Coumadin antagonists

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  1. Coumadin blocks the carboxylation of glutamate residues in coagulation factors prothrombin (II), VII, IX, and X
  2. Action of coumadin takes 8-12 hours for onset
  3. Anticoagulation effect is increased by aspirin (decreased platelet function), hepatic disease and hyperthyroidism (increased turnover of clotting factors); metronidazole, cimetidine, miconazole and trimethoprim-sulfa inhibit the transformation of warfarin
  4. Cephalosporins eliminate the bacteria in the gut that produces vitamin K increasing the anticoagulant effect; heparin may prolong the prothrombin time by inhibiting the activity of clotting factors
    1. Remember: make an increase in the cephalosporin deposit at the First Bank of California (cephalosporins, Flagyl, Bactrim, Cimetidine)
  5. Barbiturates and rifampin causes a decrease in the anticoagulant effect by induction of hepatic enzymes that transform coumadin; cholestyramine binds coumadin in the gut and reduces its absorption and bioavailability
    1. Remember: everybody’s down with BARBara Rif
  6. Vitamin K laden foods (generally leafy green vegetables) and diuretics (increase clotting factor concentration) reduce the anticoagulant effect; hypothyroidism decreases anticoagulation effect (decreased the turnover of clotting factors)
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