Anti-Platelet Aggregate

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Outline

Overview

  1. Overview
    1. Purpose
      1. Prevent the formation of thrombi, aka thrombo-prevention
    2. Mechanism of Action
      1. Most common pathway: Cyclooxygenase inhibition
        1. Basically, operates within platelets and BV walls
        2. Prevents formation of TXA2
          1.    Causes BV to constrict & platelets to aggregate
      2. There are various pathways
        1.     Clotting factors VII, IX, X
  2. Indications
    1. Stroke risk reduction
    2. Stroke prophylaxis
    3. Acute unstable MI
    4. Thromboembolic complications
    5. Thromboembolic disorders
    6. Post-MI thrombo-prevention
    7. PCI (angioplasty)
  3. Types
    1. Glycoprotein IIb/IIIa Inhibitors
      1. Abcimab
      2. Eptifibitide
      3. Tirofiban
    2. Aggregation Inhibitors / Vasodilators
      1. Treprostinil
    3. Aggregation Inhibitors
      1. Cilostazol
      2. Clopidogrel
    4. Miscellaneous
      1. Anagrelide
      2. Dipyridamole
  4. Contraindications
    1. Drug allergy
    2. Thrombocytopenia
    3. Active bleeding
    4. Leukemia
    5. Traumatic injury
    6. GI ulcer
    7. Vitamin K deficiency
    8. Recent stroke
  5. Interactions

    A.    Heparin

    B.    Oral antidiabetic drugs

    C.     Dipyridamole

    D.    Steroids

  6. Side Effects

    A.    Aspirin

    1.     CNS

    a.     Drowsiness

    b.     Dizziness

    c.     Confusion

    d.     Flushing

    2.     GI

    a.     N / V / D

    b.     GI Bleeding

    c.     Heartburn

    3.     Hematologic

    a.     Thrombocytopenia

    b.     Leukopenia

    c.     Anemia

    d.     Bleeding

    B.    Clopidogrel

    1.     Cardiovascular

    a.     Chest pain, HTN, edema

    2.     CNS

    a.     Flulike symptoms

    b.     Headache

    c.     Dizziness

    d.     Fatigue

    3.     GI

    a.     Abdominal pain

    b.     Dyspepsia

    c.     Diarrhea

    d.     Nausea

    4.     Miscellaneous

    a.     Epistaxis

    b.     Rash

    C.     GP IIb / IIIa Inhibitors

    1.     Bleedings

    2.     Bradycardia

    3.     Dizziness

    4.     Edema

    5.     Leg pain

    6.     Pelvic pain

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Transcript

Welcome back and today we are going to discuss anti-platelet aggregrates.

Alright, let’s do a quick review. The purpose of anti-platelet aggregates is thrombus prevention. Now don’t get them confused with dissolve current clots. These simply prevent FUTURE thrombus formation.

The mechanism of actions is the inhibition of Cyclooxygenase. Basically it works within the platelet and BV walls to dilate and prevent platelet grouping. It also prevents the formation of TXA2, which has prothrombotic properties.

Alright, let’s do a quick review. The purpose of anti-platelet aggregates is thrombus prevention. Now don’t get them confused with dissolve current clots. These simply prevent FUTURE thrombus formation. The mechanisms of actions are the inhibition of Cyclooxygenase. Basically it works within the platelet and BV walls to dilate and prevent platelet grouping.

Types of anti-platelet aggregates include glycoprotein inhibitors, aggregation inhibitors, aggregation inhibitors with vasodilation properties and miscellaneous. An easy way to remember this is GAAM.

Anti-platlet contraindications are plentiful and include drug allergies, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, vitamin K deficiency, and a recent stroke. All of which are side effects of the very drug class. So, we wouldn’t want a patient who is at risk of bleeding receiving a drug that will exacerbate that condition. We want therapeutic responses in the right settings.

Heparin + glycoproteins = increased bleeding potential, oral antidiabetic drugs + aspirin = uncontrolled BG results, dipyridamole + anti-platelet aggregates = increase bleeding potential, and lastly steroids + aspirin = increased risk for GI ulceration. Any easy way to remember this is HODS.

Aspirin side effects include hematologic (thrombocytopenia, anemia, bleeding), GI (N/V/D), GI bleeding, heartburn, and CNS (drowsiness, dizziness, confusion).

Clopidogrel side effects include GI (abdominal pain, dyspepsia, diarrhea, nausea), CNS (headache, dizziness, fatigue), and cardiovascular (chest pain, HTN, and edema).

Glycoprotein inhibitor side effects include bleeding, bradycardia, dizziness, edema, leg, and pelvic pain, along with edema.

Nursing priorities for a patient taking anti-platelet aggregates include clotting and pharmacology.

Indications include stroke risk reduction, stroke prophylaxis, MI, thromboembolic complications and disorders, along with PCI (angioplasty). Types of anti-platelet aggregates include glycoprotein inhibitors, aggregation inhibitors, aggregation inhibitors with vasodilation properties and miscellaneous (GAAM). Anti-platelet contraindications are plentiful and include drug allergies, thrombocytopenia, active bleeding, leukemia, traumatic injury, GI ulcer, vitamin K deficiency, and a recent stroke. Interactions include heparin, oral antidiabetic drugs, dipyridamole and steroids (HODS). Side effects are extensive but focus on CNS (headache, dizziness drowsiness), Heme (thrombocytopenia, bleeding), GI (N/V/D, bleeding), and Other (leg and pelvic pain).

You know now the important details regarding anti-platelet aggregates. Now, go out and be your best self today and as always, Happy Nursing!

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Pharm 1

Concepts Covered:

  • Test Taking Strategies
  • Learning Pharmacology
  • Medication Administration
  • Dosage Calculations
  • Adult
  • Emergency Care of the Cardiac Patient
  • Cardiac Disorders
  • Cardiovascular Disorders
  • Vascular Disorders
  • Hematologic Disorders
  • Acute & Chronic Renal Disorders
  • Disorders of Pancreas
  • Female Reproductive Disorders
  • Immunological Disorders
  • Urinary System
  • Central Nervous System Disorders – Brain
  • Pregnancy Risks
  • Neurological
  • Disorders of the Posterior Pituitary Gland
  • Shock
  • Male Reproductive Disorders
  • Urinary Disorders

Study Plan Lessons

12 Points to Answering Pharmacology Questions
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Interactive Practice Drip Calculations
Pediatric Dosage Calculations
ACLS (Advanced cardiac life support) Drugs
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
Anti-Platelet Aggregate
Clopidogrel (Plavix) Nursing Considerations
Coumarins
Warfarin (Coumadin) Nursing Considerations
Thrombin Inhibitors
Enoxaparin (Lovenox) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Thrombolytics
Alteplase (tPA, Activase) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
Antidiabetic Agents
Glipizide (Glucotrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Insulin
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
Essential NCLEX Meds by Class
Renin Angiotensin Aldosterone System
Sympatholytics (Alpha & Beta Blockers)
Atenolol (Tenormin) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
ACE (angiotensin-converting enzyme) Inhibitors
Captopril (Capoten) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Angiotensin Receptor Blockers
Losartan (Cozaar) Nursing Considerations
Calcium Channel Blockers
Amlodipine (Norvasc) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Cardiac Glycosides
Digoxin (Lanoxin) Nursing Considerations
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Furosemide (Lasix) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin (Lipitor) Nursing Considerations
Magnesium Sulfate
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
Vasopressin
Epinephrine (EpiPen) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
Anti-Infective – Sulfonamides
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Insulin Drips