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06.03 Coumarins

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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

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Video 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!

 

Read more

  • Question 1 of 5

The nurse is preparing discharge teaching for a client taking coumadin. Which of the following teaching points is not appropriate to include?

  • Question 2 of 5

The nurse is assigned to a client taking coumadin. Prior to giving the client’s dose of coumadin, the nurse notes that the client’s INR is 2.2. Which of the following actions is appropriate?

  • Question 3 of 5

Which client condition would cause the nurse to question an order for coumadin?

  • Question 4 of 5

A client asks the nurse why he should avoid large amounts of kale while taking coumadin. Which response is correct?

  • Question 5 of 5

The nurse understands that coumadin prevents clots in which of the following ways?

Module 0 – Pharmacology Course Introduction

Module 3 – Disease Specific Medications

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