Antiplatelet/ Thrombolytic Flashcards
3 types of drugs effecting coagulation
Anticoagulants
Antiplatelet
Thrombolytic Therapy
prevents the formation of clots- VENOUS (DVT)
Anticoagulantsz
inhibits platelet aggregation (arterial - MI/Stroke)
Antiplatelet Agents
dissolves life threatening clots
Thrombolytic
4 types of antiplatelet agents?
- Aspirin
- Adenosine Diphosphate Receptor (ADP) Antagonists
- PAR-1 Antagonists
- Glycoprotein Ilb/llla Receptor Antagonists
how does apirin fxn?
- antiplatelet
- interfere with platelet aggregation or “stickiness”
- Used to prevent clot formation in arteries
how long is single dose of aspirin good for antiplatelet effects?
up to 1 week!
how does 1 week dose of aspirin fxn? what is the dose?
- –>Irreversible inhibition of cyclooxygenase (COX)
- –>Used to prevent heart attack, TIA & stroke with 81mg
side effects of aspirin? what we gonna do about it?
GI Bleed
-GI Bleed not reduced with enteric coated but is helped with proton pump inhibitor
If we put someone on bigger dose of aspirin will it make their shit less sticky and their heart more good?
No!
-if increase dose - increase side effects and no CV benefits
Prototype for Adenosine Diphosphate Receptor (ADP) Antagonists
clopidogrel (Plavix)
How does clopidogrel (Plavix) fxn?
- Irreversible blockade of ADP receptors on platelet surfaces
- Used to prevent clots –> high risk MI, CVA patients
What is clopidogrel (Plavix) used for? which patient populations?
prevent clots –> high risk MI, CVA patients
Side effects of clopidogrel (Plavix)? what we gonna do about it?
Adenosine Diphosphate Receptor (ADP) Antagonists
GI bleed
-Might just let them bleed if risk of thrombotic event (MI/Stroke) is high
Always check with provider before stopping
Adenosine Diphosphate Receptor (ADP) Antagonists
clopidogrel (Plavix)
What is dual platelet therapy? when ya gonna do it?
give Aspirin + ADP Antagonist
-give this ACS (acute coronary Syndrome)
Stop clopidogrel (Plavix) ___ _____ before surgery
5 days
CYP2C19 genetic variant testing with which drug? what we gonna do about it?
Adenosine Diphosphate Receptor (ADP) Antagonists
Prototype: clopidogrel (Plavix)
–poor metabolizers should use another ADP
drug interaction with clopidogrel (Plavix)? what we gonna do about it?
PPI - but still give it
Prototype for PAR-1 Antagonists
vorapaxar (Zontivity)
how does vorapaxar (Zontivity) fxn?
REVERSIBLY blocks the PAR-1 expressed on platelets
Route for vorapaxar (Zontivity)?
PAR-1 Antagonists
-oral
_____ lasts 7-10 days after last dose
PAR-1 Antagonists
Prototype: vorapaxar (Zontivity)
What do we give vorapaxar (Zontivity) with to prevent CV events? which patient populations?
clopidogrel and/or ASA
high risk patients history of MI, PAD disease
Prototype for Glycoprotein Ilb/llla Receptor Antagonists
abciximab (ReoPro)
abciximab (ReoPro) fxn?
Reversible inhibition of all factors in platelet aggregation
Glycoprotein Ilb/llla Receptor Antagonists
This antiplatelet is IV only
Glycoprotein Ilb/llla Receptor Antagonists
Prototype: abciximab (ReoPro)
When do we give abciximab (ReoPro)
Glycoprotein Ilb/llla Receptor Antagonists
- Short term use for ongoing instability
- –>during cardiac catheterization/ balloon angioplasty/stents
- –>ACS
Why does abciximab (ReoPro) suck?
costs 1200$!
-major risk of bleeding
What other drugs do we give abciximab (ReoPro) with?
ASA or Heparin
prototype for thrombolytic?
alteplase (tPa)
fxn of alteplase (tPa)?
Break down clots (lysis)
Thrombolytic
When do we want to administer alteplase (tPa) for MI?
within 6 hours of onset
-3o min ideal!
When do we want to administer alteplase (tPa) for CVA?
within 3 hours
Half life of alteplase (tPa) ?
5 Minutes
does alteplase (tPa) have narrow or wife margin of safety?
narrow
What do we do if their are signs of bleeding with alteplase (tPa)?
STOP!
Contraindication considerations for alteplase (tPa)?
Has someone had recent preg? Already on anticoag? Internal bleeding? Severe HTN? Peptic ulcer disease?
