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CAD / Lytic Drugs


Antithrombotics include: Fibrinolytics, anticoagulants, antiplatelet drugs
Use of fibrinolytics STEMI only
Anticoagulants: acute & chronic Acute: UFH, LMWH, DTIs; chronic: warfarin
UFH vs LMWH re: inactivating thrombin UFH > LMWH
Beta blockers AEs Hypotension; Decrease HR, heart block; May worsen HF symptoms; CNS (fatigue, malaise, depression); Bronchospasm (use ß1 selective agents)
Irreversibly binds to ADP receptor on platelets; Full reversal requires removal of plts Clopidogrel
Fibrinolytics: absolute CI Prior hemorrhagic CVA; any cerebrovascular events < 1 year; active internal bleeding; Known intracranial neoplasm; suspected aortic dissection
Fibrinolytics: relative CI BP > 180/110; Use of anticoags w/ INR > 2; Noncompressible vascular punctures; Prolonged CPR (> 10 minutes); PG or Menstruation; Trauma < 2-4 weeks prior; Major surgery < 3 weeks prior
UFH: main risk = bleeding
UFH: used for: Both STEMI and NSTEMI
ATPIII/heparin has greatest effect on: Factor II (thrombin)
Can use to monitor LMWH Factor Xa
UFH/LMWH adverse effects Bleeding, HIT, osteoporosis
UFH vs LMWH: which inhibited by PF4 (thus limited effect vs ACS)? UFH
UFH vs LMWH: which requires renal dose adjustment? LMWH
Tx for catheter thrombosis during PCI Fondiparinux
Bivalirudin is used in STEMI in place of: UFH / LMWH
Add warfarin for: pts w/ USA or NSTEMI w/anticoag indication (to maintain INR 2.0-3.0)
Clopidogrel dosing usu loading & maint doses
Clopidogrel AEs Bleeding; Thrombocytopenia; Leukopenia; TTP
Which patients get clopidogrel? All STEMI/NSTEMI (2-4 wks to 1 yr)
Which patients get GP IIb/IIIa inhibitors? STEMI pts going for PCI
GP IIb/IIIa inhibitors are not recommended if: PCI is not planned
ACS mgmt = MONA (morphine, O2, NTG, ASA or antiplatelet tx); BB, ACEI, CCB, statin, anticoag (STEMI: fibrinolytics: streptokinase / alteplase); Surg: PTCA
Examples (5) of direct thrombin inhibitors dabigatran (Pradaxa), desirudin, lepirudin, argatroban, bivalidrudin
Xa inhibitors Fondaparinux (Arixtra): DVT/PE. Rivaroxaban (Xarelto): nonvalvular A-fib. Apixaban (Xarelto): DVT/PE
Created by: Abarnard