Drug Case Study: Warfarin

Sodium

Basic Overview

Warfarin Sodium is a thrombolytic drug (an agent that dissolves an

existing thrombus when administered after its occurrence) and these types of

drugs diffuse the clot and activate plasminogen that is within it. A

plasminogen is a protein in the prevention of fibrin clot formation (Rice,

2006). Warfarin is also known as the following: Coumadin Sodium, Miradon,

Coumadin, Sintron, Nicoumalone, Dicoumarol, and Warfilone. Warfarin may

be given in doses of 1, 2, 2.5, 3, 4, 5, 6, 7.5 and 10 mgin a tablet form. On

average Warfarin is given in a tablet form. The average prescribed range is 2

to 10 milligrams depending on the individuals INR (INTERTERNATIONAL

NORMALIZED RATIO)/Protimeand if the patient is therapeutic. The physicians

would maintain the patient’s labs on a routine basis and adjust the dosage

accordingly to reach a therapeutic INR (INTERTERNATIONAL NORMALIZED

RATIO). It may also be given intravenously in doses of 2.5 mg/mL

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 intravenously to prevent the blood from clotting and

creating DVTs (deep vein thrombosis) or PEs

(pulmonary emboli.)

This drug is a widely prescribed blood thinner

many times for elderly patients especially for those

suffering from cardiac problems. It is also used in

patients with blood clotting disorders and patients

who are in a stationary position for a long period of

time- for example recovering from a major surgery

such as hip replacements, open heart and even

routine abdominal surgeries (Shannon, Wilson,

Shields, Stang, 2007-2008).

Warfarin is not offered in other forms other than the basic tablet or

liquid form. However, there are other medications that perform faster and

effectively as Warfarin does such as Heparin, Lovenox or Plavix. Warfarin is

considered the best choice in treatinglong-term use patients. This medication

does not target any certain neurotransmitters as some othermedications do.

The sole purpose of Warfarin is related to blood and the performance its

clotting process.

The medical professional prescribing Warfarin to the patient will usually

direct them to take the medication at the same time each day. Teaching is

essential to the patient while on this medication. Educating the patient on

the following is important:

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 • Purpose of the medication
• Possible adverse reactions (notify the doctor of any new
medications
• Discussing the importance of taken the prescribed dose
• Avoiding alcohol, aspirin, large amounts of green vegetables
• Drastic changes in diet- certain foods can effect the
performance of the Coumadin

Educating the patient will ensure that the patient not only remembers to take

their medication, but also to provide the physician with a specific factor to

place in their determination of the dosage to be taken and remain at a

therapeutic rate.

If you miss a dose then it should be taken immediately, on the other

hand if it is close to your next dose you should skip it all together and only

take the scheduled dose. At no time should the patient “double-up” on the

missed dose. Warfarin has not been proven to be less effective if it is taken

with or without food. However, it is always a good idea to take your

medications with food overall.

It is a fact that Warfarin does interact with certain foods you eat.

Usually, leafy green vegetables and other foods that are high in Vitamin K

affect the lab work. Consuming these types of foods can interfere with INR

(INTERTERNATIONAL NORMALIZED RATIO) results that are taken and possibly

influence the dosage that is directed to be taken. The medical professionals

should be informed if you have consumed a large amount or a significant

change in the amount you have consumed. Depending on the frequency you

eat these particular foods it may be arranged so you can consume a

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certainamount that would not affect the dosage you are asked to take-

prescribed with food consumption in mind.

This medication must be kept out of the reach of children as it can be

fatal to them if consumed. Last year an incident involving a celebrity’s twins

occurred while in the hospital they were mistakenly given Heparin instead of

the correct vaccine that wasintended to be given. Warfarin should be stored

at room temperature 59° to 86°, away from moisture and not in the

bathroom. Unlike other anticoagulants which build up over time to become

effective Warfarin takes12 to 24 hoursto become effective in the body. It

takes only a few days to get out of your system when the dose is decreased

or discontinued completely.

Luckily the cost of Warfarin is relativelylow with or without insurance

on average for 100 tablets the price is $25 to $35. It is an important fact that

his medication can be obtained at a low price because once you are on the

medication it is highly likely that you will be on it for a long duration if not for

life dependingon your illness.

While taking this medication you need to take many precautions due to

the delicate and highly dangerous drug itself enhance the release of

athermanousplaque emboli. It may cause cuts, catheters, some hypertensive

patients, protein deficient patients polycythenia vera, vasculitis, severe

diabetics to be uncontrollable/manageable. An interaction could lead to

hemorrhage which one of the most common adverse reactions, notifying you

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physician is one of the first things you should do prior to taken any new

medications.

Patients taking Warfarin will need to be careful using objects, such as

knives and scissors, which could make them bleed. Also avoiding some

activities and sports that could cause injury would be a recommendation for

patients taking Warfarin. For example, it is not a good idea to take up risky

sports while you are on Warfarin. This does not mean they cannot do the

things that are enjoyable, but when doing them, to think about how measures

can be taken to protect from injuries. For example, if working in the yard, be

sure to wear sturdy shoes and gloves. Activities that would be safe for include

swimming and walking. It is very important to know that bleeding can occur

and not see any blood at all. For example, a possible fall hitting your head,

bleeding could occur under the skull. A fall can occur hurting your arm and

notice a large purple bruise this would be bleeding under the skin. If the

patient has taken a bad fall, even if they are not bleeding the doctor should

be called or be directed to go to the hospital.

What does Warfarin consist of and function?

Acting by inhibiting the synthesis of Vitamin K dependant on

coagulation factors, Warfarin Sodium is categorized as an anticoagulant-

acenocoumarol and anisindione-dicumarol this anticoagulant decreases the

clotting ability and prevents harmful blood clots forming within the blood

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vessels. These blood thinners, will not dissolve clots they do prevent them

from getting larger and there fore causing a more serious problems. Warfarin

will prevent other clots from forming and is made up of two mixtures which

are active optical isomers both of these are processed through different

pathways. It is five time more potent than R-isomers in comparison to

Vitamin K antagonism. It is not unusually for many people to associate this

medication with “rat poison”. This medication is in deed used for population

control of rats. In these cases Warfarin is mixed with food (bait.) It may also

be put within a powder, over a period of time both mixtures end the lives of

these rodents however,many have became resistant to the mixture.

Osmetech plc (OMH.L) a new producer of Warfarin James White, Chief

Executive Officer for the company stated, “We are delighted with the

performance of our Warfarin testing and are confident of achieving FDA

clearance to launch our Warfarin test in the first half of 2008. We believe that

the Osmetech, eSensor ® 2C9/VKOR Warfarin which should lead to

commercial success with the growth of this particular market.” (1EZ

Consulting Services, 2008). Other companies produce the drug as well as

with many other medications, all are anxious to be the most reliable in their

productionof the medication and offer the best quality at the best prices.

One of the leading manufacturersof the mixture is Squibb Bristol-Myers and

Company.

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Is Warfarin dangerous?

Yes, this drug is dangerous and has the potential to adversely react with

other elements. Warfarin can be very dangerous if not monitored closely by a

physician. Many patients have to have blood work INR (INTERTERNATIONAL

NORMALIZED RATIO) taken on a regular basis and the physician will adjust

the dosageas necessary. Otherdangers include some of the following:

hemorrhage, Warfarin necrosis, osteoporosis and a rare complication which is

called Purple Toe Syndrome (Wikipedia contributors, 2008). Side effects with

Warfarin may happen and most side effects relate to how the medicine

works. To lower the risk of bleeding, your blood Warfarin level will be kept

within a range that is right for you. Even when you’re INR

(INTERTERNATIONAL NORMALIZED RATIO)blood test is in range, you might

see a little bleeding like bruises on your body or slight gum bleeding when

you brush your teeth. Some people may experience hair loss or skin rashes,

but this is rare. If you notice something wrong that you feel may be caused

by your medication, call your doctor.

Some of the side effects are slight bleeding which you may notice from

time to time in the following locations:

• Bleeding while brushing teeth.

• Occasional nosebleed.
• Easy bruising.
• Bleeding after a minor cut that stops within a few minutes.
• Menstrual bleeding that is a little heavier than normal.

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Warfarin is not addictive, but can be dangerous and even deadly if not taken

correctly especially when you have an open sore or have had recent surgery

internally or should you injure yourself then you would be at risk to

hemorrhage . This medication can be taken with other medication however;

there are medicines that cannot be taken with it as they may cause adverse

effects.

Why is Warfarin Prescribed?

This medication is prescribed in many cases due to a particular condition

the patient has incurred such as the following:

➢ Atrial Fibrillation
➢ Deep Vein Thrombosis
➢ Heart Attack
➢ Heart valve Replacement
➢ Peripheral vascular Disease
➢ Pulmonary Embolism
➢ Stroke
➢ Valvular Heart Disease

In many of the heart related illnesses Warfarin will decrease the chance of

blood clots by helping the blood flow easier through the blood vessels

especially in the smaller vessels. In many heart related illnesses plaque build

up plays a big role in the reduction of the flow of blood and increases the

chance of blood clots. When there is the increased threat of blood clotting

anticoagulation therapy use such as Warfarin is very effective.

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 Pulmonary Embolismis a very serious condition, a blood clot that formed

in some other area within you r body breaks loose and moves through the

blood to your lungs. The clot then is stuck in a blood vessel which brings

blood to the lungs. This type of clot blocks the blood vessel so your lungs do

not get blood flow. In the event that the lungs cannot get enough blood, they

will become damaged causing shortness of breath. In other instances such

as hereditary disease or other types of blood clotting disorders such as Factor

V, Protein C Deficiency, or Protein S Deficiency Warfarin has proven to be very

effective.

Insider view of Warfarin

Warfarin has saved my life and has been an asset maintaining

andlengthening my life. I have a blood clotting disorder and have had

several PEs (pulmonary embolisms) living with Protein C & S Deficiency is not

easy but knowing that Warfarin along with the IVC filter in my heart has

helped me lead a better quality of life both physically and mentally. At times

it is cumbersome to have lab work completed sometimes weekly but I know

that it is all worth it in the end. Without Warfarin, I may not be able to see

my children grow up and prevents me from spending long lengths of time in

the hospital. Being educated about this medication is one of the most

important keys to your medical plan if you do not know what the potential

dangers are when taking this medication you can put yourself at further risk

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than facingthe reason you are on it in the first place. Following the physician

instructions and always being educated is one of the most important parts of

your health plan.

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 Works Cited

1EZ Consulting Services, I. (2008, January 7). OSMETECH. Retrieved

September 1, 2008, from News:

http://www.osmetech.com/news/n20080107.htm

Rice, J. (2006). Principles of Pharmacology for Medical Assisting (4th ed., Vol.

Section 4; Unit 25 Medications Used for Circulatory Disorders). (N.

Pashoukos, Ed.) Clifton Park, NY, United States of America: Thompson

Delmar Learning.

Shannon, Wilson, Shields, Stang. (2007-2008). Prentice Hall Health

Professional's Drug Guide. Upper Saddle River, New Jersey, USA: Pearson

Prentice Hall.

Wikipedia contributors. (2008, August 14). Warfarin. Retrieved September 1,

2008, from Wikipedia, The Free Enclycopedia- Page Version ID:

231973978:

http://en.wikipedia.org/w/index.php?title=Warfarin&oldid=231973978

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