ACS Meds

Aspirin

Class: antiplatelets

MOA

• inhibits COX-1 —> decreases thromboxane A2

Clopidogrel

Class: P2Y12 inhibitor (usually used with aspirin = DAPT)

MOA:

• P2Y12 blockade —> lowers platelet aggregation

ADR:

• bleeding/ bruising

• thrombotic thrombocytopenic purpura

*can not give with PPIs (omeprazole)

Unfractionated Heparin

Class: anticoagulant

MOA:

• increases antithrombin activity —> limits clotting

ADR:

• HIT (heparin-induced thrombocytopenia)

*monitor aPTT/anti-Xa

Enoxaparin

Class: Low-molecular-weight heparin

Used for: Unstable angina/ non-STEMI, selective STEMI

ADR:

• HIT

*longer half-life

*given subQ

Eptifibatide

Class: GP IIb/ IIIa Inhibitors

MOA:

• prevents fibrinogen linking platelets

ADR:

• hypotension/ bradycardia

Tenecteplase

Class: fibrinolytics

MOA:

plasminogen —> plasmin —> fibrin breakdown —> clot dissolution

ADR:

• major bleeding

• intracranial hem

*only use w/ STEMI when timely PCI is unavailable

*never use w/ non-STEMI and unstable angina

Nitroglycerin

Class: Nitrates

MOA:

• converts to nitric oxide —> venodilation —> decreases O2 demand in body

ADR:

• reflex tachycardia

• hypotension (check BP)

*can not be used with cidenophil because it will cause severe hypotension

Meds for protection after ischemia

• statins: atorvastatin / rosuvastatin

• metoprolol

• ACE inhibitor/ ARB