lecture 5 Flashcards
Name antiplatelet drugs
Aspirin
Psy12 inhibitors
GPIIBIIIA inhibitors
Aspirin dose when pt presents to hospital
162-325 mg upon presentation and 81 mg indefinitely
name P2y12 inhibitor drugs
Clopidogrel, ticagrelor, prasgurel (cangrelor is an IV option)
how long is DAPT recommended for in STEMI or NSTEMI/UA patients
12 months
How fast does cangrelor IV work
2 mins
WHen to use cangrelor
Use during PCI when patient did not receive loading dose p2y12 inhibitor
Clopidogrel generic
plavix
clopidogrel loading and maintenance dose
loading- 300-600 mg
maintenance- 75 mg daily
Ticagrelor generic
Brilinta
Ticagrelor loading and maintenance dose
loading- 180 mg
Maintenance- 90 mg BID
Prasgurel generic
Effient
Prasgurel loading and maintenance dose
loading- 60 mg
maintenance- 10 mg
cangrelor loading and maintenance dose
loading- 30 mcg/kg, followed by
4 mcg/kg/min x 2 hours
maintenance- use an oral agent
preferred loading dose of clopidogrel
600 mg loading dose preferred because it results in greater, more rapid and more reliable platelet inhibition compared to 300 mg
600 mg loading dose of clopidogrel preferred except
when using fibrinolytic
times when clopidogrel is not given at 600 mg
fibrinolytic+age>75= no loading dose
fibrinolytic+age<or = 75 =300 mg loading dose
which psy12 is a prodrug? what is it metabolized by?
clopidogrel. metabolized by CYP2C19
(prasgurel is also a prodrug)
which has greater pletelet aggregtion inhibition ticagrelor or clopidogrel
Ticagrelor
Considerations when taking tidagrelor
Max dose of Aspirin is 81 mg.
Side effects of ticagrelor
Dyspnea and ventricular pauses
prasgurel is not recommended in patients that are
> 75 yo, <60 kg or high bleeding risk
reason to switch from clopidogrel to ticagrelor or prasgurel
Inadequate response (genetics/CV event)
Reason to switch from ticagrelor to clopidogrel
Bleeding, cost, dyspnea, adherence
Reason to switch from prasgurel to clopidogrel
Bleeding, cost, stroke