Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Pharmacology > Anti-platelet Drugs > Flashcards

Anti-platelet Drugs Flashcards

1
Q

What is a pearl about the use of antiplatelet agents?

A

They are used for the prevention and treatment of ARTERIAL thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Commonly used Anti-platelet agents

A
  • COX inhibitors: ASA

- ADP receptor inhibitors: Clopidogrel, prasugrel, ticagrelor, cangrelor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Less commonly used antiplatelets (recognize the name)

A
  • Cilostazol (PDE inhibitor)
  • ER Dipyridamole/ASA (Adenosine reuptake inhibitor)
  • Vorapaxar (PAR-1 antagonist)
  • Eptifibatide (GP IIb/IIIa inhibitor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aspirin MOA

A
  • Irreversibly acetylates COX
  • Impairing PG, prostacyclin, and thromboxane A2 production
  • this leads to decreased platelet aggregation and vasoconstriction

***IRREVERSIBLE platelet effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Aspirin clinical indications

A
  • AMI/TIA/CVA prophylaxis
  • DVT prophylaxis
  • Analgesia

Falling out of favor for primary prevention due to benefits being offset by bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What antiplatelet therapy is indicated in ACS and why?

A
  • Aspirin + clopidogrel or others
  • Dual antiplatelet therapy is mandatory b/c coronary lesions & stents behave like unstable plaques as long as they are not fully covered by a cellular layer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long will you be on ASA + clopidogrel after bare-metal stent placement? What about drug eluding?

A
  • Bare-metal: 1 month

- Drug eluding: minimum 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pearl about ASA use in cardiac disease

A
  • With few exceptions, pts with CAD, PAD, or a h/o of ischemic CVA are candidates for ASA use
  • Take at any time. just be consistent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Do you continue ASA if a pt develops a GI bleed? (Think about their prevention category)

A
  • Primary prevention: D/c for most patients and focus on BP control, statins, smoking cessation
  • Secondary prevention: Consider restarting ASA for pts with a CV event history!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some pearls about enteric coated ASA related to dyspepsia and GI bleeding?

A

-Causes decreased dyspepsia but it does NOT decrease GI bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ASA Monitoring/Interactions

A
  • Monitor for anemia/bleeding periodically (H/H)
  • NSAIDs decrease ASA antiplatelet effect**

**Take ASA 1 hour before NSAID, not-enteric coated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Common ASA ADRs

A
  • Dyspepsia
  • GI ulceration
  • Bleeding: Daily dose at least doubles GI risk**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What drug can you consider adding on to ASA if the patient is at high risk for GI bleeding?

A

PPI

RF: Hx PUD, chronic NSAIDs, Clopidogrel, anticoagulant use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some other dose-dependent ADRs of ASA?

A
  • HTX
  • SNHL (salicyclism)
  • AKI
  • Reye’s Syndrome
  • Aspirin exacerbated respiratory disease (AERD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thienopyridines

A
  • Clopidogrel**

- Prasugrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Clopidogrel MOA (entire process added for completeness)

A

-Prodrug that is metabolized twice to get to its active metabolite

  • Active metabolite irreversibly blocks P2Y12 component of the ADP receptor
  • Prevents activation of GP IIb/IIIa receptor complex
  • Prevents fibrinogen binding at that site
  • Decreased platelet aggregation/adhesion

-END RESULT IS A IRREVERSIBLE PLATELET EFFECT

17
Q

What is a pearl about the MOA of Prasugrel?

A
  • It is also a prodrug

- It prevents platelet activation better than clopidogrel

18
Q

This allele significantly decreases the body’s ability to metabolize Clopidogrel into its active metabolite

A
  • CYP2C19*2
  • Diminished platelet inhibition and higher rate of major adverse CV events
  • Genotyping advised for moderate-high risk CV event patients who are treated with clopidogrel
19
Q

Thienopyridines Indications

A

-Clopidogrel: ACS, TIA/CVA, PAD

Prasugrel: ACS

20
Q

Clopidogrel interactions

A
  • PPIs (Omeprazole/esomeprazole***)
  • Cimetidine
  • Fluoxetine
  • Fluconazole
  • Opioids

-Can increase bleeding risk if added with other antiplatelets or NSAIDs

21
Q

What PPI should you use to avoid interactions in patients taking clopidogrel at high risk of GI bleeding?

A

-Pantoprazole

Save PPIs for patients with HIGH bleeding risk or multiple risk factors due to the risk of drug interactions

22
Q

Prasugrel causes bleeding more often than clopidogrel. What patient population is Prasugrel contraindicated in?

A

-Patients with hx of TIA/CVA

23
Q

If Clopidogrel is mixed with ASA what is a common side effect?

A

GI intolerance (N/V, dyspepsia, gastritis)

24
Q

Non-thienopyridines

A
  • Ticagrelor
  • Cangrelor

MOA: Same as clopidogrel but has REVERSIBLE anti-platelet effects (Still hits ADP receptor)

25
Q

Clinical Indications for Ticagrelor

A

-ACS (with concomitant low-dose ASA) pts managed medically or with PCI/CABG

26
Q

Ticagrelor/cangrelor monitoring

A

Monitor H/H

-Ticagrelor you need to monitor renal function and uric acid concentration in patients with gout or risk of hyperuricemia

27
Q

Ticagrelor Interactions

A
  • 3A4 substrate
  • Opioids

ADRs: Bleeding, dyspnea

Clinical Pharmacology (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions