Anti Platelet Agents (Stable Angina CAD)

Question 1

What is the MOA of Aspirin

Answer 1

Irreversible

Inhibits TxA2

Question 2

What are the indications for ASA daily Tx? Why?

Answer 2

Men >65
Women > 55
For thromboprotection

Question 3

How long does it take for ASA to metabolize and where?

Answer 3

Half life 2-3 hrs initially then 15-30 once hepatic metabolism is saturated

Question 4

What are the SE of ASA?

Answer 4

GI bleed- age + dose influence
H2RA or PPI for gastroprotection

Tinnitus (salicyclate toxicity, bruising or bleeding)

Question 5

Extra info for ASA-
How to take during ACS,
what decreases bioavailability and how is it metabolized?

Answer 5

Chew and swallow during ACS- inc. bioavailability
Enteric coating decreases bioavail
Erythrocytes metabolize ASA into salicylate in GI

Question 6

Considerations of ASA

Answer 6

if pt stops ASA- body makes new platelets–(10% per day) and they live for 7 days
ASA has a lot of salt to consider BP!

Question 7

Clopidogrel MOA

Answer 7

Irreversible

Inhibits ADP mediated platelet activation by GP IIB/IIIA via shear stress

Question 8

Clopidogrel Indications

Answer 8

PAD, vascular Dz– better than ASA

used instead of ASA if allergic or intolerant

Question 9

Metabolism of Clopidogrel

Answer 9

Bioactivated by CYP2C19

Active antiplatelet metabolite with half life of 8 hours

Question 10

SE of clopidogrel

Answer 10

bleeding- especially if older, Low body weight, on NSAIDS or on Warfarin

Question 11

DI of Clopidogrel

Answer 11

Ompreazole and PPI are major DI

use an H2 blocker or space out drugs 12 hours apart

Question 12

Considerations for Clopidogrel

Answer 12

stop 7 days before major surgery

Question 13

Prasugrel MOA

Answer 13

Irreversible

Inhibits ADP mediated platelet activation by CYP3A4/3A5

Question 14

Prasugrel Indications

Answer 14

protections of cardiac BMS or DES for 12 mo

12 mo in non cardiac vessel stents

Question 15

Prasugrel Metabolism

Answer 15

slightly more effective than clopidogrel and avoid CYP2C19 interactions with PPIs

Question 16

Contraindications of Prasugrel

Answer 16

hx of hemorrhagic events

hx of stroke or TIA

Question 17

SE Prasugrel

Answer 17

Bleeding if body wt 75 yo

Question 18

Extra/DI for Prasugrel

Answer 18

consider pharmacodynamics and bleeding if pt is on ASA, NSAIDS, or warfarin

Question 19

Considerations for Prasugrel

Answer 19

do NOT give if pt is

Question 20

Ticgrelor MOA

Answer 20

Reversible
Inhibits ADP mediated platelet activation
*dose dependent!

Question 21

Ticgrelor Indications

Answer 21

protections of cardic BMS or DES for 12 mo

12 mo in non cardiac vessel stents

Question 22

Ticgrelor metabolism

Answer 22

CYP3A4 to active metabolite

half life 7 hours (parent.) & 9 hrs (metabolite)

Question 23

Contraindications of Ticgrelor

Answer 23

Active liver dz- bc its >99% protein bound

Question 24

SE of Ticgrelor

Answer 24

Bleeding

hepatic dx greatly increases this risk

Question 25

Considerations of Ticgrelor

Answer 25

Consider pharmacodynamics and bleeding if pt is on ASA, NSAIDS, warfarin, older or low body weight

Question 26

Dipyridamole MOA

Answer 26

Inhibits adenosine deaminase and phosphodiesterase platelets | Increases camp to vasodilate and inhibit platelets

Question 27

Indications Dipyridamole

Answer 27

stroke prevention vascular dz combo with ASA

Question 28

SE dipyridamole

Answer 28

bleeding

Question 29

Considerations of Dipyridamole

Answer 29

consider pharmacodynamics and bleeding if pt is on NSAIDS, Warfarin, Older pts or low body weight

Question 30

What are the anti platelet agents?

Answer 30

``` Aspirin Clopidogrel Prasugrel Ticagrelor Dipyridamole ```