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Pharmacology > Antiplatelet Therapies > Flashcards

Antiplatelet Therapies Flashcards

1
Q

what are clinical indications for antiplatelet therapies?

A

to decrease risk of stroke, MI, vascular disease

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2
Q

what are the two most commonly used antiplatelets overall?

A

> Plavix (Clopidogrel)

> Aspirin (ASA)

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3
Q

name the most common P2Y12 receptor blocker antiplatelets

A 
-Thienopyridines
> Plavix (Clopidogrel) 
> Effient (Prasugrel) 
- Non-Thienopyridines:         
> Ticagrelor (Brilinta) 
> Cangrelor (Kengreal)
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4
Q

what is the MOA of ASA?

A

Irreversibly inhibits cyclooxygenase (COX-1) -> repeated dosing is necessary

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5
Q

aside from an antiplatelet therapy, what is aspirin also considered?

A

Salicylate acid

also: NSAID, antipyretic, anti-inflammatory

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6
Q

what is the therapeutic & maintenance/prophylaxis dose for ASA?

A

therapeutic: 75mc PO qd
maintenance: 81mg PO qd -»> preferred

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7
Q

what is the ASA dose after patients have a stroke or MI?

A

325mg PO QD

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8
Q

if a patient has an NSAID allergy, is it safe for them to take ASA and why?

A

no -> cross sensitivity: both drugs are grouped together

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9
Q

why are children NOT allowed to be given ASA? what is safe to give to them instead?

A

risk for developing Reye’s syndrome -> results in liver damage or swelling in the brain in kids
» safe to give Tylenol or Ibuprofen

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10
Q

in order to prevent GI Sx, what type of ASA should be given to patients?

A

enterocoated tablets -> prevents erosion of stomach lining

*also can provide Rx for PPIs or H2 blockers

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11
Q

most common sx of ASA?

A

N/V
GI bleed
ecchymosis (prolonged bleeding)

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12
Q

what PPIs are prescribed to prevent GI Side Effects of ASA?

A 
•   Omeprazole 
•   Esomeprazole
•   Pantoprazole 
•   Lansoprazol
*** NOT PRN DRUGS -> QD dosing that must be tapered after 8 weeks
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13
Q

what are the adverse effects of PPIs? interactions?

A 
adverse effects:
> diarrhea
> C. diff
> hypomagnesemia overtime 
interactions
> vitamin B12 
> Plavix
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14
Q

what is PGE1 analog drug (non-PPI option) used to protect the stomach to prevent GI side effects of ASA & NSAIDs? what is it contraindicated in the use of?

A

Misoprotstol - Cytotec

-contraindicated in pregnant patients

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15
Q

what is the most commonly prescribed P2Y-12 ADP Receptor Blocker/Antagonist for antiplatelet therapy? what is its MOA?

A

Clopidogrel - Plavix

MOA- irreversible binding d/t to being a pro-drug that must be metabolized in the liver -> active metabolite

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16
Q

what is the dosage for Clopidogrel (Plavix) and what is it usually prescribed with fro dual platelet therapy?

A

75mg PO qd

-ASA

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17
Q

if a patient is undergoing surgery and is prescribed Clopidogrel (Plavix), how many days in advance must they hold it?>

A

at least 5 days prior to surgery

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18
Q

what are the adverse effects of Clopidogrel (Plavix)?

A

Bleeding
Steven Johnson Syndrome
TTP (Thrombocytopenia purpura)

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19
Q

what are drug interactions for Clopidogrel (Plavix)?

A

PPIs
> Omeprazole (Prilosec)
> Esomeprazole (Nexium)

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20
Q

if a patient with GERD is on Plavix what should they be prescribed? if they have a bleed, what should they be switched to?

A

Famotidine

> Switch to Pantoprazole (Protonix)

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21
Q

what P2Y-12 ADP Receptor Antagonist antiplatelet therapy has REVERSIBLE binding?

A

Ticagrelor (Brilinta)

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22
Q

what is a another P2Y-12 ADP Receptor Antagonist antiplatelet therapy has IRREVERSIBLE binding?

A

Prasugrel (Effient)

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23
Q

what antiplatelet therapy has a dual MOA of inhibiting platelet aggregation as well as being a coronary vasodilator?

A

Dipyridamole (Persantine)

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24
Q

what are side effects of Dipyridamole (Persantine) & what is a common food interaction?

A

side effects: dizziness, hypotension

food interaction: horse chestnut

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25
Q

what antiplatelet agent is a Phosphodiesterase inhibitor that is rarely used and inhibits the maturation of platelets?

A

Anagrelide (Agrylin)

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26
Q

what treatment is given to patients with Idiopathic Thrombocytopenic Purpura (ITP)?

A

high dose steroids or IVIG

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27
Q

what treatment is given to patients with Thrombotic Thrombocytopenic Purpura (TTP)?

A

plasmapheresis or exchange transfusion

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28
Q

what is the first line of tx for patients with ITP? what is the dosing and which requires a taper?

A
  1. Dexamethasone 40 mg po per day for 4 days with no taper

2. Prednisone po 1 mg/kg daily for one to two weeks followed by a gradual taper

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29
Q

what happens if a pt is not tapered off of Prednisone?

A

patients will experience side effects if not tapered because it is weight based

30
Q

what is given to ITP patients if they cannot tolerate glucocorticoids?

A

IVIG within 24-48 hours

31
Q

what is the first line tx for patients with Von Willebrand’s Disease & why?

A

Desmopressin (DDAVP) infusion because it works the fastest as an ADH replacement therapy

32
Q

what is the MOA for Desmopressin (DDAVP)?

A

it is a synthetic analogue of antidiuretic hormone (ADH) that also increases factor VIII & vWF levels in plasma

33
Q

what are the routes of administration available for Desmopressin?

A

subcutaneous
IV
intranasal
oral preparations

34
Q

aside from ITP, what is Desmopressin also used for?

A

for peds patients that frequently wet the bed at night

35
Q

what is important to monitor in dosing of Warfarin and why?

A

monitor labs (PT/INR) for incidence of clotting due to rapid decrease of protein C

36
Q

what is the reversal for Warfarin and what routes of administration is it given by?

A

> Vitamin K PO (Mephyton)

> IM (Aquamephyton)

37
Q

can vitamin K be given IV?

A

no -> will cause anaphylaxis

38
Q

what drugs are given for Hyperfibrinolytic states?

A 
Tranexamic Acid (TXA) 
Aminocaproic Acid (Amicar)
39
Q

what is the MOA for TXA & Amicar?

A

Fibrinolysis inhibitors -> decreases plasmin formation and fibrinolysis

40
Q

which fibrinolysis inhibitor is used more commonly and why?

A

TXA -> 10 times more potent than Amicar

41
Q

what is a complication that can occur in heparin therapy? which is an immune reaction?

A

Type 1 & Type 2 Heparin-induced thrombocytopenia (HIT)

|&raquo_space; Type 2 HIT: triggers formation of anti-heparin antibodies

42
Q

what is the tx for HIT & when is it indicated?

A

Fondaparinex

> when pt on Heparin therapy has platelet levels < 50% of baseline

43
Q

what are the main components of the plasmin (fibrinolysis) system responsible for natural anticoagulation within the body?

A
  • Kallikrein
  • Factors XIa and XIIa
  • tissue plasminogen activator (tPA): most important, used to reduce thrombotic strokes
44
Q

what is the most common fibrinolytic agent used in clinical settings? what are other recombinant forms of tPA?

A
  1. Alteplase (only tPA that is FDA approved): derived from human melanoma cells
  2. Tenecteplase
  3. Reteplase
45
Q

which recombinant tPA has the longest half life and why?

A

Tenecteplase - greater binding affinity for fibrin than alteplase

46
Q

what is the route of administration for tPA & what is its primary MOA?

A

IV only

> dissolves clots

47
Q

when is tPA clinically indicated?

A
  1. Treatment of ST-segment elevation myocardial infarction (STEMI)
  2. Acute ischemic stroke (Alteplase only)
  3. Acute massive PE (Alteplase only)
  4. open clotted central venous access devices (Alteplase only)
48
Q

what MUST be considered before administration of tPA for strokes?

A

TIME SENSITIVE

> must be given 3-4.5 hours from onset of stroke symptoms

49
Q

what are pharmacologic & food interactions for tPA?

A

ASA, warfarin, anticoagulants, dipyridamole, heparin -> increase risk of bleeding
> horse chestnut

50
Q

which fibrinolytic therapy is difficult to reverse & why?

A

Tenecteplase due to its long half life

51
Q

what are clinical indications for tPA in thrombolytic therapy?

A 
> extensive DVT
> hypotension related to PE
> severe hypoxemia
> perfusion defect that is substantial
> right ventricular dysfunction assoc w/ PE
52
Q

what must be discontinued if a pt w/ acute venous thromboembolism is to start thrombolytic therapy?

A

heparin

53
Q

what are absolute contraindications in the use of fibrinolytic therapy for acute DVT or PE?

A
  • prior ICH -> including head contusion
  • known structural cerebral vascular lesion
  • malignant intracranial neoplasm
  • ischemic stroke w/in 3 months
  • aortic dissection
  • active bleeding
  • bleeding diathesis
  • TBI or facial trauma w/in 3 months
54
Q

what are relative contraindications in the use of fibrinolytic therapy for acute DVT or PE?

A
  • trauma or surgery < 3 weeks
  • pregnancy
  • uncontrolled HTN -> SBP > 180 or DBP > 110
  • recent internal bleeding
  • pregnancy
  • PUD
  • current use of AC such as warfarin
  • age > 75
  • diabetic retinopathy
  • pericarditis
55
Q

what is the main difference between anticoagulants and thrombolytics?

A

anticoagulants are used for PREVENTION

thrombolytics re used for REMOVAL of clots already formed

56
Q

what is an adverse rxn for Heparin?

A

excessive bleeding s/p small abrasions or minor trauma

-use of ASA

57
Q

what is an adverse effect of Warfarin in regards to pregnant patients and why?

A

teratogenic -> can cross placental barrier & harm fetus including:
skeletal deformations
hemorrhagic disorders

58
Q

what is a fatal complication for thrombolytics?

A

intracranial hemorrhage

59
Q

what can NEVER be given with the use of thrombolytics?

A

heparin

60
Q

what is the most common chemo induction therapy in tx for AML?

A

Cytarabine: antimetabolite
Daunorubicin: antitumor antibodies

61
Q

in the treatment of AML, what is included in all chemo induction regimens?

A

Cytarabine

> added with antitumor antibody for collateral damage of good cells

62
Q

what is the goal of chemo induction regimens for AML?

A

enable pt to get to remission and resolve hematologic effects

63
Q

which leukemia is associated with the Philadelphia chromosome and what is considered a cause of this leukemia?

A

Chronic Myelogenous Leukemia (CML)

> high dose irradiation

64
Q

what is the most commonly used preferred Tx for CML patients in REMISSION (in chronic phase)?

A

Imatinib (Gleevec)

> tyrosine kinase inhibitor that has the most long-term safety data

65
Q

what is the route of administration for all tyrosine kinase inhibitors and dosing frequency?

A

oral - QD or BID

66
Q

what enzyme does Imatinib (Gleevec) inhibit and what are the adverse effects?

A

CYP450 enzyme inhibitor
> Fluid retention, edema hepatotoxicity,
thrombocytopenia, or neutropenia

67
Q

what is a PCP note that MUST be considered for patients with Acute Lymphocytic Leukemia (ALL)?

A 
ALL patients cannot receive LIVE virus vaccines
> varicella
> zoster 
> MMR 
> nasal influenza
68
Q

what is the preferred steroid tx for ALL patients?

A

Dexamethasone

potency is greater than prednisone

69
Q

what is used for induction tx for patients with ALL?

A

Vincristine injections or infusions weekly

70
Q

what are the adverse effects of Vincristine?

A

decreased creatinine clearance -> increased adverse drug effects
> permanent neurotoxicity, 8th cranial
nerve damage

71
Q

what drugs are given in tx for Hodgkin lymphoma and what is the MOA?

A 
1. Disruption of DNA function 
> Doxurubicin
> Bleomycin
2. Disruption of DNA synthesis
> Vinblastine
> Dacarbazine
72
Q

what drugs are given in tx for non-Hodgkin lymphoma?

A 
Rituximab
Cyclophosphamide 
Doxorubicin 
Vincristine
Prednisone

Pharmacology (7 decks)

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