Question

8-15 help

8. What is the clinical indication for vorapaxar? 9. Which anti-platelet medications are irreversible and what does that mean in terms of administration, therapeutic effect, and side effects? 10. Which anti-platelet drugs are administered via the oral route? 11. Which anti-platelet drugs are administered parenterally? 12. Why is it important to know /distinguish which anti-platelet drugs are administered orally vs parenterally? 13. What are the clinical indications for anti-platelet medications? Provide 2-3 examples, keeping in mind the various sub-classes of anti-platelet medications available: 14. What is the most common side effect of anti-platelet medications? 15. Which drug class(es) will most likely lead to an additive pharmacodynamic drug-drug interactions with anti-platelet medications that will lead to increased risk of bleeding?

Answer 1

8) Vorapaxar is a novel oral anti platelet drug . Food and Drug administration approved the use of this drug as a secondary prevention of cardiovascular events.

9)Aspirin is the anti platelet agent that irreversibly inhibits COX-1 and COX-2 enzymes resulting in inhibition of platelet aggregation and also has anti inflammatory effects)

Clopidogrel and Prasugel are the other irreversible anti platelet agents that irreversibly inhibits ADP receptor causing inhibition of platelet activation.

So these irreversible anti platelet agents are used only when we want inhibition of platelet function for longer duration. Therapeutic effect of these agents last longer upto 7 days .

As these agents are irreversible , inhibition of their anti platelet action can only be achieved by administering plasma concentrates. side effects include risk of bleeding, gastric ulceration, allergic reactions, acute thrombocytopenia.

10) Aspirin, clopidogrel, prasugrel, ticagrelor, vorapaxar are oral anti platelet agents.

11)Abciximab, cangrelor,eptifibatide,tirofiban are anti platelet agents administered parenterally.

12)It is important to distinguish between oral or iv antiplatelets as some require immediate platelet inhibition in such cases, i.v antipatelets are preferred as they induce the action quick

13)Aspirin is a irreversible COX inhibitor which is indicated in acute coronary syndrome, myocardial ischemia, prevention of cardiovascular diseases.

clopidogrel is ADP receptor inhibitor indicated in STEMI, unstable angina.

Abciximab is glycoprotein 2b/3a inhibitor used in high risk patients with unstable angina.

14)The most common side effect of antiplatelets are gastrointestinal side effects like dyspepsia, gastric ulceration and hemorrhage.

15)NSAID's and anticoagulants like warfarin have drug-drug interactions with antiplatelets and when given together the risk of bleeding is high due to synergistic effects.