QuestionSBA
QuestionChoice
Haemorrhage is a common or very common side effect of warfarin. In a situation where there is minor bleeding and an INR of more than 8, NICE recommends to stop warfarin and give 0.5–1 mg phytomenadione by slow intravenous injection, or 5 mg by mouth
34305
a
Stop warfarin and give phytomenadione 1mg slow IV injection
QuestionChoice
Phytomenadione needs to be given if there is bleeding and INR is 8 or more
34307
c
Omit two doses of warfarin and restart thereafter
QuestionChoice
Urgent intravenous treatment with phytomenadione (vitamin K1), and/or dried prothrombin complex concentrate (factors II, VII, IX, and X), or fresh frozen plasma 15mL/kg is only required if there is heavy bleeding
34309
e
Stop warfarin and commence urgent intravenous treatment with phytomenadione and prothrombin complex concentrate
QuestionChoice
Warfarin needs to be stopped. Phytomenadione also needs to be given if there is bleeding and INR is 8 or more
34308
d
Continue with current dose
QuestionChoice
Phytomenadione needs to be given if there is bleeding and INR is 8 or more
34306
b
Reduce the dose of warfarin to 5 mg PO OD
QuestionComment
Given the patient has a NOF wouldn't you'd be thinking that there could be more significant internal bleeding... and so you'd go for Fit K and prothrombin complex concentrate... if not why not?
8384
QuestionComment
Yeah I agree, i thought it was a bit strange to just give vit K when he has to go to theatre?
17158
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DNA Tachycardia
QuestionComment
We have to only go by what the question says: 'Minor bleeding from a cut on his right hand (and no other bleeding sites)' 
17608
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Hereditary Hematoma
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Dominant Hematoma
QuestionComment
A tip for anyone doing PSA is to search "phytomenadione", and it essentially gives you the treatment for various bleeding severities and INR. Good luck!
40202
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Endoscopic retrograde cholangiopancreatogra-chap
QuestionComment
this person is going to theatre so why would you not give it all
40291
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HarryDM
QuestionComment
agree with the theatre people
61347
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Vaccine Complement
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

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Warfarin side effects
Topic
9
Internal Medicine
6872
Case presentation: A 60-year-old man is brought to the accident and emergency department. He had a fall this morning after accidentally walking into a glass door. Besides his prescribed medication, he has been taking some herbal supplements lately.  

PMH: Atrial fibrillation
DH: Warfarin Sodium 10 mg PO once daily, Bisoprolol 10 mg PO once daily
Observations: Temperature 36.5°C , blood pressure 125/80 mmHg, heart rate 80 bpm, respiratory rate 18; oxygen saturation 100% (on air)
On examination: Minor bleeding from a cut on his right hand (and no other bleeding sites), cannot weight bear, pain on external rotation of left leg
Investigations: Pelvic x-ray: Left Intracapsular neck of femur fracture ; INR: 8.2

Question: Select the most appropriate option for the management of this adverse drug event.
a