Anti Platelet Agents (Stable Angina CAD) Flashcards

1
Q

What is the MOA of Aspirin

A

Irreversible

Inhibits TxA2

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2
Q

What are the indications for ASA daily Tx? Why?

A

Men >65
Women > 55
For thromboprotection

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3
Q

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

A

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

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4
Q

What are the SE of ASA?

A

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

Tinnitus (salicyclate toxicity, bruising or bleeding)

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5
Q

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

A

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

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6
Q

Considerations of ASA

A

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!

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7
Q

Clopidogrel MOA

A

Irreversible

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

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8
Q

Clopidogrel Indications

A

PAD, vascular Dz– better than ASA

used instead of ASA if allergic or intolerant

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9
Q

Metabolism of Clopidogrel

A

Bioactivated by CYP2C19

Active antiplatelet metabolite with half life of 8 hours

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10
Q

SE of clopidogrel

A

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

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11
Q

DI of Clopidogrel

A

Ompreazole and PPI are major DI

use an H2 blocker or space out drugs 12 hours apart

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12
Q

Considerations for Clopidogrel

A

stop 7 days before major surgery

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13
Q

Prasugrel MOA

A

Irreversible

Inhibits ADP mediated platelet activation by CYP3A4/3A5

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14
Q

Prasugrel Indications

A

protections of cardiac BMS or DES for 12 mo

12 mo in non cardiac vessel stents

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15
Q

Prasugrel Metabolism

A

slightly more effective than clopidogrel and avoid CYP2C19 interactions with PPIs

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16
Q

Contraindications of Prasugrel

A

hx of hemorrhagic events

hx of stroke or TIA

17
Q

SE Prasugrel

A

Bleeding if body wt 75 yo

18
Q

Extra/DI for Prasugrel

A

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

19
Q

Considerations for Prasugrel

A

do NOT give if pt is

20
Q

Ticgrelor MOA

A

Reversible
Inhibits ADP mediated platelet activation
*dose dependent!

21
Q

Ticgrelor Indications

A

protections of cardic BMS or DES for 12 mo

12 mo in non cardiac vessel stents

22
Q

Ticgrelor metabolism

A

CYP3A4 to active metabolite

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

23
Q

Contraindications of Ticgrelor

A

Active liver dz- bc its >99% protein bound

24
Q

SE of Ticgrelor

A

Bleeding

hepatic dx greatly increases this risk

25
Considerations of Ticgrelor
Consider pharmacodynamics and bleeding if pt is on ASA, NSAIDS, warfarin, older or low body weight
26
Dipyridamole MOA
Inhibits adenosine deaminase and phosphodiesterase platelets | Increases camp to vasodilate and inhibit platelets
27
Indications Dipyridamole
stroke prevention vascular dz combo with ASA
28
SE dipyridamole
bleeding
29
Considerations of Dipyridamole
consider pharmacodynamics and bleeding if pt is on NSAIDS, Warfarin, Older pts or low body weight
30
What are the anti platelet agents?
``` Aspirin Clopidogrel Prasugrel Ticagrelor Dipyridamole ```