ORFARIN

ORFARIN

GENERIC NAME:

Warfarin Sodium

DOSAGE:

·         3 MG/TABLET

·         5 MG /TABLET

INDICATION:

Ø  Deep venous thrombosis

Ø  Pulmonary embolism

Ø  Prevention of thromboembolic complications ( stroke / systemic embolism ) after MI

Ø  Prevention of thromboembolic complications ( stroke / systemic embolism) in patient with AF, cardiac  valvular disease or prosthetic heart valves.

CONTRAINDICATIONS:

Ø  Pregnancy and lactation

Ø  Bleeding tendency ( von Willebrand disease , hemophilia, thrombocytopenia, and platelet function disorder)

Ø  Severe hepatic insufficiency and hepatic cirrhosis

Ø  Untreated or uncontrolled hypertension

Ø  Recent intracranial hemorrhage . E.g aneurysms

Ø  Surgery of the CNS

Ø  Gastrointestinal or urinary tract haemorrhage.

Ø  Infectious endocarditis, pericarditis or pericardial effusion.

SPECIAL PRECAUTIONS:

Ø  Hyperthyroidism, fever and uncompensated heart  failure may enhance the wafarin effect.

Ø  Heparin therapy is continued along with the initiated warfarin therapy for at least 5  to 7 days until the INR has been at the target level for at least 2 days.

Ø  To avoid coumarin necrosis,patient with a hereditary deficiency of protein C and S should first start heparin for 5 to 7 days along with warfarin therapy .

Ø  Patient must compliance and the abilities to follow strict rules on drug intake.

OVER DOSAGE:

Ø  STOP WARFARIN THERAPY TEMPORARILY

Ø  IF PATIENT TAKE A LARGE AMOUNT OF WARFARIN, GASTIC LAVAGE IS NOT RECOMMENDED BECAUSE  THE RISK  OF BLEEDING COMPLICATIONS.

Ø  ADMISTER IV VITAMIN K.

Ø  IF BLEEDING COMPLICATION OCCUR, THE WARFARIN EFFECT CAN BE REVERSED  BY VITAMIN K , COAGULATION FACTOR CONCENTRATE OR FROZEN PLASMA .

DRUG HAVE BEEN REPORTED TO POTENTIATE OR REDUCE THE WARFARIN EFFECT:

INCREASED EFFECT:

·         Allopurinol, gemfibrozil, grepafloxacin, ifosamide, indomethacin                                                           

·         Amiodarone, influenza vaccine, interferon alpha and beta,itraconazole, carboxyuridine

·         Acetylsalicylic acid,claritromycin,Azapropazone

·         Azithromycin,Vit.A,Vit.E

·         Bezafibrate,Dextropropoxiphene,Digoxin

·         Disulphiram,Erythromycin,Etoposide

·         Fenofibrate,Phenylbutazone,Feprazone

·         Fluconazole,Flutamide,fluvastatin

Action of Warfarin:

·         Warfarin interferes with hepatic synthesis of vitamin K-dependent clotting factors, resulting in depletion of coagulation factors II, VII, IX, and X.

·         Prevents further extension of formed existing clot, prevention of new clot formation, and secondary thromboembolic complications.

Side Effects of Warfarin

• GI distress: nausea, anorexia, abdominal cramps, and diarrhea.
• Hypersensitivity reaction: dermatitis and urticaria. (Especially in patients sensitive to aspirin.)

Nursing Cosiderations for Clients Taking Warfarin

• Cross-check dose with co-worker (nurse).
• Determine INR prior to administration and daily following therapy initiation. When stabilized, follow with INR determinations ever 4-6 weeks.
• Monitor INR reports diligently.
• Assess hematocrit, platelet count, urine/stool culture for occult blood, AST, ALT, regardless of route administration.
• Be alert to complaints of abdominal or back pain and severe headache.
• Question for increase in amount of discharge during menses.
• Assess area of thromboembolus for color and temperature.
• Assess peripheral pulses; skin for bruises, and petechiae.
• Check for excessive bleeding from minor cuts, and scratches.
• Assess for gums for erythema and gingival bleeding.
• Assess urine output for hematuria.
• Scored tablets may be crushed.
• Give without regard to food. If GI upset occurs, give with food.

Patient Teachings for Clients Taking Warfarin

• Take medication exactly as prescribed.
• Do not take or discontinue any other medication except on advice of physician.
• Avoid alcohol, salicylates, and drastic dietary changes.
• Do not change from one brand to another.
• Consult with physician before surgery or dental work.
• Urine may become red-orange.
• Notify physician if bleeding, bruising, red-brown urine, or black stools occur.
• Use electric razor and soft toothbrush to prevent bleeding.
• Report any sign of coffee-ground colored vomitus and red-speckled mucus from cough.
• Do not use any OTC medication without physician approval.