filter

Routes of medication administration

1). sublingual(under the tongue) 2). oral (swallowed) 3). inhalation 4). injection 5).buccal (cheek) 6).Rectal(can also be topical) PARENTAL: Intravenous (IV)( fastest delivery into the blood circulation)rapid onset,monitor site,check compatibility,flush in-between meds. Intramuscular:onset period depends on route/site 45 to 90 degree angle (glute prefer / babies - vastus lateralis ; aspirate if you see blood do not use) Subcutaneous(fat) 45 to 90 degree angel Intradermal(Skin) 5 to 15 degree angel Intraartery(artery) Intrathecal(within the sheath of the spine) Intraarticular(joint) ENTERAL : referring to a route of medication administration that uses the gastrointestinal tract, such as swallowing a pill. 1.oral 2.sublingual 3.Buccal(cheek) 4. Rectal(can also be topical) TOPICAL: Applied to surface of skin Skin (including transdermal patches) Eyes Ears Nose Lungs (inhalation) Rectum Vagina EYE DROP: Apply in sac, occlude inner canthus depress the lower lid and place the medication in the lower conjunctival sac. RECTAL : Solid or semi-solid bullet shaped dosage forms. They melt at body temperature, dispersing the medication.-Position client in left lateral position** -Insert suppository just beyond internal sphincter -Instruct client to retain medication 20 to 30 min for stimulation of defecation and 60 min for systemic absorption (lubricate w/ a water based lubricant) Z track technique - technique used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort mix crushed tabs in small art. of soft food clean equipment after use DO NOT crush enteric-coated tabs DO NOT crush timed-release tabs

Vancomycin

30-40 (peak), 5-10 (trough) vancomycin (Vancocin) *Treatment of choice for MRSA* and other gram-positive infections Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis. May cause ototoxicity and nephrotoxicity (reduces kidney function) ****Red man syndrome may occur (itching and flushing of the upper neck) Flushing or itching of head, neck, face, upper trunk *Antihistamine may be ordered to reduce these effects* Additive neuromuscular blocking effects in patients receiving neuromuscular blockers *Should be infused 60> minutes* Rapid infusions may cause hypotension. Normal vanco level is 10 - 20

Antabuse

A drug that, when combined with alcohol, causes violent nausea; it is used to control a person's drinking. treats alcoholism disulfiram (Antabuse) -the patient cannot drink alcohol for at least 3 or 4 days after taking disulfiram (Antabuse)." all forms of alcohol including mouthwash.

Xanax

Alprazolam Benzodiazepine used for alchohol withdrawl and anxiety Antidote: flumazenil

Leucovorin

Antidote for methotrexate toxicity

Nystatin

Antifungal, Mycostatin May follow antibiotic therapy, antineoplastics, or immunosuppressants (corticosteroids) May result in overgrowth and systemic infections Growth in the mouth is called thrush or oral candidiasis -Nystatin AE: Nausea, vomiting, anorexia, diarrhea, rash Contraindications: Liver failure Renal failure Porphyria (griseofulvin) Drug allergy Nystatin given as an oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole). Nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing.

Hydroxychloroquine

Antimalarial Kill parasitic organisms Hydroxychloroquine Has antiinflammatory effects Sometimes used in the treatment of rheumatoid arthritis and systemic lupus erythematosus A/E = dizziness, rash, diarrhea, headache

Digoxin

Cardiac glycoside tx: heart failure) Positive inotrope, negative chronotrope and dromotrope Used for HF, a-fib Can cause dysrhythmias, bradycardia, GI effects (EARLY), vision changes (EARLY) Hypokalemia = toxicity; hyperkalemia = decreased effects (Normal potassium level 3.5 - 5) Eyes: *colored vision (seeing green, yellow, purple), halo vision, flickering lights* Digoxin toxicity signs: anorexia, N/V, visual disturbances, dysrhythmias, fatigue, weakness. Avoid verapamil (CCB) Hold if pulse < 60 Therapeutic level = 0.5-2.0ng/mL *Antidote: cholestyramine or Digibind* Interacts w/ many meds (monitor potassium levels 3.5-5, toxic = >2.0ng/mL)

Misoprostol

Cytotec Prostaglandin E analog *Used w/ NSAIDs to prevent gastric ulcers* Can induce labor Can cause diarrhea, abdominal pain, dysmenorrhea, spotting Take w/ meals and at bedtime

Aspirin

Daily tablet (81 mg or 325 mg): prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or cardiovascular accident prevention of thrombotic events. aspirin - stroke prevention Do not give salicylates to children and teenagers because of the risk of Reye's syndrome.

Mucinex

Guaifenesin Expectorant Productive cough *Expectorants* Drugs that aid in the expectoration *(removal) of mucus* Reduce the viscosity of secretions Disintegrate and thin secretions Example: guaifenesin (mucinex/humibid) *By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished.* *(YOU CANNOT GIVE A EXPECTORANT FOR A NON PRODUCTIVE COUGH)* increase fluid intake

Simvastatin

HMG CoA reductase inhibitor/Statin *-Statins* Inhibit HMG-CoA reductase *first-line drug therapy for hypercholesterolemia* -reduce LDL levels by 30-40% -increase HDL levels by 2-15% -reduce triglycerides by 10-30% AE: flu-like symptoms, myopathy (muscle pain)* possibly leading to rhabdomyolysis* if severe can be serious! Hepatotoxicity : signs of poor liver function (vomiting, nausea, jaundice). Do not take with grapefruit juice Take at bedtime Interactions : Oral anticoagulants - Coumadin (warfarin) Grapefruit juice at bedtime or with evening meal. *Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption.*

Lisinopril

Hypertension HF (either alone or in combination with diuretics or other drugs) Slow progression of left ventricular hypertrophy after myocardial infarction (MI) * (cardioprotective)* *Renal protective effects* in patients with diabetes ACE Inhibitors (-prils) *Captopril and lisinopril* are NOT prodrugs Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective. Captopril and lisinopril can be used if a patient has *liver dysfunction*. AE: Fatigue Dizziness Headache Mood changes Impaired taste Possible hyperkalemia Dry, nonproductive cough, which reverses when therapy is stopped Angioedema (swelling of the tongue and throat: rare but potentially fatal, treat with epi) Note: First-dose hypotensive effect may occur.

Main TB drugs (A/E)

INH: peripheral neuropathy (GIVE B6 TO TREAT), hepatotoxicity Ethambutol: retrobulbar neuritis, blindness Rifampin: hepatitis; discoloration of urine (red orange color), stools, and other body fluids Pyrazinamide and rifampin can both cause hepatotoxicity, thus the provider will monitor liver function regularly. Contraindication: hepatic/liver impairment and contraceptives Perform liver function studies in patients who are to receive INH or rifampin (especially in older patients and those who use alcohol daily).

Methotrexate

Interferes with the use of folic acid; cannot reproduce DNA Used in combination with other drugs to treat various types of cancer, such as solid tumors and some hematologic cancers Methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis. AE: Hair loss, nausea and vomiting, myelosuppression/bone marrow suppression

Synthroid

Levothyroxine Hypothyroidism Levothyroxine (Synthroid, Levoxyl) Take med on an empty stomach 30 - 60 mins before breakfast. Give at the same time each day to maintain consistent blood levels. Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt). Teach patients to take thyroid drugs once daily in the morning to decrease the likelihood of insomnia if taken later in the day. Antacid and OCT preparation with iodine must also be avoided. Iodized salt and iodine rich foods such as soybean,tofu,turnips,high-iodine seafood and some breads must be avoided. (NO SOY, AE: CARDIAC DHYSTHRYMIAS)

Lasix

Most commonly used loop diuretic Uses: pulmonary edema and the edema associated with HF, liver disease, nephrotic syndrome, ascites, hypertension Causes photosensitivity so avoid prolonged sun exposure -Act directly on the loop of Henle and blocks chloride, sodium and water reabsorption *best given in the morning* LAST 6 HOURS, ORAL 30-60 MIN AFTER INGESTION, IV 2-5 MIN. Useful in treatment of edema, pulmonary edema, HBP Useful in emergencies to get rid of excess fluid. INDICATIONS - To increase renal excretion of calcium in patients with hypercalcemia Drug effects: - decreased fluid volume causes a reduction in: Blood pressure Potassium (hypokalemia) and sodium depletion AE: (CNS) - Dizziness, headache, *tinnitus*, blurred vision Cardiac - hypotension Gastrointestinal (GI - Nausea, vomiting, diarrhea Integumentary- Stevens-Johnson syndrome (torsemide) Some ototoxicity can be experienced with lasix Hematologic - Agranulocytosis, neutropenia, thrombocytopenia Metabolic -Hypokalemia, hypomagnesia hyperglycemia, hyperuricemia hyponatremia dehydration *Teach patients to eat more potassium foods (bananas, potatoes, nuts) Signs of hypokalemia: nausea, vomiting, leg cramps, gen. weakness Signs of dehydration:dry mouth, increased thirst,weight loss, minimal urine output* Must monitor patient electrolyte levels INTERACTIONS: NSAIDS - decrease blood flow to the kidneys Hypokalemia may lead to digoxin toxicity Hyponatremia can lead to lithium toxicity

Steroids

Prendi(sone) Cautious use in patients with: Gastritis, reflux disease, ulcer disease Diabetes Cardiac, renal, or liver dysfunction AE: Potent effects on all body systems Cardiovascular: heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia) CNS: convulsions, headache, vertigo, mood swings, nervousness, insomnia INTERACTIONS: Multiple drug interactions, including: Non-potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypocalcemia and hypokalemia. Antidiabetic drugs may reduce the hypoglycemic effects of the latter and result in elevated blood glucose levels. *Glucocorticoids*: for control of steroid responsive bronchospastic states. AE: Hypokalemia, hypernatremia, convulsions, headache, vertigo, insomnia, mood swings, nervousness Inhaled Drugs: Beclomethasone, dexamethasone, flunisolide, triamcinolone, fluticasone: AE: -Androgens cause fluid retention. -Anabolic steroids (Liver problems) -Peliosis of the liver (blood cavities in the liver) -Hepatic neoplasms (liver cancer) -Cholestatic hepatitis -Jaundice -Abnormal liver function

Meds for worm

Pyrantel (Pin-X) the treatment of infection with intestinal roundworms, including ascariasis, enterobiasis, and other helminthic infections Only anthelmintic available in the United States without a prescription AE: Nausea Vomiting Diarrhea Dizziness Headache Praziquantel (Biltricide) Used to treat fluke infections, some tapeworms

Flomax

Tamsulosin BPH -treat both HTN and BPH. - Contraindications - drug allergy and ED drugs such as sildenafil (viagra) - can cause too much dilation adverse affects : headaches, abnormal ejaculation

Atenolol

Tenormin Beta Blocker used to prevent future heart attacks in patient who have had one tx: hypertension and angina

Tetracycline

Tetracyclines demeclocycline (Declomycin) oxytetracycline (Terramycin) tetracycline doxycycline (Doryx, Vibramycin) minocycline (Minocin) tigecycline (Tygacil) Indications: Wide spectrum Gram-negative and gram-positive organisms, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease, acne, others Demeclocycline is also used to treat SIADH by inhibiting the action of ADH Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug- binding that occur. Take all medications with 6 to 8 oz of fluid, preferably water. Because of photosensitivity, *avoid sunlight and tanning beds.* AE: *Strong affinity for calcium* *Discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants if taken by the mother* May retard fetal skeletal development if taken during pregnancy Alteration in intestinal flora may result in: Superinfection (overgrowth of nonsusceptible organisms such as Candida Diarrhea Pseudomembranous colitis May also cause: Vaginal candidiasis, Gastric upset, Enterocolitis, Maculopapular rash *Avoid direct sunlight and tanning beds while on these medications*

Rescue drugs

Used for immediate relief of breakthrough symptoms of tightness, wheezing and SOB. *Aminophylline:* intravenous (IV) treatment of patients with *STATUS ASTHAMATIC* who have not responded to fast-acting beta agonists such as epinephrine Therapeutic range: for theophylline blood level is *10 to 20 mcg/mL* Most clinicians now advise levels between 5 and 15 mcg/mL. Albuterol - Short-acting beta2-specific bronchodilating beta agonist (SABA FOR ACUTE) *Most commonly used drug in this class* Must not be used too frequently Oral and inhalational use Inhalational dosage forms include metered-dose inhalers (MDIs) as well as solutions for inhalation. MONA: Morphine Oxygen Nitro Aspirin

Propranolol

Uses: migraines, HTN, angina, arrhythmia, hypertrophic cardiomyopathy, thryotoxicosis, MI Contraindications - patients with bronchial asthma

Niacin

Vitamin B3 -*Lipid-lowering properties require much higher doses than when used as a vitamin* -Effective, inexpensive -increase HDL -Reduces the metabolism or catabolism of cholesterol and triglycerides Do not use in patients with gout, HTN, liver disease, active bleed. *AE:* Flushing (caused by histamine release) - advise patient to take aspirin/steroid 30 minutes before dose, can be minimized by starting with smaller doses first. Pruritus *Hyperglycemia* *Hepatotoxicity*

Acyclovir

Zovirax Antiviral *Topical acyclovir can cause burning when applied* *Infuse intravenous acyclovir slowly, over at least 1 hour as med can cause phlebitis.* *A/E = diarrhea so increase fluid intake and take with food* Used to suppress replication of HSV-1, HSV-2, VZV *Drug of choice for treatment of initial and recurrent episodes of these infections* Oral, topical, parenteral forms best results are generally seen when the antiviral drug is started within 72 hours of symptom onset

Opioids

acceptable for moderate to severe pain. Medications include morphine sulfate, oxycodone (OxyContin), and fentanyl (Duragestic). Combining a nonopioid and an opioid medication treats pain peripherally and centrally...this offers greater analgesia with less adverse effects (respiratory depression, constipation, nausea). AE: Respiratory Depression Constipation Nausea and Vomiting Treat: Moderate and Severe pain, cough center suppression,treatment of diarrhea Mild agonist: codeine , hydrophone Strong agonist: Morphine Ceiling effect: Drug reach maxim analgesic effect Antidote for overdose: narcan and revia

Tylenol

acetaminophen To prevent fever-->antipyretic effects and reduce pain Mild to Moderate pain does not have anti- inflammatory effects Contraindications: Liver dysfunction and Liver failure Normal dose w/ liver failure: 2000 mg for older adults Antidote: Acetylcysteine regimen (Mucomyst)--> smells like rotten egg AE: hepatic failure w/ high doses and nephrotoxcity w/ od

Verapamil

calcium channel blocker. -dipine: Primary use: treatment of hypertension and angina. Hypertension: cause smooth muscle relaxation by blocking the binding of calcium to its receptors, thereby preventing contraction, blood vessel vasodilation Results in: Decreased peripheral smooth muscle tone Decreased SVR *Decreased BP* Indications: Angina Hypertension Dysrhythmias Migraine headaches Raynaud's disease Complications: Verapamil & Diltaizem: Orthostatic hypotension Peripheral edema - (avoid w/ digoxin) Constipation(primarily with verapamil) Bradycardia, heart failure Dysrhythmias Acute toxicity - bradycardia, hypotension, dysthymias no grapefruit juice. Give epi for OD.

Garlic

can affect coumadin ; promote bleeding

MAOIs

class of antidepressant drugs sometimes used for treating Parkinson's Disease selective: Selegiline Disadvantage: potential to cause hypertensive crisis when taken with *tyramine* Aged cheeses (cheddar, bleu, Swiss) Smoked, pickled, or aged meats Yeast extracts Red wines Italian broad beans

Humalog

insulin lispro Diabetes Rapid-acting Ex: Lispro (Humalog) "make sure you've got food ready to pass immediately onset 15 min, peak 1 hr, duration 2-4 hrs May be given subcutaneously (SQ), continuous SQ infusion pump (but not intravenously [IV]) Use only insulin syringes for administration

Nitro

nitroglycerine angina Large first-pass effect with oral forms Used for symptomatic treatment of ischemic heart conditions (angina) IV form used for BP control in perioperative hypertension, treatment of heart failure (HF), ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies Oral and topical forms can be used for long term prevention of chest pain Prevents angina in stressful situations *AE:* *Headaches* - use aspirin or Tylenol to relieve pain Usually diminish in intensity and frequency with continued use *Reflex tachycardia:* administer BB if needed *Postural/orthostatic hypotension* *Tolerance* may develop - take long acting forms with a medication-free period each day. *CONTRAINDICATIONS* Known drug allergy Severe anemia Closed-angle glaucoma *Hypotension* - vasodilates Severe head injury *Use of the erectile dysfunction drugs sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)* severe liver/kidney disease or any other vasodilator - dilate vessels - relief of anginal pain - causes systemic vasodilation - rest and nitro relieve angina side effects: orthostatic hypotension, flushing , headache Available forms Sublingual* Chewable tablets Oral capsules/tablets Intravenous (IV) solutions* Transdermal patches* Ointments Translingual sprays* Do not wait till pain is severe to take sublingual tab or spray. If pain is not relieved by 1st tab call 911 then take 2nd tab, a 3rd tab may be taken if pain not relieved. Do not take more than 3 tabs. Patch should be placed on hairless area of skin (chest, back, abdomen) Bypass the liver and the first-pass effect. Rapid-acting forms Used to treat acute anginal attacks Sublingual tablets; IV infusion Long-acting forms Used to PREVENT anginal episodes; transdermal patch (remove patch during bed times, 8 hrs, apply new) tolerance may develop Nitroglycerin (both rapid and long acting) Isosorbide dinitrate (both rapid and long acting) Isosorbide mononitrate (primarily long acting) - recommended for African American

Pitocin

oxytocin labor inducer Used to induce labor at or near full-term gestation and to enhance labor when contractions are weak and ineffective Other uses Prevent or control postpartum uterine bleeding Complete an incomplete abortion (after miscarriage) Promote milk ejection during lactation

Coumadin

warfarin (anticoagulant) prevents clot formation. warfarin:can cause skin necrosis and purple toes s acute bleeding process or high risk for such an occurrence. increase bleeding-ginger,ginkgo,garlic,fever few Dietary considerations: foods high in Vitamin K reduces drug ability to prevent clots; increased bleeding with gingko and garlic Contraindications: Drug allergy pregnancy bleeding process high risk of an occurrence LMWHS in patient with indwelling epidural catheter risk of epidural hematoma Life-threatening bleeding from warfarin: Kcentra and Profiline IV vitamin K: risk of anaphylaxis. Risk is diminished by diluting it and giving it over 30 minutes. Dietary considerations: foods high in Vitamin K reduces drug ability to prevent clots; increased bleeding with gingko and garlic Antidote: vitamin K Coumadin-Prothromin time/international normalized ratio(PT/INR) A normal INR without warfarin is 1.0,but a therapeutic INR with warfarin ranges from 2 to 3.5 depending on the indication for use of the drug. (if it is too high then you are prone to bleeding, give vitamin K)