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Antiplatelets Flashcards

(46 cards)

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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

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A

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

20
Q

what are the indications for thienopyridines

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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

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A

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

22
Q

clopidogrel dosing

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A

300-600 mg LD then 75 mg daily

23
Q

prasugrel dosing

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A

60 mg LD, then 10 mg po daily

24
Q

adverse events for clopidogrel

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A

bleeding, rash, GI

25
adverse events for prasugrel
bleeding
26
what increases the risk of bleeding with prasugrel
history of transient ischemic attack or stroke is a contraindication. older than 75, body weight less than 60 kg
27
what is the mechanism of the non-thienopyridine, ticagrelor
it is a chemical derivative of nucleosides (ATP). reversibly inhibits P2Y12 receptor. not a prodrug
28
indications for ticagrelor
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
adverse events of ticagrelor
bleeding, dyspnea, bradycardia
30
drug interactions with ticagrelor
strong CYP3A inhibitors (azole, HIV protease, macrolide), strong CYP3A inducers (anticonvulsants), max simvastatin and lovastatin doses 40 mg
31
what are the PDE-3 inhibitors
cilostazol and dipyridamole
32
what is the PAR-1 antagonist
vorapaxar
33
what is the mechanism for the PDE3 inhibitors
they increase cAMP leading to vasodilation and inhibition of platelet aggregation
34
what are the indications for cilostazol
peripheral arterial disease ONLY
35
what is the dosing for cilostazol
100 mg po bid
36
what are the adverse events for cilostazol
headache, diarrhea, palpitations
37
when to avoid cilostazol
heart failure
38
what are the indications for dipyridamole
stroke prevention (aggrenox), prosthetic heart valves (persantine)
39
what are the adverse events for dipyridamole
headache, GI, dizziness, weakness, peripheral vasodilation, flushing
40
what is the mechanism for vorapaxar
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
what are the indications for vorapaxar
reduction of thrombotic CV events in patients with a history of MI or PAD
42
what is the dosing regimen for vorapaxar
2.08 mg once daily (2.5 mg vorapaxar sulfate)
43
vorapaxar must be used in combo with ___
ASA or clopidogrel
44
contraindications for vorapaxar
TIA, stroke, intracranial hemorrhage
45
adverse events for vorapaxar
bleeding
46
drug interactions for vorapaxar
strong CYP3A inhibitors or inducers

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