Antiplatelet Flashcards Preview

Pharmacology > Antiplatelet > Flashcards

Flashcards in Antiplatelet Deck (36):
1

Aspirin MOA

arachidonic acid inhibitor vie irreversible inhibition of COX I and II, inhibits thromboxane synthesis in platelets at small doses and prostacycline synthesis at large dose

2

Long term doses of aspirin

UA/STEMI, and STEMI post PCI

3

Aspirin Clinical uses

CAD/ACS, prevention of VTE in post op ortho, prevent systemic emboli in Afib, Stroke/TIA, PAD, pain, inflammation

4

Aspirin ADRs

Bleeding tinnitus

5

Aspirin Contraindications

ESRD, inherited or acquired bleeding disorders, children can exasperate infection (Reye's syndrome), H/O GI bleeds (81 mg only)

6

Aspirin Pearls

All CAD/ACS pt, All diabetics, Irreversible, platelet function should return in 7-10 days after d/c, T1/2 of both the drug and platelets are critical

7

Dipyridamole (Persantine) MOA

phosphodiesterase III inhibitor, results in increase cAMP which inhibits platelets aggregation

8

Depyridamole (Persantine) clinical uses

adjunct for prevention of embolic disease in valve replacement and stroke patients, used for cardiac stress tests for its role as a vasoldilator, given IV

9

Aspirin and dipyridamole (Aggrenox)

primarily used for 1 and 2 stroke prevention, very well tolerated

10

Cilostazol (Pletal) MOA

phosphodiesterase-III platelet inhibitor, reversible

11

Cilostazol (Pletal) Clinical uses

PAD/intermittent claudication, usually a last resort

12

Cilostazol (Pletal)

lots of drug interactions, contraindicated in heart failure, normal platelet function returns in 4 days after D/C

13

Thienopyridines

Clopidogrel (Plavix), Prasugrel (Effient), Ticlodipine (Ticlid)

14

Thienopyridines MOA

inhibit the binding of ADP to receptors by irreversibly modifying the receptor and prevent platelet aggregation

15

Class dominates the oral antiplatelet market

thienopyridine

16

Clopidogrel (Plavix)

a prodrug, irreversible, normal platelet function returns 7-10 days after d/c

17

Clopidogrel (Plavix) clinical uses

NSTEMI, PCI w/stent, stroke, also continue aspirin to prevent restenosis

18

Clopidogrel (Plevix) drug interactions

tranformation to active metabolite (CYP2C19), high degree of interpatient variability in CYP enzymes, genetic testing available

19

Prasugel (Effient)

a prodrug, irreversible, produces more potent and consistent platelet inhibition compared to clopidogrel, avoids CYP2C19 interactions, shown to reduce risk of recurrent MI in ACS pts, platelet function return 5-9 days

20

Prasugel (Effient) cautions

Caution in patients >75 yo and low body weight, must adjust, contraindicated in patients with active bleeding or history of stroke/TIA, increases risk of major bleeding

21

Ticlopidine (Ticlid)

a prodrug, irreversible, very little dose, boxed warning surroundings use and subsequent development of hematologic toxicities

22

Ticagrelor (Brilinta) MOA

similar to thienopyridines, but it is officially a cyclopentyltriazolopyrimidine, completely inhibits ADP through reversible receptor binding

23

Ticagrelor (Brilinta)

BID, being to be given with aspirin 81 mg, not recommended with >100 mg aspirin cause bleeding, contraindicated in severe disease, reversible, faster? normal platelet function returns 3-5 days

24

Ticagrelor (Brilinta) ADRs and DI

bleeding, dyspnea, ventricular pauses, bradyarrhythmias, N/D, hypotension, NSAIDs and warfarin increases bleeding, avoid with CYP2C19

25

Anagrelide (Agrylin) MOA

phosphodiesterdase-3 inhibitor, inhibits cyclic nucleotide phosphodiesterase and the release of arachidonic acid

26

Anagrelide (Agrylin) clinical uses

thrombocythemia, usually associated with myeloproliferative disorders

27

Glycoprotein IIb/IIIa inhibitors

Eptifibatide (Intreglin), abciximab (reopro), Tirofiban (Aggrastat)

28

Glycoprotein IIB/IIIa inhibitors MOA

blocks the platelet glycoprotein IIb/IIa which is the binding site for fibrinogen and von Willebrand factor, an antagonist at this receptor reversibly blocks platelet aggregation and prevents clotting

29

Eptifibatide (Integrilin) clinical uses

acute coronary syndrome (STEMI, NSTEMI), percutaneous coronary intervention PCI

30

Eptifibatide (Integrilin) contraindication

active abnormal bleeding within previous 30 days, history of stroke, severe HTN, major surgery within previous 6 weeks

31

Eptifibatide (Integrilin) ADRs

bleeding, relative to anticoagulants, bleedings is much less of a concern with primary concern of bleeding at the point of catheter entry

32

Eptifibatide (Integrilin) Pearls

hemostasis generally restored 4 hours after infusion is stopped because it is a reversible inhibitor, very $$$

33

Abciximab (Reopro) Clinical uses

PCI, unstable angina/NSTEMI, STEMI, concurrent heparin and aspirin recommended for prevention of ischemic complications

34

Abciximab (Reopro)

IV only, short term, apt to develop immune response, contraindicated with bleeding, need to monitor signs and symptoms of bleeding

35

Abciximab (Reopro) ADRs

Bradycardia, hypotension, CP, Nausea, immunogenicity

36

Tirofiban (Aggrastat)

Stabile ischemic heart disease undergoing elective PCI, unstabile angina/ NSTEMI, STEMI; IV only, short term use only via continuous infusion, quick onset 10 min, no major difference with this drug, very limited use