Final Exam Medication Megaset
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1. Aspirin class: antiplatelet/NSAID
2. Aspirin MOA: irreversibly inhibits COX (COX-1 > COX-2)
3. Aspirin adverse effects: bleeding, GI distress, renal dysfunction, tinnitus, Reyes
syndrome, hypersensitivity
4. Aspirin interactions: anticoagulants, glucocorticoids, alcohol, other NSAIDs,
ACE inhibitors, ARBs, vaccines
5. Aspirin patient teaching: contraindicated in children. Both parent drug and
metabolite are active. Parent drug is the one that provides COX inhibition. Contraindi-
cated in pregnancy after 30 weeks. Discontinue 7-10 days before surgery. Chew 325
mg of non-enteric coated aspirin if MI is suspected.
6. Clopidogrel class: antiplatelet/ADP receptor antagonist
7. Clopidogrel MOA: irreversible ADP receptor antagonist --> inhibits platelet ag-
gregation for the life of the platele
8. Clopidogrel adverse effects: bleeding, dyspepsia, abdominal pain, diarrhea,
rash
9. Clopidogrel interactions: proton pump inhibitors, cannabis, anything that mess-
es with CYP2C19.
10. Clopidogrel patient teaching: combine with low-dose aspirin for patients with
ACS. PRODRUG. Metabolized by CYP2C19. People with genetic disorders im-
pacting the CYP2C19 enzyme will gain little benefit from this drug. People who
metabolize it fast will have more adverse effects
11. Warfarin class: anticoagulant/vitamin K antagonist
12. Warfarin MOA: prevents active vitamin K regeneration by blocking vitamin K
epoxide reductase (VKORC1)--> reduces levels and functionality of vitamin K-de-
pendent clotting factors
13. Warfarin adverse effects: bleeding, ecchymosis
14. Warfarin interactions: vitamin K rich foods, anything that messes with
CYP2C19, many antibiotics, cannabis, NSAIDs
15. Warfarin patient teaching: 99% protein bound, monitor PT/INR, affected by
genes coding for VKORC1 (target, converts vitamin K to active form) and CYP2C19
(metabolizer) --> may need dose reduction. Contraindicated in pregnancy!! Antidote
for interaction = vitamin K or 4F-PCC (clotting factors). Tell other providers you're
taking warfarin, avoid falls, cuts, and bruises, maintain consistent intake of foods
with vitamin K (do not need to avoid), medical alert bracelet, patients with cognitive
dysfunction should not have free access to warfarin.
16. Heparin class: anticoagulant
17. Heparin MOA: increases antithrombin activity 1000x (blocks thrombin and factor
Xa). Binds to thrombin and antithrombin directly.
18. Heparin adverse effects: bleeding, heparin-induced thrombocytopenia (HIT)
, Final Exam Medication Megaset
Study online at https://quizlet.com/_f20upf
19. Heparin patient teaching: measured in units. Antidote is protamine sulfate.
Monitor aPTT. IV or subQ ONLY. Use caution in patients w/bleeding risk or spinal
tap/epidural.
20. Enoxaparin class: anticoagulant/low molecular weight heparin (LMWH)
21. Enoxaparin MOA: increases antithrombin activity. Preferentially inactivates clot-
ting factor Xa and has much less effect on thrombin (unlike heparin which works on
both). This is due to shorter molecular length.
22. Enoxaparin adverse effects: bleeding, less risk of heparin-induced thrombocy-
topenia, but not no risk, ecchymosis
23. Enoxaparin patient teaching: IV or injectable only. Antidote is protamine sul-
fate. Not as much need for monitoring labs. Avoid in severe renal impairment. Use
caution in patients w/bleeding risk or spinal tap/epidural.
24. Dabigatran Etexilate class: anticoagulant/direct thrombin inhibitor
25. Dabigatran Etexilate MOA: direct thrombin inhibitor: binds to free thombin AND
thrombin already bound to clots
26. Dabigatran Etexilate adverse effects: bleeding, gastritis-like complaints, in-
creased risk of thrombotic events if drug is not tapered
27. Dabigatran Etexilate interactions: P-glycoprotein inhibitors (carvedilol, vera-
pamil) or inducers (rifampin)
28. Dabigatran Etexilate patient teaching: PRODRUG, converted to active
metabolite in plasma and liver by esterases NOT CYP enzymes. DO NOT crush
capsule, crushing will increase bleeding risk. Contraindicated if GFR is less than 30.
Contraindicated if the patient is actively bleeding or if they have a prosthetic heart
valve. Inhibitors of P-glycoprotein INCREASE absorption and serum concentration
of the drug. Antidote = idarucizumab. Keep med in original bottle/blister pack, med
is unstable when exposed to moisture. DO NOT CRUSH CAPSULE.
29. Rivaroxaban class: anticoagulant, factor Xa inhibitor
30. Rivaroxaban MOA: factor Xa inhibitor
31. Rivaroxaban adverse effects: bleeding, paradoxical increased risk of throm-
boembolitic events
32. Rivaroxaban interactions: P-glycoprotein inhibitors (carvedilol, verapamil,
grapefruit juice, ketoconazol, ritonavir, cannabis) or inducers (rifampin, carba-
mazepine, St. John's Wort)
33. Rivaroxaban patient teaching: take with food unless immediately post op.
Contrindicated in patients with a GFR of less than 30. Contraindicated if active
bleeding. Antidote: andexanet alfa (a factor Xa decoy protein).
34. Alteplase class: thrombolytic
35. Alteplase indication: acute MI, pulmonary embolism, ischemic stroke
Study online at https://quizlet.com/_f20upf
1. Aspirin class: antiplatelet/NSAID
2. Aspirin MOA: irreversibly inhibits COX (COX-1 > COX-2)
3. Aspirin adverse effects: bleeding, GI distress, renal dysfunction, tinnitus, Reyes
syndrome, hypersensitivity
4. Aspirin interactions: anticoagulants, glucocorticoids, alcohol, other NSAIDs,
ACE inhibitors, ARBs, vaccines
5. Aspirin patient teaching: contraindicated in children. Both parent drug and
metabolite are active. Parent drug is the one that provides COX inhibition. Contraindi-
cated in pregnancy after 30 weeks. Discontinue 7-10 days before surgery. Chew 325
mg of non-enteric coated aspirin if MI is suspected.
6. Clopidogrel class: antiplatelet/ADP receptor antagonist
7. Clopidogrel MOA: irreversible ADP receptor antagonist --> inhibits platelet ag-
gregation for the life of the platele
8. Clopidogrel adverse effects: bleeding, dyspepsia, abdominal pain, diarrhea,
rash
9. Clopidogrel interactions: proton pump inhibitors, cannabis, anything that mess-
es with CYP2C19.
10. Clopidogrel patient teaching: combine with low-dose aspirin for patients with
ACS. PRODRUG. Metabolized by CYP2C19. People with genetic disorders im-
pacting the CYP2C19 enzyme will gain little benefit from this drug. People who
metabolize it fast will have more adverse effects
11. Warfarin class: anticoagulant/vitamin K antagonist
12. Warfarin MOA: prevents active vitamin K regeneration by blocking vitamin K
epoxide reductase (VKORC1)--> reduces levels and functionality of vitamin K-de-
pendent clotting factors
13. Warfarin adverse effects: bleeding, ecchymosis
14. Warfarin interactions: vitamin K rich foods, anything that messes with
CYP2C19, many antibiotics, cannabis, NSAIDs
15. Warfarin patient teaching: 99% protein bound, monitor PT/INR, affected by
genes coding for VKORC1 (target, converts vitamin K to active form) and CYP2C19
(metabolizer) --> may need dose reduction. Contraindicated in pregnancy!! Antidote
for interaction = vitamin K or 4F-PCC (clotting factors). Tell other providers you're
taking warfarin, avoid falls, cuts, and bruises, maintain consistent intake of foods
with vitamin K (do not need to avoid), medical alert bracelet, patients with cognitive
dysfunction should not have free access to warfarin.
16. Heparin class: anticoagulant
17. Heparin MOA: increases antithrombin activity 1000x (blocks thrombin and factor
Xa). Binds to thrombin and antithrombin directly.
18. Heparin adverse effects: bleeding, heparin-induced thrombocytopenia (HIT)
, Final Exam Medication Megaset
Study online at https://quizlet.com/_f20upf
19. Heparin patient teaching: measured in units. Antidote is protamine sulfate.
Monitor aPTT. IV or subQ ONLY. Use caution in patients w/bleeding risk or spinal
tap/epidural.
20. Enoxaparin class: anticoagulant/low molecular weight heparin (LMWH)
21. Enoxaparin MOA: increases antithrombin activity. Preferentially inactivates clot-
ting factor Xa and has much less effect on thrombin (unlike heparin which works on
both). This is due to shorter molecular length.
22. Enoxaparin adverse effects: bleeding, less risk of heparin-induced thrombocy-
topenia, but not no risk, ecchymosis
23. Enoxaparin patient teaching: IV or injectable only. Antidote is protamine sul-
fate. Not as much need for monitoring labs. Avoid in severe renal impairment. Use
caution in patients w/bleeding risk or spinal tap/epidural.
24. Dabigatran Etexilate class: anticoagulant/direct thrombin inhibitor
25. Dabigatran Etexilate MOA: direct thrombin inhibitor: binds to free thombin AND
thrombin already bound to clots
26. Dabigatran Etexilate adverse effects: bleeding, gastritis-like complaints, in-
creased risk of thrombotic events if drug is not tapered
27. Dabigatran Etexilate interactions: P-glycoprotein inhibitors (carvedilol, vera-
pamil) or inducers (rifampin)
28. Dabigatran Etexilate patient teaching: PRODRUG, converted to active
metabolite in plasma and liver by esterases NOT CYP enzymes. DO NOT crush
capsule, crushing will increase bleeding risk. Contraindicated if GFR is less than 30.
Contraindicated if the patient is actively bleeding or if they have a prosthetic heart
valve. Inhibitors of P-glycoprotein INCREASE absorption and serum concentration
of the drug. Antidote = idarucizumab. Keep med in original bottle/blister pack, med
is unstable when exposed to moisture. DO NOT CRUSH CAPSULE.
29. Rivaroxaban class: anticoagulant, factor Xa inhibitor
30. Rivaroxaban MOA: factor Xa inhibitor
31. Rivaroxaban adverse effects: bleeding, paradoxical increased risk of throm-
boembolitic events
32. Rivaroxaban interactions: P-glycoprotein inhibitors (carvedilol, verapamil,
grapefruit juice, ketoconazol, ritonavir, cannabis) or inducers (rifampin, carba-
mazepine, St. John's Wort)
33. Rivaroxaban patient teaching: take with food unless immediately post op.
Contrindicated in patients with a GFR of less than 30. Contraindicated if active
bleeding. Antidote: andexanet alfa (a factor Xa decoy protein).
34. Alteplase class: thrombolytic
35. Alteplase indication: acute MI, pulmonary embolism, ischemic stroke
