Introduction to CV Pharmacology - Orlando Health

More documents

Recommendations

Info

CV Pharmacology The American College of Cardiology/American Heart Association Guidelines for the Management of Patients with ST-Elevation MI guidelines list the absolute and relative contraindications of fibrinolytic therapy. These are viewed as advisory for clinical decision making and may not be all-inclusive. NOTE: See package insert or institutional guidelines for more information, as well as the ACC/AHA Guidelines for the Management of Patients with ST Elevation Myocardial Infarction (updated 7/1/04) via the ACC website as listed in the References section of this SLP. Absolute contraindications to the use of fibrinolytics include: ANY HISTORY OF INTRACRANIAL HEMORRHAGE Known malignant intracranial neoplasm (primary or metastatic) Known structural cerebral vascular lesion (e.g., AVM) Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours Active internal bleeding or bleeding diathesis (excluding menses) Suspected aortic dissection Acute pericarditis Significant closed head or facial trauma within 3 months Relative contraindications must be weighed against potential benefits and include: Severe uncontrolled hypertension (>180/110) or history of chronic severe hypertension History of prior ischemic stroke greater than 3 months, dementia, or known intracranial pathology not covered in contraindications Pregnancy Active peptic ulcer or recent internal bleeding within the previous 2-4 weeks Non-compressible vascular punctures Current use of anticoagulants, the higher the INR, the higher the risk of bleeding Traumatic or prolonged (greater than 10 minutes) CPR or major surgery with the previous 3 weeks For streptokinase/anistreplase: Prior exposure ( more than 5 days) or prior allergic reaction to these agents All patients are to be monitored closely for signs of bleeding, including changes in neurological status, abdominal pain or rigidity, or hypotension. When used in the management of acute myocardial infarction, the patient may experience chest pain or dysrhythmias when the coronary artery opens and the supply of oxygenated blood to the myocardium is restored (reperfusion). It is vital not to stop the administration of the fibrinolytic agent due to reperfusion symptoms. If needed, symptoms are to be managed with morphine and antidysrhythmics. 2010 Orlando Health, Education & Development 45
CV Pharmacology Platelet Inhibitors IIb/IIIa GP Platelet Inhibitors Platelet inhibitors bind to the platelet receptor site named the glycoprotein IIb/IIIa site. These receptor sites function at the end of final common pathway to block the binding of fibrinogen and other components in the clotting cascade. Consequently, this action inhibits platelet aggregation and blood clotting. Drugs in this class include Reopro (abciximab), Aggrastat (tirofiban), and Integrilin (eptifibatide). Administration of these agents can result in reducing refractory myocardial ischemia, myocardial infarction, and mortality. Recent research indicates a significant decrease in complications and mortality from ischemic stroke, even when administered up to 24 hours following the onset of symptoms. Indications Reopro, Aggrastat, and Integrilin are indicated in the treatment of refractory unstable angina, and as an adjunct to percutaneous coronary interventions (PCI), such as angioplasty an planned within 24 hours. These agents should not be used together and need to be used cautiously with other drugs that effect clotting. It is important to note that all of these agents have been administered in clinical trials with aspirin, clopidogrel (Plavix), unfractionated heparin and enoxaparin (Lovenox), and bivalirudin (Angiomax). Administration Please consult Lexi-Comp, Micromedex, and PDR for dosage administration and usage. Please contact a pharmacist at your facility for further information. Precautions and Interactions Also refer to fibrinolytics for the contraindications of GP IIb/IIIa inhibitors. Patients are to be monitored closely for signs of bleeding, changes in neurological status, abdominal pain or rigidity, and hypotension. A platelet assay count should be monitored daily during therapy. One must obtain a platelet count within 4 hours of the bolus therapy. In addition, Reopro is a monoclonal antibody derivative, meaning it has the potential to cause allergic and anaphylactic reactions if the patient has had this drug in the past. Platelet Aggregation Inhibitors These drugs, include Plavix (clopidrogrel) and Ticlid (ticlopidine), work by modifying the platelet membrane, to block the ADP pathway to prevent platelet aggregation and prolong bleeding time. Aspirin, another antiplatelet agent, does not work through the ADP pathway. Aspirin irreversibly inactivates the COX-1 enzyme in platelets preventing the formation of thromboxane A 2 (a platelet aggregating substance). The effect of all of these agents is irreversible for the life of the platelets modified. Consequently, platelet function and bleeding time may take up to 2 weeks following discontinuation of the drug to return to normal. Because ticlopidine can cause life-threatening hematological reactions including neutropenia, thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), agranulocytosis, and aplastic anemia, its use is generally reserved for patients 2010 Orlando Health, Education & Development 46
Page 1 and 2: Introduction to CV Pharmacology * S
Page 3 and 4: CV Pharmacology EPINEPHRINE .......
Page 5 and 6: CV Pharmacology replace current dru
Page 7 and 8: CV Pharmacology The Adrenergic Rece
Page 9 and 10: CV Pharmacology Check Yourself Pop
Page 11 and 12: CV Pharmacology Review of Antidysrh
Page 13 and 14: CV Pharmacology produce proarrhythm
Page 15 and 16: CV Pharmacology General Rules The
Page 17 and 18: CV Pharmacology Class I Antidysrhyt
Page 19 and 20: CV Pharmacology Antidysrhythmics: C
Page 21 and 22: CV Pharmacology substitutions are n
Page 23 and 24: CV Pharmacology Summary chart of ca
Page 27 and 28: CV Pharmacology Antihypertensives A
Page 29 and 30: CV Pharmacology Beta-Adrenergic Blo
Page 31 and 32: CV Pharmacology Vasodilators Nitrog
Page 33 and 34: CV Pharmacology Morphine Sulfate Mo
Page 37 and 38: CV Pharmacology Precautions and Int
Page 39 and 40: CV Pharmacology Phenylephrine Pheny
Page 41 and 42: CV Pharmacology Indications Dobutam
Page 45: CV Pharmacology Fibrinolytic Agents
Page 49 and 50: CV Pharmacology Direct Thrombin Inh
Page 53 and 54: CV Pharmacology 7. Platelet Aggrega
Page 55 and 56: CV Pharmacology It is recommended t
Page 59 and 60: CV Pharmacology Summary This comple
Page 61 and 62: CV Pharmacology 5. Which of the fol
Page 63 and 64: 15. Which of the following is the i
Page 65 and 66: CV Pharmacology 25. After addressin
Page 67: CV Pharmacology References AEHLERT,

Introduction to CV Pharmacology - Orlando Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?