Antiplatelet drugs

Question 1

Aspirin

Answer 1

MoA - COX inhibitor (COX 2 in platelets)

Oral

Ind - Acute coronary syndrome, stroke, arterial thrombosis

Adverse - Bleeding, gastric irritation

Metab - hepatic

81mg (low) dose for antiplatelet effect

Question 2

NSAIDs

Answer 2

MoA - COX inhibitor

Oral

Ind - Various diseases

Adverse - bleeding, gastric irritation

Metab - hepatic

Question 3

Ticlopidine

Answer 3

MoA - 1st gen. ADP receptor inhibitor

Oral, prodrug

Ind - Acute coronary syndrome, stroke, stent thrombosis

Adverse - several. Increased cholesterol, diarrhea, bleeding, neutropenia, hepatic toxicity, TTP, etc.

Rarely used b/c of adverse effects

Question 4

Clopidogrel

Answer 4

MoA - 2nd gen. ADP receptor inhibitor

Oral, prodrug

Ind - Acute coronary syndrome, stroke, stent thrombosis

Adverse - Bleeding, thrombotic thrombocytopenic purpura (TTP)

Fewer adverse effects than 1st gen but large variability in pt response to drug

Question 5

Prasugrel

Answer 5

MoA - 3rd generation ADP receptor inhibitor

Oral, prodrug

Ind - Acute coronary syndrome, stroke, stent thrombosis

Adverse - Bleeding

Decreased variability in response

Question 6

Ticagrelor

Answer 6

MoA - 4th gen ADP receptor inhibitor

Oral, non-prodrug

Ind - Acute coronary syndrome, stroke, stent thrombosis

Adverse - Bleeding

Maintained 3rd gen low response variability, no longer needs liver func. for activity

Question 7

Cangrelor

Answer 7

MoA - 5th gen ADP receptor inhibitor

I.V.

Ind - Prep for stenting

Adverse - Bleeding

I.V. administration allows for fast action

Question 8

Dipyridamole

Answer 8

Phosphodiesterase inhibitor

Oral

Ind - Arterial thrombosis, stroke

Adverse - Bleeding

Question 9

Cilostazol

Answer 9

Phosphodiesterase inhibitor

Oral

Ind - Intermittent claudication

Adverse - Hypotension

Question 10

Abciximab

Answer 10

MoA - GP IIb/IIIa inhibitor

I.V.

Ind - Acute coronary syndrome, percutaneous coronary intervention (PCI)

Adverse - Bleeding

Question 11

Eptifibatide

Answer 11

MoA - GP IIb/IIIa inhibitor

I.V.

Ind - Acute coronary syndrome, percutaneous coronary intervention (PCI)

Adverse - Bleeding

Question 12

Tirofiban

Answer 12

MoA - GP IIb/IIIa inhibitor

I.V.

Ind - Acute coronary syndrome, percutaneous coronary intervention (PCI)

Adverse - Bleeding

Question 13

Fish oil

Answer 13

Omega-3 fatty acid

MoA - Phospholipase A2 antagonist (converted into thromboxane A3 instead of A2, which is inactive)

Oral

Not really a drug, just be aware

Question 14

Vorapaxar

Answer 14

MoA - Thrombin receptor antagonist

Oral

Ind - Repeat MI prevention, peripheral artery disease

Adverse - Bleeding

Metab - Hepatic (CYP3A4)

Question 15

Montelukast

Answer 15

MoA - Leukotriene receptor inhibitor

Oral

Ind - Allergic reactions

Adverse - Hypotension, behavioral changes

Metab - Hepatic (CYP3A4)

(Don’t really need to know for this block)

Brand name - Singulair

Question 16

Zafirlukast

Answer 16

MoA - Leukotriene receptor inhibitor

Oral

Ind - Asthma

Adverse - Hypotension

Metab - Hepatic (CYP2C9)

Question 17

Zileuton

Answer 17

MoA - Lipoxygenase inhibitor

Oral

Ind - Maintenance of asthma

Adverse - Hypotension

Metab - Hepatic