Antiplatelet Drugs

Question 1

What are the release products of the light (alpha) granules?

Answer 1

Platelet factor 4
Beta-thromboglobulin
Platelet-derived growth factor (PDGF)

Question 2

What are the release products of the dense (beta) granules?

Answer 2

Ca+2
Serotonin (5-Hydroxytryptamine)
ATP/ADP

Question 3

Is primary aggregation reversible? Is secondary?

Answer 3

Primary aggregation is reversible but secondary is NOT.

Question 4

What are the functions of the anti platelet drugs?

Answer 4

An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet adhesion, activation and aggregation thereby inhibit thrombus formation.

Question 5

What is the difference in effectiveness of the anti-platelet drugs in the arterial circulation VS drugs like heparin and warfarin?

Answer 5

These drugs are effective in the arterial circulation, where anticoagulants such as heparin and oral anticoagulants have relatively little effect.

Question 6

What is the general usage of anti-platelet drugs?

Answer 6

They are widely used in primary and secondary prevention of thrombotic cerebrovascular or cardiovascular disease

Question 7

Which of the ADP receptor inhibitors are prodrugs?

Answer 7

Ticlopidine
Clopidogrel
Prasugrel

Question 8

What is the difference between these two ADP receptor inhibitors: Ticagrelor and Cangrelor?

Answer 8

Cangrelor is available via IV only whereas Ticagrelor is oral

Question 9

What is the most potent class of anti platelet drugs?

Answer 9

GPIIb/IIIa Inhibitors

Question 10

What are the COX inhibitors?

Answer 10

Aspirin
Celecoxib (COX2 only)
Ibuprofen
Naproxen

Question 11

What are the ADP receptor inhibitors?

Answer 11

Ticlopidine
Clopidogrel 
Prasugrel 
Ticagrelor
Cangrelor

Question 12

What are the GP IIb/IIIa inhibitors?

Answer 12

Abciximab
Tirofiban
Eptfibatide

Question 13

What is a PAR-1 antagonist?

Answer 13

Vorapaxar

Question 14

What is the difference between the ADP receptor inhibitors Clopidogrel and Prasugrel?

Answer 14

Prasugrel has less population variation in response to treatment so it is more likely to be effective in patients.

Question 15

How is anti platelet therapy generally administered?

Answer 15

Dual Antiplatelet Therapy as combination therapy often with aspirin. Sometimes even Triple Therapy is used.

Question 16

What are some of the clinical applications of anti-platelet drugs?

Answer 16

• Cerebrovascular disease:
  a. Transient ischemic attack (TIA)
  b. Complete stroke
• Coronary artery disease:
  a. Acute myocardial infarction
• Saphenous vein coronary artery bypass grafts
• Venous Thrombosis
• Claudication
• Thrombotic thrombocytopenic purpura
• Prevention of thrombus formation on artificial surfaces

Question 17

What are some drugs that possibly have interaction with anti-platelet drugs?

Answer 17

1. Thrombolytic agents (urokinase, streptokinase and tissue plasminogen activator)
2. Heparin/LMW heparin/oral anticoagulants
3. Warfarin
4. Antithrombin agents (hirudin, bivalirudin and argatroban)

Question 18

What are the two major pathways of arachidonic acid metabolism?

Answer 18

1. Cyclooxygenase pathway

2. Lipoxygenase pathway

Question 19

What is the main drug that acts on the Cyclooxygenase Pathway?

Answer 19

Aspirin

Question 20

What are the main products of the Cyclooxygenase Pathway in platelets?

Answer 20

TXA2

Question 21

What is the main product of the Lipoxygenase Pathway in leukocytes?

Answer 21

Leukotrienes

Question 22

What are the leukotriene antagonists and what are they used for?

Answer 22

• Montelukast is used for the treatment of asthma and seasonal allergies
• Zarirlukast is used in the treatment of asthma

Question 23

Aspirin MOA and Route of Administration

Answer 23

COX inhibitor

Oral

Question 24

Aspirin Indications

Answer 24

ACS, stroke, arterial thrombosis

Question 25

Aspirin SE

Answer 25

Bleeding

Gastric Irritation

Question 26

Clopidegrel MOA and Route of Administration

Answer 26

ADP receptor inhibitor

Oral

Question 27

Clopidogrel Indications

Answer 27

ACS, stroke, in stent thrombosis

Question 28

Clopidogrel SE

Answer 28

Bleeding, TTP

Question 29

Prasugrel and Ticagrelor MOA and Route of Administration

Answer 29

ADP receptor inhibitor

Oral

Question 30

Prasugrel and Ticagrelor Indications

Answer 30

ACS, stroke, in stent thrombosis

Question 31

Prasugrel and Ticagrelor SE

Answer 31

Bleeding

Question 32

NSAIDs MOA and Route of Administration

Answer 32

COX inhibitor

Oral

Question 33

Dipyridamole MOA and ROA

Answer 33

Phosphodiesterase inhibitor

Oral

Question 34

Dipyridamole Indications

Answer 34

Arterial thrombosis, stroke

Question 35

Dipyridamole SE

Answer 35

Bleeding

Question 36

Cilostazol MOA and ROA

Answer 36

Phosphodiesterase inhibitor

Oral

Question 37

Cilostazol Indications

Answer 37

Intermittent claudication

Question 38

Cilostazol SE

Answer 38

Hypotension

Question 39

Abciximab/Eptifibatide/Tirofiban MOA and ROA

Answer 39

GP IIb/IIIa inhibitor

IV

Question 40

Abciximab/Eptifibatide/Tirofiban Indications

Answer 40

ACS

Coronary Heart Disease

Question 41

Abciximab/Eptifibatide/Tirofiban SE

Answer 41

Bleeding

Question 42

Monteleukast MOA and ROA

Answer 42

Leukotriene receptor inhibitor

Oral

Question 43

Monteleukast Indications

Answer 43

Allergic reactions

Question 44

Monteleukast SE

Answer 44

Hypotension

Behavioral Changes

Question 45

Zafirleukast MOA and ROA

Answer 45

Leukotriene receptor inhibitor

Oral

Question 46

Zafirleukast Indications

Answer 46

Asthma

Question 47

Zafirleukast SE

Answer 47

Hypotension

Question 48

Zieuton MOA and ROA

Answer 48

Lipoxygenase inhibitor

Oral

Question 49

Zieuton Indications

Answer 49

Asthma

Question 50

Zieuton SE

Answer 50

Hypotension

Question 51

Which of the following mechanisms represents the antiplatelet actions of Diprydamole?

A. ADP receptor inhibition
B. Cyclooxygenase inhibition
C. Glycoprotein IIb/IIIa inhibition 
D. Lipoxygenase inhibition
E. Phosphodiesterase inhibition

Answer 51

E. Phosphodiesterase inhibition