Coumarins
Included In This Lesson
Outline
Overview
I. Overview
A. Derivative of the natural plant anticoagulant known as coumarin
B. Most commonly prescribed oral (PO)
C. Requires careful monitoring
1. Prothrombin time/international normalized ratio (PT/INR)
a. INR
1. 2.0-3.0 while taking blood thinners
b. PT
1. 11-13.5 seconds
II. Mechanism of Action
A. Inhibits vitamin K–dependent clotting factors II, VII, IX, and X
III. Indications
A. Atrial fibrillation
B. DVT / PE thrombo-prevention
C. DVT / PE treatment
D. Stroke prevention
E. Prosthetic heart valve
F. Post-MI prevention / treatment
G. Unstable angina
IV. Contraindications
A. Recent trauma
B. Active internal bleeding
C. Bleeding disorders
D. Intracranial hemorrhage
E. Severe HTN
F. Bacterial endocarditis
G. Liver failure
H. Kidney failure
V. Interactions
A. Alcohol
B. NSAIDs
C. Diuretics
D. SSRIs
E. Vitamins
F. Antibiotics
G. Foods
1. Kale
2. Spinach
3. Turnip
4. Mustard greens
5. Broccoli
6. Brussel sprouts
7. Cabbage
H. Herbals
1. Green tea
2. Ginkgo
3. Feverfew
4. Garlic
5. Cranberry
6. Chamomile
7. Ginger
VI. Side Effects
1. Bleeding
2. Red or brown urine
3. Black or bloody stool
4. Severe headache or stomach pain
5. Joint pain, discomfort or swelling (after injury)
6. Hemoptysis
7. Hematemesis
8. Bruising
Transcript
Welcome back, today we are going to discuss coumarins – specifically coumadin.
Coumadin comes from the plant derivative, coumarin. It is the most commonly prescribed oral anticoagulant. It requires monitoring via blood work in the form of PT/INR levels.
Coumadin inhibits vitamin K dependent factors 2, 7, 9 and 10.
Coumadin indication include atrial fib, DVT/PE prevention and treatment, prosthetic heart valves, post-MI prevention and treatment, stroke prevention and unstable angina. An easy way to remember this is ADDPPSU.
Contraindications include: Bleeding disorders, bacterial endocarditis, recent trauma, active intracranial bleeding, severe HTN, intracranial hemorrhage, liver and kidney failure. Can easy way to remember these is BBRASILK.
Now, coumadin has various interactions, let’s review the medication first. Alcohol, NSAIDs, diuretics, SSRIs, vitamins, antibiotics and vaccines – which all increase coumadin effects.
Food interactions for coumadin include kale, spinach, turnip, mustard greens, broccoli, Brussel sprouts, and cabbage – all of which decrease coumadin effects.
Lastly, herbal interactions include green tea, ginkgo, feverfew, garlic, cranberry, chamomile, and ginger – all of which, increase coumadin effects.
Side effects include bleeding, red/brown urine, black/bloody stools, severe headache, stomach pain, joint pain, hemoptysis, hematemesis and bruising. Do you see a trend? Every side effects include bleeding in one aspect of the body. Priority nursing concepts for a patient taking coumadin include clotting and pharmacology. Alright, let’s recap: Coumadin indication includes atrial fib, DVT/PE prevention and treatment, prosthetic heart valves, post-MI prevention and treatment, stroke prevention and unstable angina. An easy way to remember this is ADDPPSU. Contraindications include Bleeding disorders, bacterial endocarditis, recent trauma, active intracranial bleeding, severe HTN, intracranial hemorrhage, liver, and kidney failure. Can easy way to remember these is BBRASILK. Food interactions for coumadin include kale, spinach, turnip, mustard greens, broccoli, Brussel sprouts, and cabbage – all of which decrease coumadin effects. Lastly, herbal interactions include green tea, ginkgo, feverfew, garlic, cranberry, chamomile, and ginger – all of which, increase coumadin effects. Side effects include bleeding, red/brown urine, black/bloody stools, severe headache, stomach pain, joint pain, hemoptysis, hematemesis and bruising. Do you see a trend? Every side effects include bleeding in one aspect of the body.
You know now the important details regarding coumadin. Now, go out and be your best self today and as always, Happy Nursing!
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System