Warfarin therapy for Medical Student OSCE
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Introduce, identify, explain, consent
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Explain: ‘warfarin is a drug that thins your blood and makes it less likely to clot. You are taking it because you are suffering from a condition that makes you more likely to form clots’
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Side effects – jaundice, skin rashes, hair thinning, diarrhoea, bleeding, nausea and vomiting
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Toxicity – over-coagulation – look out for prolonged bleeding / blood in urine; do not take another dose and inform doctor immediately
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Precautions
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Trauma – at work and hobbies. Avoid contact sports
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Alcohol – excess intake may increase anticoagulant effect – have no more than 2 drinks a day
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Diet – avoid large changes, especially with foods containing vit K, e.g. liver and green vegetables. Cranberry and grapefruit juice.
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Pregnancy – warfarin dangerous especially in 1st trimester – keep GP informed
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Drugs
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Analgesia – NSAIDs not safe (ibuprofen, diclofenac), paracetamol safe
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Interactions
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OTC drugs – inform pharmacist of warfarin therapy. Do not take St John’s Wort
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Regular blood tests – need to test how well blood clots at regular decreasing intervals, to tailor warfarin dose
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INR book
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Check pt has one
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Explain: contains record of doses, clotting tests and INR. Show to any health professional treating you
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Additional points
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Bracelet – during long term treatment, in case of accident or emergency, so doctors are aware of your condition and treat accordingly
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Dentist – warn before any procedures
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Dose – at the same time each day, with or without food. If dose missed, take normal dose next day
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Concordance – important not to stop warfarin without seeking advice first from doctor
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Check for understanding
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Give chance for questions
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Offer more information in handout
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About the Author
by: Admin
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Word Count: 476
Date: Fri, 22 Jan 2010 Time: 4:19 PM
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