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17 Cards in this Set
- Front
- Back
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Aspirin |
- Irreversible COX inhibitor used prophylactically @ low concentrations to prevent platelet production of Thromboxane by COX1
- Short 1/2 life but lasting duration (lifetime of platelet)
- Risks (general): Tinnitus, hearing loss, gastric intolerance
- Risks (pregnancy): Closure of ductus arteriosus, prolongation of labor, bleeding risk during labor; used only for arterial clotting risk |
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Dipyridamole (Aggrenox) |
- Pyrimidopyrimidine derivative with vasodilator and antiplatelet properties - mechanism unclear
- Approved as combination medication with aspirin for ischemic stroke prevention
- Adverse events: headache (most common), hypotension, bronchospasm/dyspnea, MI, arrhythmias, nausea, rash/flushing, parathesias |
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Clopidogrel (Plavix) |
- Most commonly used Thienopyridine that permanently inhibits the P2Y12 receptor on the platelet
- Indications: Acute Coronary syndrome (Both non-STEMI/unstable angina and STEMI), recent MI/stroke or established peripheral disease
- Risk: bleeding, rash, diarrhea, thrombocytopenia, TTP but **NO NEUTROPENIA (unlike 1st gen drug) |
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Abciximab (ReoPro) |
- Ab directed against the GPIIb/IIIa receptor to block final pathway of platelet activation; not irreversible
- Renal clearance (dosing in renal failure unclear)
Risk: AV nodal block, thrombocytopenia, Anti-abciximab antibody development
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Eptifibatide (Integrilin) |
- Reversible receptor inhibition by peptide derived from snake venom
- Renal clearance
- Adverse effects: Bleeding, thrombocytopenia, chestpain/bradycardia/angina reported |
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Unfractionated Heparin (UFH) |
- Xa and IIa inhibition (meets IIa req for sufficient length) via indirect binding of ATIII
- Indications: pregnancy, patients undergoing procedures or with renal impairment
- Fully reversed with protamine sulfate (risk of allergic reaction to fish)
- Adverse effects: Promotion of bone loss, HIT, Heparin-induced skin necrosis, alopecia, hypersensitivity reactions |
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Low molecular weight Heparin (LMWH) - Enoxaparin |
- Smaller derivative of UFH with Xa > IIa activity; primarily used for outpatient bridging
- CONTRAindications: renal failure pts
- Only partially reversed with protamine sulfate
- Adverse effects: bleeding but less likely to cause HIT or bone loss than UFH |
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Fondaparinux (AriXtra) |
- Modified Pentasaccharide with greater anti-Xa affinity and longer half life than LMWH
- "Ultra-low Weight Heparin"
- Contraindications: Severe renal impairment or weight <50 kg for patients undergoing orthosurgery
- Suggested use as treatment for HIT + pregnant patients
- Option for patient with HIT but NOT for bridging due to long half life |
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Rivaroxaban (Xarelto) |
- Direct Xa inhibition
- Indicated for atrial fibrillation, treatment of DVT/PE, prophylaxis of DVT following surgery
- No reversal agent available
- Risks: Epidural/subdural hematoma, thrombocytopenia, Stevens-Johnson syndrome, elevated LFTs, pruritus, thrombocytopenia |
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Apixaban (Eliquis) |
- Direct Xa inhibition
- Indicated for atrial fibrillation only (No DVT/PE)
- Dose adjustments necessary for CYP3A4 and P-glycoprotein strong inhibitors and renal impairment patients |
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Lepirudin |
- Bivalent direct thrombin inhibitor (DTI) that binds to both the active site and exosite 1 of thrombin
- Inhibits both free and clot-bound thrombin
- Renal clearance (caution with reduced creatine clearance)
- Risk: Ab formation and anaphylaxis |
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Argatroban |
- Univalent direct thrombin inhibitor (DTI) that binds only to the active site on thrombin
- Hepatic clearance (caution with hepatic insufficiency)
- Primary go to for patients with HIT that are awaiting surgery |
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Dabigatran (Pradaxa) |
- Univalent direct thrombin inhibitor (DTI) that binds only to the active site on thrombin
- Renal clearance
- No means of reversal
- Contraindications/Cautions: do not open capsules or give before surgery
- Adverse reactions: GI bleed, anaphylaxis (severe), dyspepsia, gastritis, bleeding (common) |
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Streptokinase |
- 1st generation fibrinolytic forms stable complex with plasminogen to allow for plasmin conversion
- Lacks fibrin specificity
-Fibrinolytics indicated for STEMI but not non-STEMI, PE with hemodynamic compromise, thromboses IV access tx, catheter-directed thrombosis
- Risk: Allergic reactions if prior streptococcal infection
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Alteplase/tPA |
- 2nd generation fibrinolytics binds to fibrin and converts fibrin-bound plasminogen-->plasmin
- More expensive than streptokinase
- Fibronolytics indicated for STEMI but not non-STEMI, PE with hemodynamic compromise, thromboses IV access tx, catheter-directed thrombosis |
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Reteplase |
- 3rd generation fibrinolytics that is a deletion mutant variant of alteplase
- Modest increased efficacy vs. alteplase with a similar cost per dose and similar risk profile and rate of ICH |
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Warfarin |
- Vitamin K antagonist
- Initial prothrombotic period because it effects anticoagulants Protein C and S
- NARROW THERAPEUTIC INDEX = no loading dose; most cases require bridging therapy
- Risks: Bleeding, limb gangrene, skin necrosis, protein C deficiency, "warfarin embryopathy" teratogenic effects |
