Warfarin Pharmacokinetics/Active Ingredient - Oral vitamin K antagonist; warfarin sodium inhibits vitamin K-dependent clotting
factors II, VII, IX, X and proteins C/S; delayed onset 3–5 days; half-life ~36–42 hours; CYP450 metabolism
Warfarin Starting Dose - 2–5 mg PO daily; lower doses in elderly, liver disease, malnutrition, or high bleeding risk
Warfarin Indications - Atrial fibrillation stroke prevention, DVT/PE treatment, mechanical heart valves
Warfarin vs Antiplatelets - Warfarin prevents fibrin clot formation through coagulation pathways; antiplatelets inhibit platelet
aggregation and are used for arterial disease (MI, stroke, CAD, PCI)
Warfarin Contraindications - Pregnancy, active bleeding, severe liver disease, inability to monitor INR, hemorrhagic disorders
Warfarin Patient Teaching - Maintain consistent vitamin K intake; avoid NSAIDs unless prescribed; report bleeding; use soft
toothbrush/electric razor; notify provider before starting new medications
Warfarin Antidote - Vitamin K (phytonadione); severe bleeding may require PCC or FFP
INR Monitoring After Starting Warfarin - Draw INR within 2–3 days after initiation and adjust until therapeutic
Target INR for Atrial Fibrillation/DVT/PE - 2.0–3.0
Target INR for Mechanical Mitral Valve - 2.5–3.5
Target INR for Mechanical Aortic Valve - 2.0–3.0 depending on risk factors
Major Antiplatelet Drugs - Aspirin (COX inhibitor ↓ thromboxane A2), clopidogrel/prasugrel/ticagrelor (P2Y12 receptor inhibitors),
dipyridamole (PDE inhibitor), abciximab/eptifibatide (GP IIb/IIIa inhibitors)
Aspirin Pharmacokinetics - Irreversibly inhibits platelet COX-1, preventing thromboxane A2 formation; effect lasts 7–10 days for
platelet lifespan
Clopidogrel Pharmacokinetics - Prodrug activated by CYP450 enzymes; irreversibly blocks P2Y12 receptors; decreased
effectiveness with CYP2C19 inhibitors
Ticagrelor Pharmacokinetics - Reversible P2Y12 inhibitor with rapid onset; does not require hepatic activation
Heparin Pharmacokinetics - Parenteral anticoagulant that activates antithrombin III, inhibiting thrombin and factor Xa; rapid onset;
monitored by aPTT
Heparin Contraindications - Active bleeding, severe thrombocytopenia, history of heparin-induced thrombocytopenia (HIT),
hypersensitivity
Heparin Pregnancy Category - Category B; preferred anticoagulant in pregnancy because it does not cross the placenta
Low Molecular Weight Heparin (LMWH) - Enoxaparin; primarily inhibits factor Xa; predictable anticoagulant response with less
monitoring than unfractionated heparin
LMWH Contraindications - Active bleeding, severe renal impairment, history of HIT, thrombocytopenia, hypersensitivity
CHADS₂ Score - Stroke risk assessment for atrial fibrillation: CHF = 1 point, HTN = 1 point, Age ≥75 = 1 point, Diabetes = 1 point,
Stroke/TIA history = 2 points
PCI Anticoagulants - Unfractionated heparin, bivalirudin, or low molecular weight heparin; combined with antiplatelet therapy
(aspirin + P2Y12 inhibitor)
Missed Anticoagulant Dose Education - Take dose when remembered unless close to next dose; do not double dose; contact
provider for repeated missed doses
Iron Supplement Education - Take on empty stomach with vitamin C for improved absorption; avoid calcium, antacids, and dairy
around dosing; dark stools are expected; constipation is common
Average Daily Iron Intake - Adult men/postmenopausal women: 8 mg/day; premenopausal women: 18 mg/day
Iron Contraindications - Hemochromatosis, hemosiderosis, anemia not caused by iron deficiency, hypersensitivity
Iron Toxicity Signs - Severe abdominal pain, vomiting, diarrhea, GI bleeding, metabolic acidosis, shock, organ failure
Adult Iron Deficiency Anemia Dose - Ferrous sulfate providing approximately 100–200 mg elemental iron/day in divided doses
Folic Acid Contraindications - Hypersensitivity; avoid treating undiagnosed vitamin B12 deficiency because neurologic damage
may worsen
Folic Acid Pregnancy Dose - 400–800 mcg daily for prevention of neural tube defects; higher doses for high-risk patients
Vitamin B12 Deficiency Treatment - Cyanocobalamin IM injections or high-dose oral therapy depending on cause and absorption
ability
Vitamin B12 Therapy Not Needed - Normal B12 levels and no evidence of deficiency; avoid unnecessary supplementation
Hematopoietic Growth Factors - Erythropoietin stimulates RBC production; filgrastim/pegfilgrastim stimulate neutrophil production
Hematopoietic Growth Factor Administration - Usually subcutaneous; monitor CBC, hemoglobin, neutrophil response, and
adverse effects
Hematopoietic Growth Factor Contraindications - Hypersensitivity; uncontrolled hypertension with erythropoietin; caution with
malignancy due to possible tumor stimulation
Live Vaccine Contraindications - Pregnancy, immunocompromised patients, severe immune suppression, recent
immunosuppressive therapy
MMR Vaccine Schedule - Two doses; first dose at 12–15 months, second dose at 4–6 years; adults without immunity receive 2
doses separated by ≥28 days
Influenza Vaccine Recommendation - Annual vaccination recommended for everyone ≥6 months of age
Influenza Vaccine Contraindications - Severe allergic reaction to previous influenza vaccine or vaccine component; delay with
moderate/severe acute illness
, Flu Vaccine Education - Influenza vaccine cannot cause influenza; mild fever, soreness, and fatigue are immune responses, not
infection
Cyclosporine Indications - Immunosuppressant used for prevention of organ transplant rejection and treatment of autoimmune
disorders such as rheumatoid arthritis and psoriasis
Cyclosporine Mechanism of Action - Calcineurin inhibitor that decreases T-cell activation and inhibits IL-2 production
Cyclosporine Major Side Effects - Nephrotoxicity, hypertension, hyperkalemia, tremor, hirsutism, gingival hyperplasia, increased
infection risk
Cyclosporine Monitoring - Renal function, blood pressure, electrolytes, liver function, drug levels, signs of infection
TSH Indicating Levothyroxine Treatment - Elevated TSH with decreased free T4 indicates primary hypothyroidism requiring
treatment
Levothyroxine Mechanism of Action - Synthetic T4 hormone converted to active T3; replaces deficient thyroid hormone and
regulates metabolism
Levothyroxine Initial Dose - Healthy adults: approximately 1.6 mcg/kg/day; elderly or cardiac patients start low (12.5–50 mcg/day)
and titrate slowly
Levothyroxine Administration - Take on empty stomach 30–60 minutes before breakfast; separate calcium, iron, and antacids by
at least 4 hours
Levothyroxine Monitoring - Check TSH 6–8 weeks after initiation or dose changes; monitor every 6–12 months once stable
Levothyroxine Contraindications - Untreated adrenal insufficiency, thyrotoxicosis, acute MI, hypersensitivity
Levothyroxine Overdose Symptoms - Tachycardia, palpitations, anxiety, tremor, insomnia, weight loss, heat intolerance
Hyperthyroidism Treatment - Antithyroid medications (methimazole, propylthiouracil), radioactive iodine therapy, or surgery
depending on cause and severity
Methimazole Mechanism of Action - Inhibits thyroid peroxidase, decreasing thyroid hormone synthesis
Propylthiouracil (PTU) Mechanism of Action - Inhibits thyroid peroxidase and blocks peripheral conversion of T4 to T3
Methimazole Preferred Use - First-line for most patients with hyperthyroidism because of longer duration and fewer adverse
effects than PTU
PTU Preferred Use - First trimester pregnancy and thyroid storm due to inhibition of peripheral T4 to T3 conversion
Antithyroid Drug Major Adverse Effects - Agranulocytosis, hepatotoxicity, rash, arthralgia, GI upset
Antithyroid Drug Patient Education - Report fever, sore throat, or infection symptoms immediately due to risk of agranulocytosis
HIV Treatment Goal - Suppress viral replication to undetectable levels, increase CD4 count, prevent disease progression, and
reduce transmission risk
Initiation of Antiretroviral Therapy (ART) - Begin treatment as soon as possible after HIV diagnosis regardless of CD4 count
Six HIV Medication Classes - Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse
transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase strand transfer inhibitors (INSTIs), entry inhibitors, capsid
inhibitors
NRTI Mechanism - Block reverse transcriptase by acting as false nucleoside substrates, stopping viral DNA synthesis
NNRTI Mechanism - Directly inhibit reverse transcriptase enzyme activity
Protease Inhibitor Mechanism - Block viral protease, preventing maturation of infectious HIV particles
Integrase Inhibitor Mechanism - Prevent integration of viral DNA into host DNA
Entry/Fusion Inhibitor Mechanism - Prevent HIV attachment or fusion with host cells
Capsid Inhibitor Mechanism - Disrupt HIV capsid formation and viral replication
HIV Post-Exposure Prophylaxis (PEP) - Three-drug ART regimen started within 72 hours of exposure and continued for 28 days
HIV Pre-Exposure Prophylaxis (PrEP) - Preventive antiretroviral medication for HIV-negative individuals at high risk of exposure;
requires adherence and routine HIV testing
Common Causes of HIV Medication Resistance - Poor adherence, missed doses, incorrect dosing, drug interactions, incomplete
viral suppression, viral mutations
Pancreatitis Treatment - Supportive care with IV fluids, pain control, bowel rest, nutritional support, and treatment of underlying
cause
Pancreatitis Medication Considerations - Opioids may be used for pain but can cause sedation, constipation, and respiratory
depression; monitor hydration and complications
Pancreatic Enzyme Education - Take enzymes with every meal and snack; swallow capsules whole; dose depends on fat content;
improves digestion and nutrient absorption
Insulin Pharmacodynamics - Binds insulin receptors causing increased glucose uptake into muscle/adipose tissue, decreased
hepatic glucose production, and increased glycogen synthesis
Basal Insulin - Long-acting insulin providing continuous background glucose control; examples: glargine, detemir, degludec
Bolus Insulin - Rapid- or short-acting insulin used for mealtime glucose control and correction doses; examples: lispro, aspart,
glulisine, regular insulin
Rapid-Acting Insulin Peak/Duration - Lispro, aspart, glulisine: onset ~15 minutes; peak 1–2 hours; duration 3–5 hours
Short-Acting Insulin Peak/Duration - Regular insulin: onset 30–60 minutes; peak 2–4 hours; duration 5–8 hours
Intermediate-Acting Insulin Peak/Duration - NPH: onset 1–2 hours; peak 4–12 hours; duration 12–18 hours
Long-Acting Insulin Peak/Duration - Glargine/detemir: minimal peak; duration approximately 24 hours; degludec duration >42
factors II, VII, IX, X and proteins C/S; delayed onset 3–5 days; half-life ~36–42 hours; CYP450 metabolism
Warfarin Starting Dose - 2–5 mg PO daily; lower doses in elderly, liver disease, malnutrition, or high bleeding risk
Warfarin Indications - Atrial fibrillation stroke prevention, DVT/PE treatment, mechanical heart valves
Warfarin vs Antiplatelets - Warfarin prevents fibrin clot formation through coagulation pathways; antiplatelets inhibit platelet
aggregation and are used for arterial disease (MI, stroke, CAD, PCI)
Warfarin Contraindications - Pregnancy, active bleeding, severe liver disease, inability to monitor INR, hemorrhagic disorders
Warfarin Patient Teaching - Maintain consistent vitamin K intake; avoid NSAIDs unless prescribed; report bleeding; use soft
toothbrush/electric razor; notify provider before starting new medications
Warfarin Antidote - Vitamin K (phytonadione); severe bleeding may require PCC or FFP
INR Monitoring After Starting Warfarin - Draw INR within 2–3 days after initiation and adjust until therapeutic
Target INR for Atrial Fibrillation/DVT/PE - 2.0–3.0
Target INR for Mechanical Mitral Valve - 2.5–3.5
Target INR for Mechanical Aortic Valve - 2.0–3.0 depending on risk factors
Major Antiplatelet Drugs - Aspirin (COX inhibitor ↓ thromboxane A2), clopidogrel/prasugrel/ticagrelor (P2Y12 receptor inhibitors),
dipyridamole (PDE inhibitor), abciximab/eptifibatide (GP IIb/IIIa inhibitors)
Aspirin Pharmacokinetics - Irreversibly inhibits platelet COX-1, preventing thromboxane A2 formation; effect lasts 7–10 days for
platelet lifespan
Clopidogrel Pharmacokinetics - Prodrug activated by CYP450 enzymes; irreversibly blocks P2Y12 receptors; decreased
effectiveness with CYP2C19 inhibitors
Ticagrelor Pharmacokinetics - Reversible P2Y12 inhibitor with rapid onset; does not require hepatic activation
Heparin Pharmacokinetics - Parenteral anticoagulant that activates antithrombin III, inhibiting thrombin and factor Xa; rapid onset;
monitored by aPTT
Heparin Contraindications - Active bleeding, severe thrombocytopenia, history of heparin-induced thrombocytopenia (HIT),
hypersensitivity
Heparin Pregnancy Category - Category B; preferred anticoagulant in pregnancy because it does not cross the placenta
Low Molecular Weight Heparin (LMWH) - Enoxaparin; primarily inhibits factor Xa; predictable anticoagulant response with less
monitoring than unfractionated heparin
LMWH Contraindications - Active bleeding, severe renal impairment, history of HIT, thrombocytopenia, hypersensitivity
CHADS₂ Score - Stroke risk assessment for atrial fibrillation: CHF = 1 point, HTN = 1 point, Age ≥75 = 1 point, Diabetes = 1 point,
Stroke/TIA history = 2 points
PCI Anticoagulants - Unfractionated heparin, bivalirudin, or low molecular weight heparin; combined with antiplatelet therapy
(aspirin + P2Y12 inhibitor)
Missed Anticoagulant Dose Education - Take dose when remembered unless close to next dose; do not double dose; contact
provider for repeated missed doses
Iron Supplement Education - Take on empty stomach with vitamin C for improved absorption; avoid calcium, antacids, and dairy
around dosing; dark stools are expected; constipation is common
Average Daily Iron Intake - Adult men/postmenopausal women: 8 mg/day; premenopausal women: 18 mg/day
Iron Contraindications - Hemochromatosis, hemosiderosis, anemia not caused by iron deficiency, hypersensitivity
Iron Toxicity Signs - Severe abdominal pain, vomiting, diarrhea, GI bleeding, metabolic acidosis, shock, organ failure
Adult Iron Deficiency Anemia Dose - Ferrous sulfate providing approximately 100–200 mg elemental iron/day in divided doses
Folic Acid Contraindications - Hypersensitivity; avoid treating undiagnosed vitamin B12 deficiency because neurologic damage
may worsen
Folic Acid Pregnancy Dose - 400–800 mcg daily for prevention of neural tube defects; higher doses for high-risk patients
Vitamin B12 Deficiency Treatment - Cyanocobalamin IM injections or high-dose oral therapy depending on cause and absorption
ability
Vitamin B12 Therapy Not Needed - Normal B12 levels and no evidence of deficiency; avoid unnecessary supplementation
Hematopoietic Growth Factors - Erythropoietin stimulates RBC production; filgrastim/pegfilgrastim stimulate neutrophil production
Hematopoietic Growth Factor Administration - Usually subcutaneous; monitor CBC, hemoglobin, neutrophil response, and
adverse effects
Hematopoietic Growth Factor Contraindications - Hypersensitivity; uncontrolled hypertension with erythropoietin; caution with
malignancy due to possible tumor stimulation
Live Vaccine Contraindications - Pregnancy, immunocompromised patients, severe immune suppression, recent
immunosuppressive therapy
MMR Vaccine Schedule - Two doses; first dose at 12–15 months, second dose at 4–6 years; adults without immunity receive 2
doses separated by ≥28 days
Influenza Vaccine Recommendation - Annual vaccination recommended for everyone ≥6 months of age
Influenza Vaccine Contraindications - Severe allergic reaction to previous influenza vaccine or vaccine component; delay with
moderate/severe acute illness
, Flu Vaccine Education - Influenza vaccine cannot cause influenza; mild fever, soreness, and fatigue are immune responses, not
infection
Cyclosporine Indications - Immunosuppressant used for prevention of organ transplant rejection and treatment of autoimmune
disorders such as rheumatoid arthritis and psoriasis
Cyclosporine Mechanism of Action - Calcineurin inhibitor that decreases T-cell activation and inhibits IL-2 production
Cyclosporine Major Side Effects - Nephrotoxicity, hypertension, hyperkalemia, tremor, hirsutism, gingival hyperplasia, increased
infection risk
Cyclosporine Monitoring - Renal function, blood pressure, electrolytes, liver function, drug levels, signs of infection
TSH Indicating Levothyroxine Treatment - Elevated TSH with decreased free T4 indicates primary hypothyroidism requiring
treatment
Levothyroxine Mechanism of Action - Synthetic T4 hormone converted to active T3; replaces deficient thyroid hormone and
regulates metabolism
Levothyroxine Initial Dose - Healthy adults: approximately 1.6 mcg/kg/day; elderly or cardiac patients start low (12.5–50 mcg/day)
and titrate slowly
Levothyroxine Administration - Take on empty stomach 30–60 minutes before breakfast; separate calcium, iron, and antacids by
at least 4 hours
Levothyroxine Monitoring - Check TSH 6–8 weeks after initiation or dose changes; monitor every 6–12 months once stable
Levothyroxine Contraindications - Untreated adrenal insufficiency, thyrotoxicosis, acute MI, hypersensitivity
Levothyroxine Overdose Symptoms - Tachycardia, palpitations, anxiety, tremor, insomnia, weight loss, heat intolerance
Hyperthyroidism Treatment - Antithyroid medications (methimazole, propylthiouracil), radioactive iodine therapy, or surgery
depending on cause and severity
Methimazole Mechanism of Action - Inhibits thyroid peroxidase, decreasing thyroid hormone synthesis
Propylthiouracil (PTU) Mechanism of Action - Inhibits thyroid peroxidase and blocks peripheral conversion of T4 to T3
Methimazole Preferred Use - First-line for most patients with hyperthyroidism because of longer duration and fewer adverse
effects than PTU
PTU Preferred Use - First trimester pregnancy and thyroid storm due to inhibition of peripheral T4 to T3 conversion
Antithyroid Drug Major Adverse Effects - Agranulocytosis, hepatotoxicity, rash, arthralgia, GI upset
Antithyroid Drug Patient Education - Report fever, sore throat, or infection symptoms immediately due to risk of agranulocytosis
HIV Treatment Goal - Suppress viral replication to undetectable levels, increase CD4 count, prevent disease progression, and
reduce transmission risk
Initiation of Antiretroviral Therapy (ART) - Begin treatment as soon as possible after HIV diagnosis regardless of CD4 count
Six HIV Medication Classes - Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse
transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), integrase strand transfer inhibitors (INSTIs), entry inhibitors, capsid
inhibitors
NRTI Mechanism - Block reverse transcriptase by acting as false nucleoside substrates, stopping viral DNA synthesis
NNRTI Mechanism - Directly inhibit reverse transcriptase enzyme activity
Protease Inhibitor Mechanism - Block viral protease, preventing maturation of infectious HIV particles
Integrase Inhibitor Mechanism - Prevent integration of viral DNA into host DNA
Entry/Fusion Inhibitor Mechanism - Prevent HIV attachment or fusion with host cells
Capsid Inhibitor Mechanism - Disrupt HIV capsid formation and viral replication
HIV Post-Exposure Prophylaxis (PEP) - Three-drug ART regimen started within 72 hours of exposure and continued for 28 days
HIV Pre-Exposure Prophylaxis (PrEP) - Preventive antiretroviral medication for HIV-negative individuals at high risk of exposure;
requires adherence and routine HIV testing
Common Causes of HIV Medication Resistance - Poor adherence, missed doses, incorrect dosing, drug interactions, incomplete
viral suppression, viral mutations
Pancreatitis Treatment - Supportive care with IV fluids, pain control, bowel rest, nutritional support, and treatment of underlying
cause
Pancreatitis Medication Considerations - Opioids may be used for pain but can cause sedation, constipation, and respiratory
depression; monitor hydration and complications
Pancreatic Enzyme Education - Take enzymes with every meal and snack; swallow capsules whole; dose depends on fat content;
improves digestion and nutrient absorption
Insulin Pharmacodynamics - Binds insulin receptors causing increased glucose uptake into muscle/adipose tissue, decreased
hepatic glucose production, and increased glycogen synthesis
Basal Insulin - Long-acting insulin providing continuous background glucose control; examples: glargine, detemir, degludec
Bolus Insulin - Rapid- or short-acting insulin used for mealtime glucose control and correction doses; examples: lispro, aspart,
glulisine, regular insulin
Rapid-Acting Insulin Peak/Duration - Lispro, aspart, glulisine: onset ~15 minutes; peak 1–2 hours; duration 3–5 hours
Short-Acting Insulin Peak/Duration - Regular insulin: onset 30–60 minutes; peak 2–4 hours; duration 5–8 hours
Intermediate-Acting Insulin Peak/Duration - NPH: onset 1–2 hours; peak 4–12 hours; duration 12–18 hours
Long-Acting Insulin Peak/Duration - Glargine/detemir: minimal peak; duration approximately 24 hours; degludec duration >42
