Pharmacology

Question 1

High INR approach

Answer 1

1) Target INR
2) Why on warfarin
3) Are they actively bleeding?

Question 2

INR 5-8, no bleeding - management

Answer 2

Withhold 1-2 doses of warfarin
recheck INR
restart when INR < 5

Question 3

INR 5-8, mild bleeding - management

Answer 3

Stop warfarin
Give phytomenadione 1-3 mg IV
restart warfarin when INR < 5

Question 4

INR > 8 no bleeding

Answer 4

Stop warfarin
Give phytomenadione 5mg orally
recheck inr, repeat dose if too high
restart warfarin when INR < 5

Question 5

INR > 8 and mild bleeding - management

Answer 5

Stop warfarin
Give phytomenadione IV 1-3 mg
Recheck INR after 24 hours, repeat dose if too high
Restart warfarin when INR < 5