Seton 2014 Day 2 AM Breakout 2 Cardiovascular Pharmacology

144 Pages·2014·2.32 MB·English

by  Cynthia Webner

Cardiovascular
Pharmacology:
D
rugs by Disease
Karen Marzlin DNP, RN, CCNS, CCRN-CMC, CHFN
www.cardionursing.com
2014 1
“I’m not telling you it is going
to be easy, I’m telling you it is
going to be worth it.”
~ Art Williams
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UNDERSTANDING WHY WE DO
WHAT WE DO
Differentiating mortality benefit
from symptom relief.
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Drugs Used to Alter Clotting in ACS
• Fibrinolytics
• Antiplatelets
– STEMI
– STEMI / NonSTEMI / UA
– tPA
– GP IIb/ IIIa Inhibitors
• Alteplase
• Eptifibitide (Integrelin)
• Retaplase
• Tirofiban (Aggrastat)
• Tenecteplase
• Abciximab (Repro)
– Streptokinase (no longer used)
– ADP Receptor Blockers

• Clopidogrel

Anticoagulants • Prasugrel
•
• Ticagrelor
o STEMI / NonSTEMI / UA
– Thromboxane A Inhibitor
o Unfractionated Heparin 2
• ASA
o Low Molecular Weight Heparin

o Direct Thrombin Inhibitors

o Factor Xa Inhibitors

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Clot Formation: Clotting Cascade
Intrinsic Pathway Extrinsic Pathway
• Initiated by vascular injury • Initiated by endothelial
and direct exposure to release (secondary to tissue
collagen injury) of thromboplastin
tissue factor
• From initiation to a clot is 2-
6 minutes • From initiation to clot is 15
to 20 seconds
• Measured by APTT
• Measured by Protime

A clot can be produced by activation of either
the intrinsic or extrinsic pathway.
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The
Clotting
Cascade
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The Clotting Cascade
• The Common Pathway
– Prothrombin is converted to thrombin
– Thrombin permits fibrinogen to be converted to fibrin
– Result is fibrin stable clot (red clot)
– This fibrin stable clot is cause of STEMI MI
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Anticoagulants
• Unfractionated Heparin • Warfarin
(Vitamin K
– Heparin by Weight antagonist)
– STEMI, NonSTEMI,UA • Dabigatran
(Direct
– Mortality benefit thrombin inhibitor)
• Low Molecular Weight • Rivaroxaban
(Factor Xa
Heparin
inhibitor)
– STEMI, NonSTEMI, UA • Apixaban
(Factor Xa
• Direct Thrombin
inhibitor)
Inhibitors

– If history of HIT, PCI
NonSTEMI
• Factor Xa Inhibitors
– Not in PCI

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Xa
Inhibitors
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A Closer Look at Heparin
• Antithrombin activator that inhibits factors Xa and IIa
• Prevents conversion of prothrombin to thrombin by binding to
antithrombin III
• Antithrombin III naturally inhibits thrombin; when heparin
binds with it the inhibition is increased 1000 times
• Neutralizes the clotting capabilities of thrombin
• Works in the intrinsic and common pathway
• Also inhibits platelets (thrombin is most potent platelet
stimulator)
• Anticoagulation is almost instant
• ½ life relatively short
• Antidote: Protamine 1 mg per 100 units

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