Antiplatete Drugs

Question 1

Aspirin loading dose

Answer 1

162-325 mg (usually go with 325)

Question 2

Aspirin indefinite dose

Answer 2

81 mg (if cannot tolerate, Clopidogrel 75mg)

Question 3

Aspirin mechanism

Answer 3

Irreversibly, Selectively inhibits COX-1 blocking the formation of TXA2

at higher doses: detrimental. Blocks COX-2 stopping the production of PGI2

Question 4

Clopidogrel: name, loading dose, daily dose

Answer 4

Plavix

Loading: 300-600mg

Daily: 75mg

Question 5

Prasugrel: name, loading dose, daily dose

Answer 5

Effient

Loading: 60mg

Daily: 10mg

**NOT generally recommended: very selective group of people can use*^

Question 6

Ticagrelor: brand, loading dose, daily dose

Answer 6

Brillanta

Loading: 180mg

Daily: 90 mg

Question 7

Cangrelor: brand, loading dose

Answer 7

Kangreal

IV ONLY

Question 8

P2Y12 MOA

Answer 8

Selectively inhibit adenosine diphosphate induced platelet aggregation with no direct effect on TXA2

Question 9

Clopidogrel AE

Answer 9

Bleeding
Diarrhea
Rash

Question 10

Prasugrel AE

Answer 10

Bleeding
Diarrhea
Rash

Question 11

Ticagrelor AE

Answer 11

Bleeding
Bradycardia
Heart block
Dyspnea

Question 12

When to use SAPT

Answer 12

Indefinitely
no history of a stent/CABG

Question 13

When to use DAPT

Answer 13

High risk patients
Post CABG/Stent

Question 14

Duration of use for DAPT

Answer 14

1-3 months; would LIKE to use for 6

if we have to stop early:
P2Y12 for 12 months
-After: switch to ASA

Question 15

All of these rules only apply if

Answer 15

Patients are not using anticoagulation agents for anything else
-Ex: if patient is using anti-coag for afib, they will not have this typical regimen

Question 16

There is emerging evidence that personalized medicine approach may be desirable for

Answer 16

P2Y12i’s

Question 17

ASA must be <_ with _

Answer 17

100 mg

Ticagrelor (Brillanta)

Question 18

Prasugrel CI when Hx includes

Answer 18

TIA, ICH, Stroke

not desirable due to narrow patient population

Question 19

Use of PPI therapy w/DAPT may

Answer 19

Reduce GI bleeding risk

Question 20

What if patients need non-emergent surgery? (knee/hip replacement)

Answer 20

Ideally, wait till DAPT is over

If cannot be avoided, antiplatelets must be stopped 5-7 days before surgery
-Lowers bleeding risk, but heavily increases risk of thrombotic event at site of stent