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Cardio > Antiplatelets > Flashcards

Antiplatelets Flashcards

1
Q

name the antiplatelets

A

aspirin, clopidogrel, prasugrel, ticagrelor, vorapaxar, cilostazol, dipyridamole

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2
Q

what is the mechanism of aspirin

A

it inhibits COX1 through irreversible acetylation so arachidonic acid is not converted to prostaglandin

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3
Q

when would you consider aspirin for PRIMARY prevention

A

adults 40-59 w/ 10 yr ASCVD risk greater than 10%, if they are not at increased risk for bleeding

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4
Q

who should NOT be initiated on aspirin for PRIMARY prevention

A

adults over 60

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5
Q

what are the indications for aspirin

A

CAD, PAD, ACS, PCI, acute ischemic stroke, SECONDARY prevention

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6
Q

adverse effects of aspirin

A

bleeding, rash, GI events

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7
Q

what are the P2Y12 inhibitors

A

clopidogrel, prasugrel, ticagrelor

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8
Q

what are the thienopyridines

A

clopidogrel, prasugrel

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9
Q

what is the non-thienopyridine

A

ticagrelor

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10
Q

what is the brand name for clopidogrel

A

plavix

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11
Q

what is the brand name for prasugrel

A

effient

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12
Q

what is the brand name for ticagrelor

A

brilanta

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13
Q

the thienopyridines are _____ (reversible/irreversible)

A

irreversible

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14
Q

the non-thienopyridines are _____ (reversible/irreversible)

A

reversible

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15
Q

which P2Y12’s are prodrugs

A

clopidogrel and prasugrel

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16
Q

how is clopidogrel metabolized

A

CYP2C19, 2 steps

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17
Q

how is prasugrel metabolized

A

CYP2C19, 1 step

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18
Q

how is ticagrelor metabolized

A

CYP3A4

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19
Q

what is the mechanism of the thienopyridines

A

they inhibit P2Y12 from binding to ADP by an irreversible, delayed inhibition

20
Q

what are the indications for thienopyridines

A

ACS, PCI (in addition to ASA as DAPT), or as an alternative to ASA if patient is allergic

21
Q

what are the clopidogrel drug interactions

A

omeprazole, esomeprazole, cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine

22
Q

clopidogrel dosing

A

300-600 mg LD then 75 mg daily

23
Q

prasugrel dosing

A

60 mg LD, then 10 mg po daily

24
Q

adverse events for clopidogrel

A

bleeding, rash, GI

25
Q

adverse events for prasugrel

A

bleeding

26
Q

what increases the risk of bleeding with prasugrel

A

history of transient ischemic attack or stroke is a contraindication. older than 75, body weight less than 60 kg

27
Q

what is the mechanism of the non-thienopyridine, ticagrelor

A

it is a chemical derivative of nucleosides (ATP). reversibly inhibits P2Y12 receptor. not a prodrug

28
Q

indications for ticagrelor

A

reduce risk of cv death/mi/stroke in pts/ w ACS or history of MI (in addition to ASA), reduce risk of stroke in patients with acute ischemic stroke or high-risk transient ischemic attack (in addition to ASA), reduce the risk of a first MI or stroke in patients with CAD

29
Q

adverse events of ticagrelor

A

bleeding, dyspnea, bradycardia

30
Q

drug interactions with ticagrelor

A

strong CYP3A inhibitors (azole, HIV protease, macrolide), strong CYP3A inducers (anticonvulsants), max simvastatin and lovastatin doses 40 mg

31
Q

what are the PDE-3 inhibitors

A

cilostazol and dipyridamole

32
Q

what is the PAR-1 antagonist

A

vorapaxar

33
Q

what is the mechanism for the PDE3 inhibitors

A

they increase cAMP leading to vasodilation and inhibition of platelet aggregation

34
Q

what are the indications for cilostazol

A

peripheral arterial disease ONLY

35
Q

what is the dosing for cilostazol

A

100 mg po bid

36
Q

what are the adverse events for cilostazol

A

headache, diarrhea, palpitations

37
Q

when to avoid cilostazol

A

heart failure

38
Q

what are the indications for dipyridamole

A

stroke prevention (aggrenox), prosthetic heart valves (persantine)

39
Q

what are the adverse events for dipyridamole

A

headache, GI, dizziness, weakness, peripheral vasodilation, flushing

40
Q

what is the mechanism for vorapaxar

A

inhibits thrombin-induced platelet activation via binding to PAR1 receptor. it is reversible at PAR1 but has a long half life of 8 days

41
Q

what are the indications for vorapaxar

A

reduction of thrombotic CV events in patients with a history of MI or PAD

42
Q

what is the dosing regimen for vorapaxar

A

2.08 mg once daily (2.5 mg vorapaxar sulfate)

43
Q

vorapaxar must be used in combo with ___

A

ASA or clopidogrel

44
Q

contraindications for vorapaxar

A

TIA, stroke, intracranial hemorrhage

45
Q

adverse events for vorapaxar

A

bleeding

46
Q

drug interactions for vorapaxar

A

strong CYP3A inhibitors or inducers

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