Clopidogrel Pharmacology

Clopidogrel is an antiplatelet agent that is often used in combination with aspirin to help reduce the risk of an MI.

The risk of bleed is a high priority with the use of clopidogrel. Patients must be monitored for signs and symptoms of bleeding and bruising.

Clopidogrel is a prodrug that is converted to its active metabolite by CYP2C19.

Fluconazole can inhibit CYP2C19 which may reduce the effectiveness of clopidogrel.

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Heparin Pharmacology

Heparin Pharmacology

Heparin is an interesting drug with a lot of unique clinical quirks. This drug ultimately inhibits the formation of fibrin. Fibrin is an essential component of a blood clot.

Because heparin has blood thinning effects, it is critical to assess a patient’s bleed risk. Look out for other agents that may increase the risk of bleeding. Examples include; NSAIDs, antiplatelet agents, and other anticoagulants.

One classic test question about heparin that often comes up is the reversal agent. Protamine can be used to help reverse the effects of heparin.

Heparin-induced thrombocytopenia is a critical adverse effect to understand. I discuss both subtypes on the podcast and let you know what to look out for.

Rarer side effects of heparin include hyperkalemia and osteoporosis (only with long term use).

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Rivaroxaban Pharmacology

Rivaroxaban is a factor 10a inhibitor that inhibits clot formation and thins the blood.

Rivaroxaban needs to be monitored for bleed risk. Checking periodic CBC can help us assess if hemoglobin and hematocrit are remaining stable.

Enzyme inducers like rifampin, St. John’s Wort, and carbamazepine can reduce concentrations and increase the risk of treatment failure.

NSAIDs and antiplatelet medications can significantly increase the risk of bleed with rivaroxaban.

Rivaroxaban should not be used with dual P-glycoprotein and CYP3A4 inhibitors. Examples include ketoconazole, itraconazole, and ritonavir.

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Aspirin Pharmacology

Aspirin Pharmacology

On this episode of the Real Life Pharmacology Podcast, I discuss aspirin pharmacology.

The two most common adverse effects with aspirin are GI upset and increasing the risk for bleeding and bruising.

A commonly asked test question about aspirin is whether it can be used in pediatrics and what risk we encounter if we use it.

Another rare effect with aspirin is tinnitus which I discuss further on this episode.

It is critical to pay attention to other medications that can thin the blood in a patient taking aspirin. Examples include anticoagulants like warfarin, apixaban, rivaroxaban; antiplatelets like clopidogrel or prasugrel; or NSAIDs.

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Apixaban Pharmacology

On this episode, I talk about apixaban (Eliquis) pharmacology.

I also cover adverse effects like bleeding and what to monitor.

Drug interactions are a concern with apixaban and I discuss a few items that you may want to look out for.

It is important to remember that apixaban does require dose adjustments in certain situations as well.

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