Page 489 - fbkCardioDiabetes_2017

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When to Use ? When Not to Use ? -Antiplatelets. 465

Disorders for Which Aspirin Has Been Shown tablets):
to Be Effective and the Lowest Effective Respiratory alkalosis combined with a severe
Daily Dose(mgm) metabolic acidosis
Hypertension 75 Seizures, coma, pulmonary edema & cardiovascular
Chronic stable angina 75 collapse can occur.
Polycythemia vera 100 Clopidogrel:
Unstable angina 75 Clopidogrel is a prodrug that must be metabolized by
CYP 2C19 to be effective
Acute myocardial infarction 160
Its active metabolite irreversibly blocks the ADP
Transient ischemic attack and ischemic stroke 50
receptor on platelets, thereby reducing platalet
Severe carotid artery stenosis 75 aggregation
Acute ischemic stroke 160 It has no effect on prostaglandin metabolism (unlike
aspirin)
Atrial fibrillation 325
75 mgm OD
Men at high cardiovascular risk 75
Indications:
Immediate postcardiac surgery graft preservation
?325 Recent MI, acute coronary syndrome, stroke or
Contraindications: established peripheral artery disease, after coronary
stenting (to reduce the risk of restenosis)
Hypersensitivity to NSAIDs or history of bleeding Secondary prevention after an MI for those who are
disorders, such as GI bleeding or hemophilia
allergic to aspirin
Not recommended during pregnancy, but may be Contraindications:
valuable in treating preeclampsia-eclampsia.
Patients with intracranial hemorrhage, peptic ulcers
Children and teenagers should not use this medicine or other active bleeding disorders
for chicken pox or flu symptoms before a doctor is
consulted about Reye’s syndrome, a rare but serious Use with caution in patients with recent trauma or
illness reported to be associated with aspirin. surgery due to risk of bleeding. Caution is needed
in patients with liver impairment.
Aspirin may trigger asthmatic symptoms in some
patients . Abciximab:
Other expected side effects are dose-dependent A humanized monoclonal antibody directed against
With therapeutic doses: the IIb/IIIa complex
gastric upset, gastric and duodenal ulcers are the It binds to the receptor complex on platelets and
most common side effects thereby prevents platelet aggregation
With higher doses: The IIb/IIIa complex functions as a receptor for
fibrinogen and other proteins involved in the final
“salicylism” can occur - vomiting, tinnitus, decreased common pathway for platelet aggregation. Blocking
hearing, vertigo (reversible) this receptor therefore inhibits platelet aggregation..
With very large doses: There are roughly 50,000 copies of this complex on
the surface of each platelet.
Hyperpnea (increased depth & rate of respiration)
through a direct effect on the medulla resulting in Indications:
arespiratory alkalosis
Adjunct antiplatelet therapy for percutaneous
Body temperature may be elevated due to uncoupling coronary intervention (PCI) (e.g. angioplasty, placement
of oxidative phosphorylation, potentially resulting of coronary stints) & in acute coronary syndromes
insevere hyperthermia (Olson, 2009).
Commonly used concomittantly with aspirin & heparin
At progressively higher and potentially fatal doses
(300 to 500 mg/kg)(or 20-35 full strength 325 mg

Cardio Diabetes Medicine