DI 11-20

Blood Thinning Medications

Aspirin (Bayer®)

Clopidogrel (Plavix®)

Warfarin (Coumadin®, Jantoven®)

Aspirin

Bayer

Aspirin Drug Class

Analgesic, non-opioid; Antiplatelet Agent; Nonsteroidal anti-inflammatory Drug, Oral; Salicylate

Aspirin Indication

Blood thinning, Acute coronary syndrome (MI, revascularization), secondary prevention CV events

Aspirin adverse effects

Bleeding, Gastrointestinal ulceration or bleeding

Aspirin counseling points

Monitor for signs/symptoms of bleed, Caution with other drugs that increase bleed

High monitoring med! May need to be held before procedure

Clopidogrel

Plavix

Clopidogrel Drug Class

Antiplatelet Agent; Antiplatelet Agent, Thienopyridine; P2Y12 Antagonist

Clopidogrel Indications

myocardial infarction, acute coronary syndrome, blood thinning, secondary prevention CV events

Clopidogrel adverse effects

Bleeding, Gastrointestinal ulceration or bleeding

Clopidogrel counseling points

Monitor for signs/symptoms of bleed, Caution with other drugs that increase bleed

High monitoring med! May need to be held before procedure

Warfarin

Coumadin, Jantoven

Warfarin Drug Class

Anticoagulant; Vitamin K Antagonist

Warfarin Indications

Atrial Fibrillation, deep vein thromboemolism, pulmonary embolism

Warfarin adverse effects

bleeding

Warfarin counseling points

• Monitor international normalized ration (INR), should be 2-3

• Monitor signs/symptoms of bleed

• Drug-drug and drug-food interactions!!

• Maintain consistent vitamin K volume in diet

• Monitor regularly, ptnt adherence

Cholesterol Medications

Atorvastatin (Lipitor®)

Ezetimibe (Zetia®)

Fenofibrate (Tricor®)

Atorvastatin

Lipitor

Atorvastatin drug class

Antilipemic Agent, HMG-CoA Reductase Inhibitor

Atorvastatin indications

Hypercholesterolemia, familial hypercholesterolemia, primary and secondary prevention of CV events

Reduce LDL (1st line)

Atorvastatin adverse effects

Arthralgia, Myalgia, Myopathy, Rhabdomyolysis, Joint/muscle pain, Hepatic failure

Atorvastatin counseling points

Lipid panel, Liver function tests (LFTs), Monitor for muscle pain/weakness/heaviness, Avoid grapefruit juice, May be more effective at night

Ezetimibe

Zetia

Ezetimibe Drug Class

Antilipemic Agent, absorption inhibitor

Ezetimibe indications

hypercholesterolemia, familial hypercholesterolemia

Ezetimibe Adverse effects

Gastrointestinal effects/diarrhea

Ezetimibe Counseling points

Lipid panel, Patient adherence

commonly taken with statins

Fenofibrate

Tricor

Fenofibrate drug class

Antilipemic Agent, Fibric Acid

Fenofibrate indications

hypercholesterolemia, hypertriglyceridemia

Fenofibrate adverse effects

Gastrointestinal upset, Abdominal pain, Indigestion, Increased LFTs

fenofibrate counseling points

Monitor lipid panel, LFTs Patient adherence

Lifestyle changes – decrease foods high in saturated fat

Stomach Medications

Famotidine (Pepcid®)

Omeprazole (Prilosec®)

FOUND OVER THE COUNTER

Famotidine

Pepcid

Famotidine drug class

Histamine 2 Receptor blocker

Famotidine indications

Gastroesophageal reflux disease (GERD), heartburn, peptic ulcer disease

Famotidine adverse effects

Gastrointestinal upset

Famotidine counseling points

Most effective taken with meal

Monitor efficacy/ plateau

Can be taken as needed

Omeprazole

Prilosec

Omeprazole drug class

Proton Pump Inhibitor

Omeprazole indication

Gastroesophageal reflux disease (GERD), heartburn, peptic ulcer disease, Zollinger-Ellison Syndrome

Omeprazole adverse effects

electrolytes (magnesium), bone fractures, severe diarrhea, infection risk

Omeprazole counseling points

Take in fasted state

Adverse effects

Monitor t-score

Duration of therapy

Drug interaction- clopidogrel, most effective if taken once a day

Osteoporosis Medications

Alendronate (Fosamax®)

Alendronate

Fosamax

Alendronate drug class

Bisphosphonate Derivative

Alendronate indication

osteoporosis, paget disease

Alendronate Adverse effects

Esophageal/ gastric ulceration

Bone necrosis of jaw

Atypical fracture

Alendronate Counseling points

Monitor T score, calcium and vitamin D intake

Take 30+ minutes before food, drink, other meds; remain upright

Dosed once a week, “drug holiday” after 5 years

Thyroid Medications

Levothyroxine (Synthroid®, Levoxyl®)

Levothyroxine

synthroid, Levoxyl

Levothyroxine drug class

Thyroid Product

Levothyroxine indications

hypothyroidism

Levothyroxine adverse effects

Hypo and hyperthyroid symptoms

Levothyroxine Counseling points

Take 30min -1hr before meals, 4 hrs before other meds

Frequent monitoring TSH/T4, hypo and hyperthyroid symptoms

Take on empty stomach and in the morning is most effective

Patient adherence!