Antiplatelet drugs, ADP-receptor antagonists

Question 1

What is it indicated for?

Answer 1

Acute coronary syndrome

Secondary prevention of major adverse cardiovascular events

Question 2

How does it work?

Answer 2

Prevent platelet aggregation

Question 3

What are the side effects of this drug class?

Answer 3

Bleeding
GI upset e.g. dyspepsia, abdominal pain and diarrhoea
Thrombocytopenia- rare side effect

Question 4

What are the warnings of this drug class?

Answer 4

Do not prescribe in active bleeding
Use with caution in renal and hepatic impairment

Question 5

When should these drugs be stopped before surgery?

Answer 5

7 days before elective surgery

Question 6

What drugs are in this class?

Answer 6

Clopidogrel
Ticagrelor
Prasugrel

Question 7

What are some of the interactions of clopidogrel?

Answer 7

It is a pro-drug activated by hepatic cytochrome P450 enzymes. Therefore its efficacy can be reduced by CYP inhibitors which reduce its activation. Examples include omeprazole, ciprofloxacin, erythromycin, some antifungals and some selective serotonin reuptake inhibitors, as well as grapefruit juice.

Question 8

What PPIs are less likely to interact with clopidogrel?

Answer 8

Lansoprazole
Pantiprazole

Question 9

What drugs increase the risk of bleeding in combination of ADP-receptor antagonists?

Answer 9

Antiplatelet drugs
Anticoagulants
Heparin
NSAIDs