Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

aspirin (ASA) Ecotrin, (commonly known Antipyretics, salicylates,
as baby aspirin) nonopiod analgesics
Peak Onset Duration
1-3 hr 5-30 min 3-6 hr
Why is your patient getting this medication
Prophylaxis of TIA, MI
Mechanism of action and indications
(Why med ordered)
Decreases platelet aggregation. The analgesic, antipyretic, and anti-
inflammatory effects of aspirin are due to actions by both the acetyl
and the salicylate portions of the intact molecule as well as by the
active salicylate metabolite. Aspirin directly and irreversibly inhibits thrombocytopenia (more important with aspirin). History of GI
the activity of both types of cyclo-oxygenase (COX-1 and COX-2)
to decrease the formation of precursors of prostaglandins and
thromboxanes from arachidonic acid. This makes aspirin different
from other NSAIDS (such as diclofenac and ibuprofen) which are
reversible inhibitors. Salicylate may competitively inhibit
prostaglandin formation. Aspirin's antirheumatic (nonsteroidal anti-
inflammatory) actions are a result of its analgesic and anti-
inflammatory mechanisms; the therapeutic effects are not due to
pituitary-adrenal stimulation. The platelet aggregation–inhibiting
effect of aspirin specifically involves the compound's ability to act as
an acetyl donor to the platelet membrane; the nonacetylated
salicylates have no clinically significant effect on platelet
aggregation. Aspirin affects platelet function by inhibiting the
enzyme prostaglandin cyclooxygenase in platelets, thereby
preventing the formation of the aggregating agent thromboxane A2.
This action is irreversible; the effects persist for the life of the
platelets exposed. Aspirin may also inhibit formation of the platelet
aggregation inhibitor prostacyclin (prostaglandin I2) in blood
vessels; however, this action is reversible.
81 mg PO Qd
Normal dosage range
For prevention of: MI: 300-325 mg/day (doses as low as 80
mg/day may be effective), TIA: 1-1.3 g daily in 2-4 divided
doses (doses as low as 325 mg/day may be used in patients who
are intolerant of the higher dose)
For IV meds, compatibility with IV drips and/or solutions
N/A
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity to aspirin, tartrazine (FDC yellow dye #5), or
other salicylates. Cross-sensitivity with other NSAIDs may
exist (less with nonaspirin salicylates). Bleeding disorders or
bleeding or ulcer disease. Chronic alcohol use/abuse. Geriatric
patients (↑ risk of adverse reactions especially GI bleeding;
more sensitive to toxic levels).
Common side effects
Dyspepsia, epigastric distress, heartburn, nausea. GI
BLEEDING, EXFOLIATIVE DERMATITIS, STEVENS-
JOHNSON SYNDROME, TOXIC EPIDERMAL
NECROLYSIS, ALLERGIC REACTIONS INCLUDING
ANAPHYLAXIS AND LARYNGEAL EDEMA

Ecotrin (ASA 81mg)

Interactions with other patient drugs, OTC or herbal medicines Lab value alterations caused by medicine
(ask patient specifically) May cause ↑ serum AST, ALT, and alkaline phosphatase,
Lovenox: In patients receiving neuraxial anesthesia or spinal especially when plasma concentrations exceed 25 mg/100 ml.
puncture, the risk of developing an epidural or spinal hematoma May alter results of serum uric acid, urine vanillylmandelic acid
during low molecular weight heparin (LMWH) or heparinoid (VMA), protirelin-induced thyroid-stimulating hormone (TSH),
therapy may be increased by the concomitant use of other drugs that urine hydroxyindoleacetic acid (5-HIAA) determinations, and
affect coagulation, including nonsteroidal anti-inflammatory drugs radionuclide thyroid imaging. May cause ↓ serum potassium and
(NSAIDs). The development of epidural and spinal hematoma can cholesterol concentrations.
lead to long-term or permanent paralysis. Be sure to teach the patient the following about this
Lantus, NovoLog: The hypoglycemic effect of insulin may be medication
potentiated by certain drugs, including ACE inhibitors, anabolic Advise patients receiving aspirin prophylactically to take only
steroids, fibrates, monoamine oxidase inhibitors (MAOIs), prescribed dose. Increasing the dose has not been found to
salicylates, selective serotonin reuptake inhibitors (SSRIs), provide additional benefits. Instruct patient to take salicylates
sulfonamides, disopyramide, propoxyphene, quinine, and quinidine. with a full glass of water and to remain in an upright position for
These drugs may increase the risk of hypoglycemia by enhancing 15-30 min after administration.
insulin sensitivity (ACE inhibitors, fibrates); stimulating insulin
secretion (salicylates, disopyramide, quinine, quinidine, MAOIs);
increasing peripheral glucose utilization (SSRIs, insulin-like growth
factor); and/or inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-
like growth factor). Clinical hypoglycemia has been reported during
use of these agents alone or with insulin and/or insulin
secretagogues.
Plavix: Clopidogrel has been shown to potentiate the inhibition of
platelet aggregation due to aspirin. Single-dose studies have not
shown a prolongation of bleeding time when aspirin was added to
clopidogrel; however, the risk of gastrointestinal (GI) bleeding may
be increased. A large clinical trial reported that clopidogrel 75
mg/day plus aspirin 75 to 325 mg/day for up to 1 year was
associated with a higher incidence of major GI bleeding (1.3% vs
0.7% with aspirin alone). These two medications are routinely used
together for their additive antiplatelet, antistroke effect. The safety of
chronic administration of aspirin or other salicylates with clopidogrel
has not been established.
Levaquin: Coadministration with nonsteroidal anti-inflammatory
drugs (NSAIDs) may potentiate the risk of central nervous system
toxicity sometimes associated with fluoroquinolone use. The
interaction has been reported most often with enoxacin. It may occur
with other fluoroquinolones as well, but is poorly documented. The
exact mechanism of interaction is unknown. Some investigators
suggest that the piperazine ring of fluoroquinolones may inhibit the
binding of gamma-aminobutyric acid (GABA) to brain receptors and
that NSAIDs may synergistically add to this effect. Patients with a
history of seizures may be at greater risk.
Fludricortisone, hydrocortisone: Coadministration with
corticosteroids may decrease the serum concentrations and
therapeutic effects of salicylates. Likewise, serum salicylate levels
may increase following withdrawal of corticosteroid therapy,
potentially resulting in salicylate toxicity. This interaction has been
reported in patients receiving intra-articular as well as oral
corticosteroids. One or more mechanisms may be involved,
including an increase in the renal clearance and/or an induction of
hepatic metabolism of salicylates caused by corticosteroids.
Pharmacologically, the potential for increased gastrointestinal (GI)
toxicity, including inflammation, bleeding, ulceration and
perforation, should be considered due to additive ulcerogenic effects
of these agents (especially aspirin) on the GI mucosa.
Lanoxin: Nonsteroidal anti-inflammatory drugs (NSAIDs) may
Ecotrin (ASA 81mg)
Nursing Process- Assessment
(Pre-administration assessment)
Ensure patient has no history of asthma, allergies,
nasal polyps or tartrazine allergies (Patients who
have asthma, allergies, and nasal polyps or who
are allergic to tartrazine are at an increased risk for
developing hypersensitivity reactions).
Ecotrin (ASA 81mg)
Assessment Evaluation
Why would you hold or not give this med? Check after giving
Monitor patient for the onset of tinnitus, Prevention of TIA, MI
headache, hyperventilation, agitation, mental
confusion, lethargy, diarrhea, and sweating.
If these symptoms appear, withhold
medication and notify physician or other
health care professional immediately.