Aspirin, ADP receptor inhibitors, GP IIb/IIIa, Cilostazol, Dipyridamole

Question 1

Platelet Adhesion _A_ctivation Aggregation MOA

Answer 1

-tissue damage → collagen +VWf exposed →GPIb on platelet binds collagen +vwf→ activation → release of TXA2 ,ADP , serotonin

• ADP⇒ binds PLT receptor P2Y12 ⇒aggregation
• ​TXA2 ⇒aggregation and activation
• ​Serotonin ⇒aggregation and vasoconstriction

​(“Peeling von Willie brand field”)
(“Holding 1b bat”)
(“Home plate”)
(“Aggregated players”)
(““ADP” aggregate Da players! Play youth ball 2-12y”)
(“Thrown happy face helmet”)
(“Batter’s box”)

Question 2

Thromboxane Synthesis pathway

Answer 2

-Cyclooxygenase 1 (COX1) synthesizes prostaglandins (prostaglandins, TXA2) within platelets
(“Head coach cox”)

-COX-1 synthesizes TXA-2 from the precursor molecule arachidonic acid (AA)
(“AA minor league dugout”)

-TXA2 (synthesized by COX-1) causes vasoconstriction
(“Coach Cox twisting hat”)

-COX-2 expression is induced during inflammation, so he is inactive until some inflammatory event
(“Sleeping assistant coach”)

Question 3

Aspirin MOA

Answer 3

-aspirin irreversibly acetylates COX-1 and COX2

-aspirin irreversible inhibits COX-1 and COX-2 reducing platelet activation and aggregation
(“ASA umpire ejecting the coaches”)

-aspirin inhibits COX 1 and 2 thus shifting AA pathway towards LOX enzyme causing “pseudo-allergy” due to excess leukotriene synthesis, seen in asthma or nasal polyposis pts.
(“Swollen ASA umpire”)

• use Clopidogrel ( ADP inhibitor)

(“Acetyl-whistle)

Question 4

Name Surface ADP receptor P2Y12 receptor inhibitors

(THI-ENO-pyridines)

Answer 4

-GREL-suffix (“Hot dog grill”)

• ClopidoGREL
• PrasuGREL
• TicaGRELor
• Ticlopidine

Question 5

ADP receptor inhibitors MOA

Answer 5

-Irreversibly Inhibit ADP surface receptor P2Y12 on platelets

(“ADP” aggregate Da players! Play youth ball 2-12y”)

Question 6

what are Antiplatelet agents used for ?

Answer 6

• antiplatelet agents (aspirin, ADP receptor inhibitors) reduce cardiovascular events in patients with peripheral artery disease,
• they do not reduce the symptoms of peripheral artery disease such as atypical pain and claudication in the effected extremity

-antiplatelet agents (aspirin, ADP receptor inhibitors) reduce cardiovascular events in patients with coronary artery disease
(“Angina anvil grill”)

-use antiplatelet therapy (aspirin, ADP receptor inhibitors) in the setting of MI and other acute coronary syndromes, give as soon as possible to a patient with a STEMI
(“Broken heart strings”)

• give chewable aspirin tablets initially in an acute MI for immediate effect
  ​(“ASA umpire chewing tablets”)

-dual antiplatelet therapy (aspirin and ADP receptor inhibitors) prevent coronary stent thrombosis​
(“Corked bat”)

-antiplatelet therapy (aspirin and ADP receptor inhibitors) prevents ischemic stroke in patients with atherosclerosis and known cerebrovascular disease
(“Black paint stroke”)

(“Greasy grill pipe”)

Question 7

Ticlopidine is an ADP P2Y12 receptor inhibitor that may cause …

(“Ty Cobb”)

Answer 7

-Neutropenia in 2% of patients

-can cause granulocytopenia, you must obtain white cell and rbc count when starting therapy
(“Falling granules in neutrophil shaped hour glass”)

Question 8

names and MOA of GP IIb/IIIa receptor inhibitor

Answer 8

1) ABCiximab - irreversible

• abciximab is a monoclonal IgG antibody
  (“Antibody shaped microphones”)

-abciximab inhibit platelet surface receptors GP IIb/IIIa from binding to fibrinogen to promote platelet aggregation

(“Crowd of spectators from seats 2b-3a jump on fries guys”)

• *2) Eptifibatide , Tirofiban -Reversible**
• must be given IV continuously

(“ABC sportscaster grabbing fries”)

Question 9

GP IIb/III receptor inhibitors Side effects

Answer 9

-cause thrombocytopenia
(“Broken plates”)

Question 10

which measurement will increase following an antiplatelet therapy ?

Answer 10

-antiplatelet therapy increases bleeding time- a measure of platelet function

(“Ketchup time”)

Question 11

Names and MOA of Phosphodiesterase inhibitors

(“Don’t Phoster disinterest”)

Answer 11

Dipyridamole
(“two pyramids”)

Cilostazol
(“player that lost the ball”)
——————————————————————————–
-phosphodiesterase inhibitors increase cAMP impairing platelet function
(“SIGN UP FOR CAMP BOOTH”)

Question 12

Cilostazol can be used to treat

Answer 12

-treats symptoms of claudication due to peripheral artery disease

(“dirt clods hitting leg”)

Question 13

Cilostazol is a Phosphodiesterase inhibitor that causes

(“player that lost the ball”)

Answer 13

-causes arterial vasodilation
(“kid who lost the ball has dilated red sleeves”)

-causes coronary artery dilation
(“kid who lost the ball wearing dilated red crown”)

• can cause coronary steal, this will dilate all of the other coronary arteries preventing blood flow to the ischemic areas exacerbating ischemia
  (“Stolen steal heart base”)