Vitamin K antagonists
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Inhibits the enzyme VKOR which then decrease the clotting factors 2, 7, 9, & 10
- Requires 2 to 3 days of treatment before anticoagulation takes effect
- Warfarin can also inhibit or induce metabolism of other drugs
Competitive antagonism with vitamin K:
- foods containing vitamin K
- (green leafy veggies)
Start at 5 mg then monitor INR
how is therapy monitored?
using the International Normalized Ratio (INR) on exam
what is the INR goal?
- 2-3(majority of ppl)
- and 2.5-3.5 in patients with artificial heart valve ---
- on exam
- Pregnancy (teratogenic!!)
- recent events that predispose to bleeding (stroke, surgery)
- platelet disorders
- Skin necrosis
- “Purple toes” syndrome
- Atheroemboli/cholesterol microemboli
what is the fastest way to correct an overdose of warfarin?
fresh frozen plasma
what can you give when INR is too high?
- Phytonadione (mephyton) 2.5-5 mg PO
- reverses anticoagulant effect of warfarin- vitamin K1
significantgenetic variability in responses to warfarin owing to:
to polymorphisms in 2C9 and VKOR
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