anti-thrombotic drugs
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24 terms
Terms | Definitions |
|---|---|
 aspirin | MOA: irreversible plt effect; dec plt aggregation by stopping thromboxane a2-> stops vasoconstriction USE: analgesia, anti pyretic, ami prophylaxis, ACS, TIA/CVA ADRs: dyspesia, GI ulceration; bleeding (dbls gi bleed risk); hepatotoxicity, SNHL, ARF, bronchospasm, reye's syndrome don't use H2RAs to stop ulcers; use PPIs instead |
| ticlopidine | anti-plt; OFF MARKET |
| clopidogrel (plavix) | anti-plt, prodrug MOA: irreversible plt effect; knocks out ADP receptor-> dec plt aggregation/adhesion consider genotyping 2C19 (not efficacious in ~20%) -less efficacious then prasugrel INTERACTIONS: PPIs, cimetidine, fluoxetine, fluconazole, other antiplts/anticoags, NSAIDS ADRs: GI intolerance, flu-like illness, TTP, bleeding stop 5 days prior to surgery -only give PPIs if high bleeding risk OR multiple risk factors |
| prasugrel | anit-plt, prodrug (not as dependent on metabolism) MOA: prevents plt activation (more so than clopidogrel) USE: ACS INTERACTIONs: other antiplts/anticoags, NSAIDS ADRs: GI intolerance, flu-like illness, TTP, bleeding stop 7 days before surgery |
| ticagrelor | anti-plt (new) MOA: same as clopidogrel/prasugrel but REVERSIBLE MONITOR: H/H, uric acid, renal fcn ADRs: bleeding, dyspnea, inc [UA], bradyarrhythmias |
| abciximab | IV antiplatelet drug MOA: glycoprotein IIb/IIIa receptor antagonist ADRs: immune mediated thrombocytopenia just like eptifibatide and tirofiban |
| eptifibatide | IV antiplatelet drug MOA: glycoprotein IIb/IIIa receptor antagonist ADRs: immune mediated thrombocytopenia just like abciximab and tirofiban |
| tirofiban | IV antiplatelet drug MOA: glycoprotein IIb/IIIa receptor antagonist ADRs: immune mediated thrombocytopenia just like abciximab and eptifibatide |
| dipyridamole | anti-plt MOA: anti-plts; vasodilation USE: post CVA/TIA (esp w/asa combo aggrenox) ADRs: severe HA, angina, dizziness, hypotension |
| warfarin | coumarin, taken qday MOA: antagonized vit K epoxide reductase complex (VKORC1)-> hypofcn clotting factors accumulate (protein C&S also inhibited) -metabolized by 2C9 (highly variable), consider genotyping S-warfarin clinically important (it is a racemic mix) USE: prevent/tx venous thrombosis/emobli; *preferred anticoagulant for Afib w/CAD; recurrent TIA. DOSING: start 5-10mg for 2 days, t1/2= 40hrs (takes 2 days to see effect); Loading >10mg could cause hypercoagulable state MONITOR: extrinsic pathway/common path (PT/INR),qday until stable -> q3-4wks REVERSAL: 1.) Vit K: oral if non-life threatening (~24hrs); IV slowly if life threatening 2.) PCC prothrombin complex concentrates (S.O.C), lowers INR fastest 3.) FFP 4.) rVIIa (expensive) INTERACTIONS: antacids, bile acid sequesterants, FQs, other antiplt/coags ADRs: bleeding |
| heparin | MOA: indirect thrombin inhibitor (supercharges anti-thrombin) USE: DVT prophylaxis (SQ q8hrs); anti-coag; ACS; use w/in 24hrs LIMITS: doesn't break up clots (may still grow) MONITOR: aPTT (intrinsic pathway); plt counts (therapeutic dose=qod; prophylactic dose=q3-4days) REVERSAL: non-urgent=stop; urgent= protamine slowly. *FFP does NOT reverse* ADRs: hemorrhage (esp post eye/spinal/brain surg), osteoporosis (>6months) ADRs: 1.) HIT (type 1 and 2(worse))), antibody driven process->plts don't work 2.) HTTS heparin induced thromboytopenia and thrombosis syndrome |
| rivaroxaban | factor Xa inhibitor; very new MOA: inhibits free & clot bound factor Xa PEARLS: start 6-10hrs post surg, don't use if CrCl<30 ADRs: bleeding, can't be turned off, protamine doesn't work, not dialyzable |
| enoxaparin | LMWH; "parins" (Lovenox) MOA: antithrombin mediated inhibition of factors Xa>IIa USE: DVT prophlx; DVT/PE tx; ACS PROS: fixed dose, no lab monitoring, less thrombocytopenia, hemorrhage, and bone loss DOSING: adjust for CrCl, PT wt, situation specific have pharm dose it MONITOR: none, except preggers, renal dysfcn, obese REVERSAL: partially with protamine, *FFP does NOT reverse* ADRs: injection site pain/hematoma, thrombocytopenia, hemorrhage -used more than dalteparin |
| dalteparin | LMWH; "parins" (Fragmin) MOA: antithrombin mediated inhibition of factors Xa>IIa USE: DVT prophlx; DVT/PE tx; ACS PROS: fixed dose, no lab monitoring, less thrombocytopenia, hemorrhage, and bone loss DOSING: adjust for CrCl, PT wt, situation specific have pharm dose it MONITOR: none, except preggers, renal dysfcn, obese REVERSAL: partially with protamine, *FFP does NOT reverse* ADRs: injection site pain/hematoma, thrombocytopenia, hemorrhage -used less than enoxaparin |
| fondaparinux | synthetic analog of heparin; MOA: Xa inhibitor can't be reveresed, do NOT USE -long 1/2life -monitor: CBC, SOB, SCr, anti-Xa assay |
| dabigatran | direct thrombin inhibitor; tablet BID MOA: dec thrombin stimulated plt aggregation MONITOR: SCr annually PEARLS: no antidote, effect wears off in 2 days 1.) sensitve to moisture 2.) can't dbl up doses, take asap if missed 3.) stop 2 days prior to surg, start 24hrs after 4.) transition from warfarin: stop warfarin until INR <2 ADRs: bleeding, dyspesia/gastritis has acid to inc absorption |
| lepirudin | injected direct thrombin inhibitor; recombinant hirudin USE: approved for anticoagulation w/ HITTS CANT REVERSE |
| argatroban | injected direct thrombin inhibitor; recombinant hirudin USE: approved for anticoagulation w/ HITTS CANT REVERSE -very short 1/2 life |
| desirudin | injected direct thrombin inhibitor; recombinant hirudin USE: approved for DVT prophylx in THA CANT REVERSE |
| bivalirudin | injected direct thrombin inhibitor; synthetic analog of hirudin USE: ACS; approved for anticoagulation w/ HITTS CANT REVERSE |
| streptokinase urokinase | old fibrinolytics |
| alteplase | older fibrinolytic; tPA (recombinant tissue-type plasminogen activator) MOA: binds fibrin and converts trapped plasminogen to plasmin USE: STEMI, acute PE, ischemic stroke, etc ADR: bleeding use this if no PCI LIMITATIONs: 15-20% failure, 5-15% reocclusion |
| reteplase | newer fibrinolytic; rPA longer 1/2 life then alteplase, less fibrin selective USE: STEMI |
| tenecteplase | newer fibrinolytic tPA 14x more fibrin specific; SINGLE iv bolus USE: STEMI |
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