Coumadin Flashcards

Coumadin Overview

• Coumadin is the trade name for the generic drug warfarin.
• Classified as an anticoagulant (therapeutic classification) and falls under the coumarins pharmacologic class.

Therapeutic Action and Side Effects

• Common gastrointestinal side effects include cramps and nausea.
• Dermal necrosis can occur as a skin-related side effect.
• Major risk is bleeding, a hematological side effect.
• Miscellaneous side effects may include fever.

Nursing Implications: Assessment

• Monitor patients for signs of bleeding or hemorrhage.
• Evaluate for additional or increased thrombotic events, with symptoms varying by affected area.
• Older patients (over 60) may respond unpredictably to treatment; more vigilant monitoring is necessary.
• Pediatric patients may require more frequent PT/INR testing to maintain therapeutic levels.
• Frequent monitoring of PT and other clotting factors is essential; therapeutic PT ranges from 1.3 to 1.5 times the control.
• PT values equate to INR, with therapeutic INR range generally being 2-3.
• In high-risk embolism patients, target PT of 1.5-2 or INR of 3-4.5 may be aimed for.
• Track hepatic function and complete blood count (CBC) before and during treatment.
• Check stool and urine for occult blood regularly.

Toxicity and Overdose Management

• If PT is excessively prolonged or mild bleeding occurs, withholding one or more doses of Coumadin may suffice.
• For severe overdose scenarios, vitamin K acts as the antidote; whole blood plasma may be needed in extreme cases due to vitamin K's delayed effect.

Nursing Diagnosis

• Potential nursing diagnoses include ineffective tissue perfusion and risk for injury.

Implementation Strategies

• Coumadin is considered a high-alert medication due to the serious consequences of misadministration.
• Verify recent INR or PT results before administration and have a second practitioner review orders.
• Be aware of interactions with a variety of medications, including prescriptions, over-the-counter drugs, and natural products.
• Administer Coumadin at the same time each day for consistency.
• Medication takes 3-5 days to reach effective levels; often initiated concurrently with heparin.
• Avoid brand interchangeability as potencies may not be equivalent.
• Reconstitute with 2.7 ml of sterile water to create a 2mg/ml solution; discard discolored solutions or those with particulate matter.
• Administer via low bolus injection over 1-2 minutes into a peripheral vein.

Patient and Family Education

• Advise on the importance of consistent medication adherence; missed doses should be taken as soon as remembered but never doubled.
• Inform healthcare providers of any missed doses during check-ups.
• Educate on foods rich in vitamin K and advocate for stable, limited intake to prevent fluctuations in PT levels due to vitamin K acting as a warfarin antidote.