Warfarin (Coumadin) & Warfarin Antidotes

Maintain Same Diet

Same-types of Food Educate the patient to maintain a consistent diet and to notify their provider of any dietary changes. Changes in consumption of foods high in vitamin K like green leafy vegetables may alter plasma levels of vitamin K.

Atrial Fibrillation (A-Fib)

A triq-heart Alarm-clock Atrial fibrillation results when there is ineffective atrial contractions. This leads to blood stasis in the atria， which can result in thrombus formation, increasing the risk of stroke and other embolic events. Warfarin prevents clot formation.

Q14. Which of the following is the most common indication for the use of warfarin?

A. Abnormal Bleeding B. Chronic Necrotizing Infection C. Chronic Anticoagulation D. Ulcerative Colitis E. Dysmenorrhea F. Men or rhea Chronic Anticoagulation Crone with Ant-tie-clogs This medication is used to decrease the tendency to form or to prevent clots in patients at risk for their formation. Common ailments requiring chronic anticoagulation include atrial fibrillation, artificial heart valves, previous pulmonary embolism and previous deep vein thrombosis.

Q15. Which of the following medications is used as a reversal agent for warfarin?

A. Ascorbic acid B. Protamine Sulfate C. Alteplase D. FFP+Vitamin K E. Whole Blood F. Eculizumab FFP Frozen Plasma-tv and Viking(K) If reversal of warfarin action is necessary, or if there is a case of severe bleeding, vitamin K+ fresh frozen plasma is administered. These can lead to a rapid reversal of warfarin's effects.

Q6. Which of the following conditions is an indication for the use of warfarin (Coumadin) ?

A. Atrial Fibrillation B. Pulmonary Stenosis C. Atrial Septal Defect (ASD) D. Myocarditis E. Coronary Vasospasm F. Pulmonary Fibrosis Atrial Fibrillation Atrig-heart Alarm-clock Atrial fibrillation results when there is ineffective atrial contractions. This leads to blood stasis in the atria， which can result in thrombus formation, increasing the risk of stroke and other embolic events. Warfarin prevents clot formation.

Q4. Which of the following laboratory values should be monitored in patients taking warfarin (Coumadin) ?

A. Bleeding Time Lab Values B. Thrombin C. PT/INR Levels D. Creatinine Lab Values E. Potassium (K+) Lab Value F. Platelet Lab Value PT/INR Levels PT-hourglass at International-building Prothrombin time(PT) and international normalized ratio(INR) levels will be routinely checked on patients taking Warfarin. Educate the patient on the importance of these routine appointments as their dosage will change depending on their blood levels. Therapeutic levels for the INR depend on the provider and diagnosis, but can range between 2.5-3.5. These values are frequently followed at the beginning of treatment and are tapered off to every 2-4 weeks once stable.

Q11. Which of the following is an important consideration when administering warfarin?

A. Bridge with Aspirin B. Bridge with Heparin C. Bridge with Vitamin K D. Bridge with Clopidogrel E. Bridge with Dabigatran F. Bridge with Phenoxybenzamine Bridge with Heparin

Q19. Warfarin is metabolized through which of the following pathways?

A. Cytochrome P 460 B. Cytochrome P 450 C. Cytochrome P 425 D. Common Pathway E. In de novo pyrimidine synthesis pathway F. Purine Synthesis Pathway Warfarin is metabolized through the cytochrome P-450 pathway 细胞色素 P450, and medications that induce or inhibit this pathway may lead to adverse effects. P-450 inhibitors would decrease the metabolism of warfarin and can lead to increased bleed risk. P-450 inducers could cause decreased bioavailability of warfarin and decreased anticoagulation.

Q5 Which of the following medications is used to reverse the effects of warfarin?

A. Digiti Minimi (Antidote) B. N-acetylcysteine Antidote C. Alteplase D. Vitamin K and Fresh Frozen Plasma E. Whole Blood F. Eculizumab Viking King with FFP Frozen Plasma-tv Vitamin K (phytonadione) is the antidote for warfarin. A typical dose is 10 mg in 50cc lV bag that boluses over 15 minutes. Fresh Frozen Plasma (FFP) can also be given depending on the INR level.

Q8. Which of the following should be monitored in patients taking warfarin(Coumadin) ?

A. Fat-Soluble Vitamin Levels B. Observe for Bleeding C. Potassium(K+) Lab Value D. Calcium Levels E. Sodium Levels F. Creatinine Lab Values Observe for Bleeding Observatory with Blood Bleeding gums while brushing teeth or prolong bleeding when a laceration is present can indicate that the INR is elevated. Gastrointestinal bleeding may occur with patients that are taking Warfarin. Educating the patient to monitors tool color can help inform the patient when to seek medical attention.

Q1: What is the mechanism of action of warfarin(Coumadin) ?

A. IIb/III a Receptor Inhibitors B. Suppress Thromboxanes and Prostaglandins C. Inhibits Clotting Factors D. Irreversible inhibition of COX-1 and COX-2 E. Tissue Plasminogen Activator F. ADP Receptor Antagonist Inhibits Clotting Factors Inhibiting chains on Clog Factory Warfarin (Coumadin) inhibits clotting factors I(prothrombin), VII， IX， X. This is accomplished by suppressing vitamin K in the clotting cascade. 级联/层叠 Vitamin K is used in the clotting cascade to activate certain clotting factors.

Q3. Which of the following patient recommendations is most likely associated with warfarin (Coumadin) use?

A. Limit Protein in Diet B. Avoid Alcohol C. Low Calorie， LowFat Diet D. High Calorie Diet E. Maintain Same Diet F. Avoid Use in Cardiac Patients Maintain Same Diet Same-types of Food Educate the patient to maintain a consistent diet and to notify their provider of any dietary changes. Changes in consumption of foods high in vitamin K like greenleaf y vegetables may alter plasma levels of vitamin K.

Q13. Which of the following side effects is most likely to be seen in patients taking warfarin?

A. Necrosis B. Secondary polycythemia C. B 6 Deficiency D. Decreased Renal Function E. Hydrocephalus F. Adrenal Insufficiency Necrosis-crow Though rare, warfarin necrosis is a very serious side effects seen in patients taking this medication and leads to massive thrombus formation, causing skin necrosis and gangrene.This side effect stems from the initial inhibition of proteins C and S， leading to a prothrombotic state when starting this medication. Patients who are protein C deficient are more susceptible to this effect.

Q17. Which of the following sideeffects is most likely to be seen in patients taking warfarin?

A. Palmar Erythema B. Increased ICP C. Hypercoagulability D. Bleeding E. Hyperkalemia F. Decreased Renal Function Bleeding Hemorrhage is the most common side effect of warfarin administration. For this reason, physicians monitor patient PT and INR to make sure that it is only 2-4 times the normal range.

Q10. Which of the following conditions IS an indication for the use of warfarin(Coumadin) ?

A. Pellagra B. Retrograde Venous Flow C. Venous Thrombosis D. Raynaud's Phenomenon E. DVT during pregnancy F. Sheehan's Syndrome Venous Thrombosis Vines Trombone Thrombosis is a blood clot that forms in the blood vessel that can partially or fully obstruct the blood flow. Thrombosis typically happens in a deep vein， which is know nasa Deep Vein Thrombosis(DVT) .These clots can break off and travel to vital organs resulting in restricted blood flow. Warfarin prevents further development of the thrombosis.

Q16. Which of the following is the most likely target of warfarin therapy?

A. Pentose Phosphate Pathway B. De Novo Pyrimidine Synthesis Pathway C. Glucose Pathway D. Extrinsic Pathway E. Glycolysis F. Pyrimidine Synthesis Pathway Extrinsic Pathway, X-Triscuit Pathway The effect of warfarin takes several days to develop because of the half-lives of already activated factors. This medication acts on the extrinsic pathway by preventing the activation of vitamin K, warfarin reduces the production of factors I, VII, IX, X, Protein C and S.

Q7. Which of the following is a contraindication for the use of warfarin (Coumadin) ?

A. Pregnancy B. Acute Renal Failure(ARF) C. Increased ICP (Intracranial Pressure) D. G6PD Deficiency E. Asthma F. Elderly Pregnancy Caution-tape Pregnant-woman Warfarin is contraindicated in pregnancy as it is a teratogen, an agent that causes birth defects. Patients should be educated about the importance of notifying their physician if they are pregnant or trying to become pregnant, so that an alternative medication can be prescribed, such as heparin instead of warfarin. Warfarin crosses the placenta as well as enters breast milk.

Q18. Which of the following is most likely a contraindication for the use of warfarin?

A. Pregnancy B. Severe Hypotension C. Alcoholism D. Bernard-Soulier Syndrome E. Pernicious Anemia F. Neonatal Hypoglycemia Pregnant-woman with Caution-tape This drug has several effects on the fetus. It passes through the placenta and may cause fatal bleeding. It is also a known teratogen and can lead to skeletal abnormalities. Administration in the third trimester may give rise to CNS disorders.

Q2: Which of the following conditions is an indication for the use of warfarin(Coumadin) ?

A. Raynaud's Phenomenon B. Sheehan's Syndrome C. Retrograde Venous Flow D. Coronary Vasospasm E. Pulmonary Embolism F. Atrial Septal Defect(ASD) Pulmonary Embolism (PE) Lungs Elmo Pulmonary embolism is a life-threatening event where a thrombus becomes lodged in a pulmonary artery blocking the circulation. An emboli typically evolves from a thrombosis. Patients with high risk or past events of a PE are often placed on Warfarin.

Q12. Which of the following best describes the mechanism of action of warfarin?

A. Synthesizes Clotting Factors II, VII， IX， X B. Epoxide reductase Agonist C. Irreversible inhibition of COX-1 and COX-2 D. IIb/IIIa Receptor Inhibitors E. Interferes with Vitamin K-dependent Clotting Factors F. ADPReceptor Antagonist Interfering with Viking(K) King ; making Clogs This medication inhibits epoxide reductase. Due to this, vitamin K is unable to be reduced to its active form-hydroquinone(vitamin KH2). This prevents gamma-carboxylation of glutamic acid on the clotting factors I, VII, IX, X, and proteins C and S. These factors are then incapable of binding to blood vessel endothelium, and become biologically inactive.

Q21. What can help reverse the anticoagulation effects of warfarin but does not have immediate onset of action?

A. Vitamin D B. Vitamin K C. Viking(K) King D. Vitamin B 6 E. Vitamin C F. Fresh Frozen Plasma Protamine Sulfate Vitamin K is involved in the production of coagulation factors, I, VII, IX, X, protein C and S. Giving vitamin K can help reverse the anticoagulation effects of warfarin but it does not have immediate onset of action.

Q20. Which of the following is a treatment for warfarin toxicity in the setting of an acute bleed, or extreme coagulopathy?

A. Whole Blood B. Intravenous Immunoglobulin (IVIG) C. Fresh Frozen Plasma D. Vitamin K E. Packed Red Blood Cells F. Protamine Sulfate Frozen Plasma-TV Fresh frozen plasma(FFP) refers to the liquid portion of human blood that has been frozen and preserved after a blood donation. FFP replaces factors Ⅱ, V, VII, IX, X, and Xl helps to reverse warfarin effects much quicker than vitamin K.

Q9. Which of the following statements is most likely to be true about warfarin(Coumadin) ?

A.Prolonged Therapeutic Onset B. Avoid Antacids C. Fast Onset D. Must Not Take with Milk，Antacids， Iron E. Alleviated with Leucovorin Rescue F. Avoid Use in Cardiac Patients Prolonged Therapeutic Onset Long On-switch Warfarin has a prolonged time to reach therapeutic levels which usually takes 2-3 days. Remember that patients are still at risk for thrombotic events during this time and are usually administered heparin alongside warfarin until therapeutic levels are reached.

Chronic Anticoagulation

Crone with Ant-tie-clogs 慢性抗凝 This medication is used to decrease the tendency to form or to prevent clots in patients at risk for their formation. Common ailments 病痛 requiring chronic anticoagulation includes atrial fibrillation 心房纤颤， artificial heart valves 人造心脏瓣膜, previous pulmonary embolism 肺栓塞, and previous deep vein thrombosis 深静脉血栓

Fresh Frozen Plasma (FFP)

Fresh frozen plasma refers to the liquid portion of human blood that has been frozen and preserved after a blood donation. FFP replaces factors I, V, VII, IX, X, XI and helps to reverse warfarin effects much quicker than vitamin K.

Bleeding

Hemorrhage is the most common side effect of warfarin administration. For this reason, physicians monitor patient PT and INR to make sure that it is only 2-4 times the normal range.

Bridge with Heparin

Heparin is usually administered with warfarin to prevent thrombosis. This is because for the first 4-5 days, though warfarin is preventing active factors from being formed, the previously formed factors must degrade. After administration, it causes a decline in factor VII but takes more time to decrease factor Ⅱ. Furthermore, proteins C and S are decreased, leading to a prothrombotic state initially. 血栓前状态

Inhibits Clotting Factors

Inhibiting-chains on Clog Factory Warfarin(Coumadin) inhibits clotting factors II (prothrombin), VII, IX, X. This is accomplished by suppressing vitamin K in the clotting cascade. Vitamin K is used in the clotting cascade to activate certain clotting factors.

Interferes with Vitamin K-dependent Clotting Factors

Interfering with Viking (K) King making Clogs 堵塞 This medication inhibits epoxide reductase. Due to this, vitamin K is unable to be reduced to its active form-hydroquinone (vitamin KH2) 氢醌. This prevents gamma-carboxylation of glutamic acid on the clotting factors I， VII， IX， X, and proteins C and S. These factors are then incapable of binding to blood vessel endothelium, and become biologically inactive.

Pulmonary Embolism

Lungs Elmo Pulmonary embolism is a life-threatening event where a thrombus becomes lodged in a pulmonary artery blocking the circulation. An emboli typically evolves from a thrombosis. Patients with high risk or past events of aPE are often placed on Warfarin. embolus/复数 emboli

Necrosis

Necrosis-crow Warfarin- induced skin necrosis Though rare, warfarin necrosis is a very serious side effect seen in patients taking this medication and leads to massive thrombus formation, causing skin necrosis and gangrene 生坏疽；腐败. This side effect stems from the initial inhibition of proteins C and S, leading to a prothrombotic state when starting this medication. Patients who are protein C deficient are more susceptible to this effect.

Observe for Bleeding

Observatory with Blood Bleeding gums while brushing teeth or prolong bleeding when a laceration is present can indicate that the INR is elevated. Gastrointestinal bleeding may occur with patients that are taking Warfarin. Educating the patient to monitors tool color can help inform the patient when to seek medical attention.

PT/INR levels

PT-hourglass at International-building Prothrombin time(PT) and international normalized ratio (INR) levels will be routinely checked on patients taking Warfarin. Educate the patient on the importance of these routinebappointments as their dosage will change depending on their blood levels. Therapeutic levels for the INR depend on the provider and diagnosis, but can range between 2.5-3.5. These values are frequently followed at the beginning of treatment and are tapered off 逐渐细少 to every 2-4 weeks once stable.

Pregnancy

Pregnant-woman with Caution-tape This drug has several effects on the fetus. It passes through the placenta and may cause fetal bleeding. It is also a known teratogen 致畸物 and can lead to skeletal abnormalities. Administration in the third trimester may give rise to CNS disorders.

Cytochrome P-450

Side-toe-chrome P450- rocket Warfarin is metabolized through the cytochrome P-450 pathway, and medications that induce or inhibit this pathway may lead to adverse effects. Cytochrome P-450 (inducers/inhibitors) P-450 inhibitors would decrease the metabolize of warfarin, and can lead to increased bleed risk. P-450 inducers could cause decreased bioavailability of warfarin and decreased anticoagulation.

FFP + Vitamin K

Viking (King) with FFP Frozen Plasma-tv If reversal of warfarin action is necessary, or if there is a case of severe bleeding, vitamin K + fresh frozen plasma is administered. These can lead to a rapid reversal 迅速逆转 of warfarin's effects. Vitamin K (phytonadione) is the antidote for warfarin. A typical dose is 10mg in 50 cc bag that boluses over 15 minutes. Fresh Frozen Plasma (FFP) can also be given depending on the INR level. phytonadione /ˌfaɪtoʊnəˈdaɪoʊn/n. 植物甲萘醌；维他命 K1（用作凝血药）

Venous Thrombosis

Vines Trombone Thrombosis is a blood clot that forms in the blood vessel that can partially or fully obstruct the blood flow. Thrombosis typically happens in a deep vein， which is know nasa Deep Vein Thrombosis (DVT) . These clots can break off and travel to vital organs resulting in restricted bloodflow. Warfarin prevents further development of the thrombosis.

Warfarin (Coumadin)

War-fairy Warfarin is a medication used in patients needing chronic anticoagulation. It works by inhibiting epoxide reductase, leading to interference in the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X, C, S). War fain or Coumadin works by inhibiting clotting factors and is used in the treatment of atrial fibrillation, venous thrombosis, and pulmonary embolism. Be sure to check PT/INR levels and observe for bleeding. Do not use it in patients who are pregnant, and remember that Vitamin K and FFP are the antidotes. Warfarin has a prolonged therapeutic onset and the patient should be educated to maintain the same diet.

Warfarin Antidotes

Warfarin is an oral anticoagulant used in the prevention of thrombosis and embolism. Warfarin toxicity leads to hemorrhage.

Extrinsic Pathway

X-Triscuit Pathway The effect of warfarin takes several days to develop because of the half-lives of already activated factors. 已激活因子的半衰期 This medication acts on the extrinsic pathway by preventing the activation of vitamin K, warfarin reduces the production of factors I, VII, IX, X, also Protein C and S.

Prolonged Therapeutic Onset

long on-switch Warfarin has a prolonged time to reach therapeutic levels which usually takes 2-3 days. Remember that patients are still at risk for thrombotic events during this time and are usually administered heparin alongside warfarin until therapeutic levels are reached.