Term
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Definition
Med Class: Anticoagulant
MOA: • Derived from porcine intestinal mucosa
• Inhibits blood clotting reactions
• No fibrinolytic activity
• May prevent clot growth |
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Term
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Definition
Indications
• During cardiac catherization
• Treatment of pulmonary embolism
• Control embolization in A-fib
• During cardiac surgery
• Acute MI
• Pre- and post-percutaneous coronary intervention (PCI)
• Ischemic CVA |
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Term
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Definition
Precautions
• Monitor for local or systemic vasospasm
• Stop or hold if PTT > 60 seconds
• Monitor invasive sites for bleeding |
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Term
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Definition
Adverse Reaction
• Chills
• Fever
• Lacrimation
• Asthma reaction |
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Term
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Definition
Med Class: Anticoagulant & Glycoprotein 2b & 3a inhibitor
MOA:
• Inhibits glycoprotein IIb/IIIa receptor in the membrane of the platelet
• Antiplatelet
• Platelet function recovers around 48 hours after administration |
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Term
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Definition
Indications
• Non “Q” wave MI
• Unstable angina with planned PCI within 24 hours
• Post PCI |
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Term
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Definition
Precautions
• Monitor for thrombocytopenia
• Use in conjunction with heparin |
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Term
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Definition
Contraindications
• Active bleeding
• Bleeding disorders
• Platelet count < 150,000 |
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Term
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Definition
Adverse Reactions
• Bleeding
• Allergic reaction |
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Term
| Tirofiban HCl (Aggrastat) |
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Definition
Med Class: Anti-platelet & Glycoprotein 2b & 3a Inhibitor
MOA:
• Inhibits glycoprotein IIb/IIIa receptor in the membrane of the platelet
• Antiplatelet
• Platelet function recovers around 48 hours after administration
• Reversibly binds to GP IIb/IIIa receptor on human platelets and inhibits platelet aggregation
• Inhibits thrombotic events during ACS management
• Made from protein found in rattlesnake venom
• Immediate onset and duration for 4 to 6 hours |
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Term
| Tirofiban HCl (Aggrastat) |
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Definition
Indications
• Treatment of acute coronary syndrome (unstable angina or non-Q wave MI)
• Administered in combination with heparin
• Adjunct therapy for those undergoing percutaneous coronary interventions
• Patients with ACS without ST segment elevation
• Medical management of ACS patients
• Used during PCI or atherectomy |
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Term
| Tirofiban HCl (Aggrastat) |
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Definition
Precautions
• Monitor for bleeding
• Minimize IV and puncture attempts, especially at noncompressible sites
• Monitor platelet count, hematocrit, and hemoglobin
• During therapy with Aggrastat, patients should be monitored for potential bleeding. When bleeding cannot be controlled with pressure, infusion of Aggrastat and heparin should be discontinued.
• Most common site for bleeding is from arterial sheaths cannulated during cardiac catheterization; reduced bleeding risk with:
• Early sheath removal
• Keep the site immobile
• Removal of sheath only after heparin infusion has been discontinued
• Minimize invasive procedures, including GI and GU tubes and IM injections
• Most major bleeding associated with Aggrastat occurs at the arterial access site for cardiac catheterization.
• Aggrastat should be used with caution in patients
• With platelet count <150,000/mm3
• With hemorrhagic retinopathy
• Chronic hemodialysis |
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Term
| Tirofiban HCl (Aggrastat) |
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Definition
Contraindications
• Known hypersensitivity to any component of the product
• Active internal bleeding or a history of bleeding diathesis within the previous 30 days
• A history of any of the following:
• Intracranial hemorrhage
• Intracranial neoplasm, arteriovenous malformation, or aneurysm
• Thrombocytopenia following prior exposure to Aggrastat
• Stroke within 30 days or any history of hemorrhagic stroke
• Major surgical procedure or severe physical trauma within the previous month
• History, symptoms or findings suggestive of aortic dissection;
• Severe hypertension (systolic blood pressure > 180 mmHg and/or diastolic blood pressure >110 mmHg)
• Concomitant use of another parenteral GP llb/llla inhibitor
• Acute pericarditis |
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Term
| Tirofiban HCl (Aggrastat) |
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Definition
Adverse Reactions
• Cardiovascular effects may include:
• Bradycardia
• Coronary artery dissection
• Edema
• Vasovagal reaction
• Occult gastrointestinal bleeding
• Thrombocytopenia, decreased hemoglobin and hematocrit
• Leg pains
• Fever, sweating, nausea
• Hives
• Difficulty breathing
• Swelling of the face, lips, tongue, or throat
• Nosebleed or other bleeding that will not stop
• Black, bloody, or tarry stools
• Coughing up blood or vomit that looks like coffee grounds
• Chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea,
• Sweating
• Intracranial bleeding, retroperitoneal bleeding, hemopericardium, pulmonary (alveolar) hemorrhage, and spinal- epidural hematoma
• Acute and/or severe decreases in platelet counts which may be associated with chills, low-grade fever, or bleeding complications
• Severe allergic reactions including anaphylactic reactions.
• Severe thrombocytopenia (platelet counts <10,000/mm3). |
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Term
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Definition
Med Class: Antitrhombotic
MOA:
• Thrombin-specific antithrombotic
• Reversible polypeptide thrombin inhibitor
• Directly inhibits clot-bound and circulating thrombin
• Prevents generation of fibrin and other activation of the clotting cascade
• Inhibits thrombin-induced platelet activation, granule release, and aggregation
• Does not require antithrombin to produce anticoagulant effects
• Derived from saliva of leeches |
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Term
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Definition
Indications
• For use as an anticoagulant in patients undergoing percutaneous coronary intervention (PCI)
• For patients with or at risk for heparin-induced thrombocytopenia and thrombosis syndrome undergoing PCI
• For use as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA) |
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Term
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Definition
Precautions
•An unexplained fall in blood pressure or hematocrit, or any unexplained symptom, should lead to serious consideration of a hemorrhagic event and cessation of Bivalirudin administration. |
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Term
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Definition
Contraindications
Hypersensitivity to bivalirudin or its components
Active major bleeding
Not for use in unstable angina patients who are not to undergo PCI, with other acute coronary conditions, or are not taking aspirin
Use with caution in heparin-induced thrombocytopenia and in patients with increased risk of bleeding
Avoid concomitant use with NSAID’s or other aspirin- containing products |
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Term
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Definition
Adverse Reactions
CNS: syncope, anxiety, headache, fever, pain, confusion, insomnia, nervousness
CV: bradycardia, hypertension, hypotension, ventricular arrhythmias, cerebral ischemia
GI: nausea, vomiting, dyspepsia, abdominal pain GU: urine retention, oliguria, kidney failure
• Hematologic: severe and spontaneous bleeding, arterial site hemorrhage
• Musculoskeletal: back pain, pelvic pain, facial paralysis
• Sepsis, lung edema, pain at injection site, infection at injection site |
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Term
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Definition
Medications Class: Thrombin inhibitor
MOA:
• Direct thrombin inhibitor that reversibly binds to the thrombin active site.
• Reversibly binds to the active thrombin site of free and clot-associated thrombin
• Argatroban does not require the co-factor antithrombin III for antithrombotic activity.
• Exerts its anticoagulant effects by inhibiting thrombin- catalyzed or -induced reactions, including fibrin formation; activation of coagulation factors V, VIII, and XIII; activation of protein C; and platelet aggregation.
• Highly selective for thrombin with an inhibitory constant (Ki) of 0.04 μM.
• Capable of inhibiting the action of both free and clot- associated thrombin |
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Term
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Definition
Indications
• As an anticoagulant for prophylaxis or treatment of thrombosis in patients with heparin-induced thrombocytopenia.
• As an anticoagulant in patients with or at risk for heparin- induced thrombocytopenia undergoing percutaneous coronary intervention (PCI). |
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Term
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Definition
Precautions
• Hemorrhage can occur at any site in the body.
• Monitor hematocrit, hemoglobin, and platelet count.
• All parenteral anticoagulants should be discontinued before administration of Argatroban.
• Argatroban should be used with extreme caution in disease states or other circumstances in which there is an increased risk of hemorrhage.
• Exercise caution when administering Argatroban to patients with hepatic impairment by starting with a lower dose and carefully titrating until the desired level of anticoagulation is achieved.
• Co-administration of Argatroban and warfarin produces a combined effect on INR without additional effect on vitamin K– dependent factor Xa activity. |
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Term
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Definition
Contraindications
• Overt major bleeding
• Hypersensitivity to drug or its components |
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Term
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Definition
Adverse Reactions
• Bleeding is the most common adverse reaction
• CV: hypotension, arrhythmias (ventricular tachycardia, atrial fibrillation)
• CNS: fever, pain, intracranial bleeding
• GI: diarrhea, nausea, vomiting, abdominal pain
• Respiratory: dyspnea, coughing, hemotypsis, pneumonia
• Allergic reaction |
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Term
| Integrilin (Eptifibatide) |
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Definition
Med Class: Anti-platelet & Glycoprotein 2b &3a Inhibitor
MOA:
• Antiplatelet
• Inhibits platelet aggregation by preventing binding of fibrinogen and other ligans to GP Iib/IIIa receptors |
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Term
| Integrilin (Eptifibatide) |
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Definition
Indications:
• Non “Q” wave MI
• Unstable angina medically managed
• Non “Q” wave Mi or unstable angina undergoing PCI |
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Term
| Integrilin (Eptifibatide) |
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Definition
Precautions
• Caution in the heparinized patient
• Monitor PT/ partial thromboplastin time (PTT), hematocrit (HCT), HbG
• Assess patient for bleeding
• Monitor for thrombocytopenia |
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Term
| Integrilin (Eptifibatide) |
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Definition
Contraindications
• Active bleeding
• Bleeding disorders |
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Term
| Integrilin (Eptifibatide) |
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Definition
Adverse Reactions:
• Bleeding
• Allergic reaction
• Intracranial bleeding |
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Term
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Definition
Med Class: Anticoagulant
MOA:
• Low molecular weight • Anticoagulant
• Inhibit thrombin generated by factor Xa
• Inhibit thrombin indirectly by formation of a complex with antithrombin III |
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Term
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Definition
Indications
• Non “Q” wave MI
• Unstable angina |
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Term
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Definition
Precautions
• Monitor for thrombocytopenia.
• Reduce dosage in patients that weigh < 45 kg or with renal impairment. |
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Term
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Definition
Contraindications
• Bleeding disorder
• Platelet count < 150,000 |
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Term
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Definition
Adverse Reactions
• Bleeding
• Hematoma |
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Term
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Definition
Med Class: •Reversal agent of heparin
MOA:
• Protein in sperm of salmon
• Anticoagulant effect when used alone
• In heparinized patients, protamine neutralizes both anticoagulant effects |
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Term
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Definition
Indications
• Used to reverse the effects of heparin post catheterization or coronary artery bypass graft (CABG).
• Heparin overdose |
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Term
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Definition
Precautions
• Bleeding
• Monitor for hypotension
• Dyspnea
• Hot flashes
• Allergic reactions |
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Term
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Definition
Contraindications
• Patients with allergies to seafood |
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Term
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Definition
Adverse Reactions
• Bleeding
• Hypotension • Dyspnea |
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Term
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Definition
Med Class: Thrombolytic
MOA:
• Tissue plasminogen activator from recombinant DNA
• Fibrin specific
• Dissolves stable fibrin clots |
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Term
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Definition
Precautions
• Arterial punctures require direct pressure for 30 min
• Handling of patient minimized
• Monitor invasive sites for bleeding |
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Term
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Definition
Contraindications
• Active internal bleeding
• Bleeding diathesis
• CVA due to hemorrhage
• Surgery or trauma within two months
• Uncontrolled hypertension |
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Term
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Definition
Adverse Reactions
• Bleeding
• Allergic reactions
• Hypotension
• Nausea and vomiting |
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Term
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Definition
Contraindications
• Active internal bleeding
• Bleeding diathesis
• Cerebrovascular accident (CVA) due to hemorrhage
• Surgery or trauma within two months
• Uncontrolled hypertension |
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Term
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Definition
Med Class: Thrombolytic
MOA:
• Thrombolytic
• Recombinant plasminogen activator
• Catalyzes with fibrin
• Converts plasminogen into plasmin |
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Term
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Definition
Indications
• Acute MI in adults
• Coronary ischemia with new left bundle branch block (LBBB)
• Coronary thrombus |
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Term
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Definition
Precautions
• Monitor for bleeding
• Assess for allergic reaction |
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Term
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Definition
Adverse Reactions
• Bleeding
• Allergic reaction |
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Term
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Definition
Med Class: Analgesic & Anti-Platelet
MOA:
• Anti-inflammatory action:
• Inhibits prostaglandin synthesis
• Enhances antigen removal and reduces the spread of inflammation in ground substances
• Analgesic action (primarily peripheral)
• Antipyretic action:
• Lowers body temperature in fever by indirectly causing centrally mediated peripheral vasodilation and sweating
• Inhibits prostaglandin synthesis
• Antiplatelet action
• Powerful inhibition of platelet aggregation
• Permanent inhibition of prostaglandin H synthase 1 or cyclooxygenase (COX)-1
• Blocks synthesis of precursor to thromboxane A2
• Impedes hepatic synthesis of blood coagulation factors, possibly via inhibition of vitamin K activity |
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Term
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Definition
Indications
• Relief of pain of low or moderate intensity
• Prevent recurrence or prophylaxis in MI
• As part of antithrombotic treatment in AMI
• Prophylaxis against thromboembolism (DVT, TIA) |
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Term
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Definition
Precautions
• Observe for signs of bleeding (petechiae, ecchymosis, bleeding gums, black or bloody stools, cloudy or bloody urine).
• Do not use enteric-coated aspirin products in emergency situations. |
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Term
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Definition
Contraindications
• Hypersensitivity or allergy to salicylates
• History of GI ulceration, bleeding, or other disorders
• Recent history of surgery
• Severe anemia
• Vitamin K deficiency
• Hemophilia or other coagulopathies
• Asthma
• Congestive heart failure
• Pregnancy (third trimester) |
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Term
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Definition
Adverse Reactions
• Nausea, vomiting, diarrhea, anorexia
• Heartburn or dyspepsia; abdominal pains
• Toxicity presents with full sensation in the ears, decreased or muffled hearing, and tinnitus; higher likelihood in elderly chronic aspirin users. |
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Term
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Definition
Med Class: Anti-Platelet & Anticoagulant
MOA:
• Thienopyridine that inhibits platelet aggregation by selectively preventing the binding of adenosine diphosphate (ADP) to its platelet receptor
• Inhibits subsequent ADP-mediated activation of the glycoprotein IIb/IIIa complex
• Results in prolongation of bleeding time due to inhibition of clotting
• Irreversible modification of platelet ADP receptor; lasts the lifetime of the platelet |
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Term
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Definition
Indications
• Reduction of atherosclerotic events in patients with recent stroke, MI, or established peripheral arterial disease
• To improve outcome of patients with acute coronary syndrome and acute MI undergoing PCI (including with stent placement)
• Combination therapy with aspirin in patients with acute coronary syndrome and acute MI not undergoing PCI |
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Term
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Definition
Precautions
• Discontinue medication for 7 days prior to elective surgery
• Monitor for GI bleeding
• Use with caution concomitantly with NSAIDs
• Avoid unnecessary invasive procedures
• Use with caution in patients receiving other drugs that may induce GI hemorrhage
• Use with caution in patients with hepatic impairment |
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Term
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Definition
Contraindications
• Drug hypersensitivity
• Acute pathologic bleeding, such as peptic ulcer or intracranial hemorrhage
• Lactating mothers |
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Term
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Definition
Adverse Reactions
• Hemorrhage (including intracranial), epistaxis, and purpura
• CV: edema, hypertension, syncope, palpitations
• CNS: headache, dizziness
• GI: abdominal pain, dyspepsia, diarrhea, nausea
• Hypercholesterolemia
• Joint pain and back pain |
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Term
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Definition
Med Class: Anti-hypertensive
MOA:
• Inhibition of conversion of angiotensin I to angiotensin II, blocking vasopressor activity and aldosterone secretion
• Reduction in blood pressure due to reduced vasoconstriction (afterload)
• Reduction in pulmonary capillary wedge pressure (measure of preload) and pulmonary vascular resistance |
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Term
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Definition
Indications
• Mild to moderate hypertension (may combine a diuretic in therapy)
• Post-myocardial infarction (to minimize ventricular remodeling; usually initiated 6 hours after onset of symptoms)
• Post-myocardial infarction for preload and afterload reduction
• Congestive heart failure |
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Term
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Definition
Precautions
• If possible, discontinue any diuretics for 2 to 3 days prior to first dose of enalapril to reduce incidence of hypotension
• If unable to do this, initial dose should be 2.5 mg PO and observe patient closely for at least 2 hours and until the BP has stabilized for at least one hour
• Sudden exaggerated hypotension following initial dose within 1 to 4 hours, especially in salt restrictive diets or very high BP
• Bedrest and BP monitoring for 3 hours after initial dose
• Be alert for hyperkalemia in patients with diabetes, CHF, or impaired renal function. |
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Term
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Definition
Contraindications
• Pregnancy
• Hypersensitivity to ACE inhibitors
• Pre-existing hypotension
• Cardiogenic shock
• Cautious use in renal impairment or renal artery stenosis, hypovolemia, hepatic insufficiency, diabetes mellitus, diuretic or dialysis therapy, and conditions where hypotension would present a potential hazard (e.g., cerebrovascular insufficiency) |
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Term
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Definition
Adverse Effects
• Headache, dizziness, fatigue
• Hypotension (including postural), syncope, chest pain, reflexive tachycardia, palpitations
• Rash and angioedema
• Acute renal failure, hyperkalemia
• Diarrhea, nausea, abdominal pain, dyspepsia
• Loss of taste (carbonated beverages)
• Cough (non-productive, usually resolves with termination of medication) |
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