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Introduction
Very Sociable
Guy
Chest Pain
Girl with a Rash
England 1944
Trouble Healing
Morning Stiffness
Bruises Easily
Shortness of
Breath
Drug Interactions
Review
Thanks to
Quiz
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Lots of things can
affect the best thought out plans.
- Medications, dietary supplements, coexisting
disease can all influence the effect of Coumadin.
- Herbal products may have a profound effect.
- Often the first indication that something is
wrong is when a patient experiences a life threatening bleed or shows up with
another pulmonary embolus.
- Regular monitoring of INR is essential.
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Effect of Coumadin enhanced by |
Effect of Coumadin decreased by |
- Decreased vitamin K absorption.
- Liver disease, CHF...
- Competition for hepatic degradation.
- fluconazole, amiodarone, alcohol, lots
of antibiotics such as metronidazole.
- Enhanced affinity of hepatic receptor.
- Increased bleeding tendency in general
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- Enzymatic induction leading to
accelerated degradation.
- rifampin, barbiturates, carbamzepin
- Things that inhibit GI absorption.
- cholystyramine, sucralfate
- Diuretics influencing renal clearance.
- Oral contraceptives.
- Estrogen replacement.
- Vitamin supplementation.
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So, how do you follow patients
on anticoagulant therapy? Back
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