Gruhn, W
Although less than 1% of gut microbiota possess the genes required for TMA synthesis, these relevant microbial communities are still sufficient to drive significant TMA production
Three months in and the kids think I look rested. Saved myself $2,000 in fillers and then some
It inhibits: Vitamin K epoxide reductase (VKORC1) Activation of Factors II, VII, IX, X Protein C & S (important for early hypercoagulability!) Effect monitored by INR Dosing (very exam & practice relevant) Initial dose: Usually 5 mg once daily Lower initial dose (23 mg) if: Elderly Liver disease Heart failure High bleeding risk Target INR: Most indications (AF, DVT, PE): 2.0 3.0 Mechanical mitral valve: 2.5 3.5 Full anticoagulant effect takes 35 days Types / Form Oral drug Racemic mixture: S-warfarin more potent R-warfarin longer half-life Important clinical pearl Initial hypercoagulable state Because Protein C & S fall first risk of: Warfarin-induced skin necrosis Solution: Bridge with heparin at initiation Antidote & reversal (VERY high-yield) Antidote: Vitamin K (Phytonadione) Situation Management INR high, no bleeding Oral Vitamin K 12.5 mg Serious bleeding IV Vitamin K 510 mg Life-threatening bleeding Vitamin K + PCC (preferred) or FFP PCC = Prothrombin Complex Concentrate (fastest reversal) Side effects Bleeding (most common) Skin necrosis (Protein C deficiency) Purple toe syndrome Teratogenic contraindicated in pregnancy Many drug & food interactions Foods rich in vitamin K (spinach, broccoli) effect Contraindications Pregnancy Active bleeding Severe liver disease Poor compliance (needs frequent INR monitoring) Take-home message Warfarin is: Powerful Cheap Effective But requires knowledge, monitoring, and respect Mastering warfarin = mastering clinical pharmacology & patient safety
This plant-based chromium 25mg is packed with bioavailable perennial vines of Gymnema sylvestre, a buffer to support glucose metabolism and healthy cholesterol levels
Its often needed for those with gallstones or cholecystitis
