Antiplatelets

Question 1

Plaque Rupture

Answer 1

• Plaque usually exists under a thin membrane in the artery
• When the membrane ruptures the plaque can move and plug vessels
• Platelets are sent because the body thinks it is a wound, and they form a clot
• This is what causes a STEMI

Question 2

Antiplatelet Mechanism of Action

Answer 2

• Prevent platelets from clumping together (aggregation)
• Do not inhibit platelet production

Question 3

Acetylsalicylic Acid

Answer 3

• Aspirin
• Baby dose or full dose
• Baby dose used for antiplatelets in coronary disease
• Not used for pain anymore
• NSAID

Question 4

P2Y12 Inhibitor Mechanism of Action

Answer 4

• Like super aspirin
• Blocks platelet activation and aggregation by blocking P2Y12 receptors

Question 5

Platelet Count and Antiplatelet Use

Answer 5

• Generally safe to give even if platelet counts are low
• You still must consider bleeding risk before administering though

Question 6

Acetylsalicylic Acid Mechanism of Action

Answer 6

• Irreversibly inhibits COX-1 in individual platelets, inhibiting aggregation
• Prevents TXA2 formation, reducing vasoconstriction and platelet aggregation
• Adult dose effective up to 10 days after stopping (consider when prepping for surgery. Baby dose can be continued up to surgery)

Question 7

Acetylsalicylic Acid Indicators

Answer 7

• Prevention of arterial thrombosis including MI and stroke
• Acute coronary syndrome
• Coronary artery disease
• Peripheral artery disease
• Analgesic
• Anti-inflammatory
• Anti-pyretic

Question 8

ASA Adverse Effects

Answer 8

• GI irritation and bleeding (all NSAIDS) - risk may be reduced with enteric coating
• Increased bleeding risk: bruising, epistaxis, etc.
• Tinnitus
• Bronchospasm

Question 9

P2Y12 Inhibitor Drug Names

Answer 9

• Clopidogrel (Plavix)
• Prasugrel (Effient)
• Ticagrelor (Brilinta)

Question 10

P2Y12 Inhibitor Indications

Answer 10

• Acute coronary syndrome
• After PCI/coronary stent placements
• Secondary prevention of MI or stroke
• used with ASA as dual antiplatelet therapy

Question 11

P2Y12 Inhibitor Adverse Effects

Answer 11

• Bleeding
• Bruising
• GI bleeding
• Dyspnea with ticagrelor
• Cannot go to surgery if used recently

Question 12

GP IIb/IIIa Inhibitor Indications

Answer 12

• Acute coronary syndrome
• During PCI/Pulmonary stent placement
• Short term use, typically IV only

Question 13

GP IIb/IIIa Inhibitor Mechanism of Action

Answer 13

• Block GP IIb/IIIa receptor on activated platelets
• Prevent fibrinogen binding
• Inhibits final step of platelet aggregation

Question 14

Antiplatelet Contraindications

Answer 14

• Active bleeding
• Thrombocytopenia (growth of abnormal platelets)
• Leukemia (causes thrombocytopenia)
• Vit. K deficiency
• Recent stroke (although antiplatelets might be indicated in some ischemic strokes) - can increase risk of bleeding during the window where ischemic strokes are likely to turn hemorrhagic

Question 15

Antiplatelet Drug Interactions

Answer 15

• Increased bleeding risk from other antiplatelets, anticoagulants, NSAIDS, thrombolytics, corticosteroids
• Proton pump inhibitors with Clopidogrel
• Other drugs affecting CYP450 enzymes
• High doses of aspiring may have hypoglycemic effect and enhance oral hypoglycemic agents

Question 16

Antiplatelet Nursing Considerations Before Admin

Answer 16

• Bleeding risk assessment
• Vitals (BP)

Question 17

Antiplatelet Ongoing Monitoring After Admin

Answer 17

• Signs of bleeding
• Lab trends
• Med effectiveness
• No new ischemic events

Question 18

When to Question or Hold Anticoagulants

Answer 18

• Active bleeding
• Significant drop in HB
• Severe thrombocytopenia
• Prior to surgery or invasive procedures
• Signs of hypersensitivity