Cardio Exam 2: Fibrinolytics Elsaid WRITTEN NOTES

What’s a major C/I with Fibrinolytics?

Active internal bleeding

What are the different Antiplatelet drugs/classes? (7)

Aspirin, Clopidogrel, Prasugrel, Ticagrelor, Cangrelor, GP IIa/IIIb Inhibitors, and Vorapaxar

What are the different Fibrinolytic drugs?

Alteplase and Tenecteplase

Aspirin MOA?

Irreversibly inhibits COX-1 and decreases TxA2 synthesis

TxA2 and ADP are _____.

platelet activators

Aspirin effects?

Dose-dependent N/V and Tinnitus

Clopidogrel (Plavix) MOA?

Irreversible P2Y12 Receptor Inhibitor activated by CYP2C19

Clopidogrel (Plavix) other info?

Most common P2Y12 inhibitor, Prodrug, and BBW (poor 2C19 metabolizers)

• Decreased ______ → lack of conversion to active metabolite → decreased ______

• Inactive (GP IIb/IIIa) = ______

efficacy, platelet inhibition and efficacy, no platelet aggregation

Prasugrel MOA?

Potent Irreversible P2Y12 inhibitor

Prasugrel vs Clopidogrel?

More potent

Prasugrel Effects?

Bleeding adverse effects for >75 y/o or <60 kg

Prasugrel C/I?

Hx of Stroke/TIA

Prasugrel other info?

Used for STEMI and diabetes

Ticagrelor MOA?

Reversible Oral P2Y12 Inhibitor

Ticagrelor vs Clopidogrel?

More potent antiplatelet effects w/o bleeding

Ticagrelor other info?

DDI with CYP3A4 inhibitors and inducers

Cangrelor (Kengreal) MOA?

Reversible IV P2Y12 Inhibitor

Cangrelor (Kengreal) other info?

Used for PCI as IV bolus and infusion

What are the GP IIb/IIIa inhibitor drugs?

Abciximab, Tirofiban, and Eptifibatide

Abciximab is a _____ drug.

GP IIb/IIIa inhibitor

Tirofiban is a _____ drug.

GP IIb/IIIa inhibitor

Eptifibatide is a _____ drug.

GP IIb/IIIa inhibitor

GP IIb/IIIa inhibitor MOA?

Blocks fibrinogen from binding to GP IIb/IIIa receptors and prevents platelet aggregation

Vorapaxar MOA?

Blocks PAR-1 Receptor and thrombin-mediated platelet activation

PAR stands for?

Protease-Activated Receptor

Alteplase MOA?

Binds to fibrin within the thrombus 1st, then Recombinant tPA converts plasminogen to plasmin by fibrinolysis

Fibrin is a _____.

substrate

Alteplase C/I?

Uncontrolled HTN (>185/110)

Alteplase other info?

Used for ischemic stroke, PE, and Acute MI

Tenecteplase MOA?

Alternative fibrinolytic to Alteplase that targets plasminogen

Tenecteplase Advantage?

Easier dosing as Single IV bolus

What drugs are commonly used during PCI/Percutaneous Coronary Intervention?

Clopidogrel, Prasugrel, Ticagrelor, Cangrelor, and GP IIb/IIIa Inhibitors (High-Risk PCI pts)

REMEMBER:

• _____ = Irreversible P2Y12 Inhibitors

• _____ = Reversible P2Y12 Inhibitors

• _____ = GP IIb/IIIa Inhibitors

• _____ = PAR-1 Receptor Blocker

• _____ = Targets plasminogen

CP, TC, ATE, Vorapaxar, AT