McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

TABLE 48.1

DRUGS IN FOCUS Drugs affecting clot formation and resolution (continued)

Drug name

Dosage/route

Usual indications

Antiplatelet agents (continued) eptifibatide (Integrilin)

180 mcg/kg IV over 1–2 minutes, then 2 mcg/kg per minute IV for up to 72 hours for acute coronary syndrome; 135-mcg/kg IV bolus before procedure, then 0.5 mcg/kg per minute IV for 20–24 hours Single 60 mg PO loading dose, then 10 mg/day PO

Treatment of acute coronary syndrome; prevention of ischaemic episodes in people undergoing percutaneous coronary interventions Prevention of atherothrombotic events in individuals with acute coronary syndromes, in conjunction with aspirin Prevention of atherothrombotic events in individuals with acute coronary syndromes, in conjunction with aspirin Reduction of the risk of thrombotic stroke in people with TIAs or history of stroke who are intolerant to aspirin therapy Treatment of acute coronary syndrome and prevention of cardiac ischaemic events during percutaneous coronary intervention; used in combination with heparin Replacement in hereditary antithrombin III deficiency; treatment of people with this deficiency who are to undergo surgery or obstetrical procedures that might put them at risk for thromboembolism Prevention of thromboembolic events in individuals who have undergone elective total hip or total knee replacement; prevention of stroke and embolism in individuals with atrial fibrillation and one or more risk factors Prevention of ischaemic events in people undergoing transluminal coronary angioplasty when used in combination with aspirin Prevention of thromboembolic events in individuals who have undergone elective total hip or total knee replacement; prevention of stroke and embolism in individuals with atrial fibrillation and one or more risk factors Prevention and treatment of venous thromboembolic events following surgery for hip fracture, hip replacement or knee replacement; used with warfarin when appropriate Prevention and treatment of venous thrombosis, pulmonary embolus, atrial fibrillation with embolisation; prevention of clotting in blood samples, dialysis and venous tubing; diagnosis and treatment of disseminated intravascular coagulation (DIC) (Box 48.3); also used as an adjunct in the treatment of MI and stroke

prasugrel (Effient)

ticagrelor (Brilinta)

180 mg PO loading dose, then 90 mg PO b.d.

ticlopidine (Tilodene)

250 mg PO b.d.

tirofiban (Aggrastat)

0.4 mcg/kg per minute IV over 30 minutes, then continuous infusion of 0.1 mcg/kg per minute

Anticoagulants antithrombin III (Thrombotrol-VF)

Dose must be calculated using body weight and baseline levels, given every 2–8 days

apixaban (Eliquis)

2.5–5 mg PO b.d.

bivalirudin (Angiomax)

1-mg/kg IV bolus, then 2.5 mg/kg per hour IV for 4 hours and 0.2 mg/kg per hour IV as a low-dose infusion

dabigatran (Pradaxa)

220 mg PO once daily

fondaparinux (Arixtra)

Prevention: 2.5 mg/day by SC injection starting 6–8 hours after surgical closure and continuing for 5–9 days Treatment: 5–10 mg/day by SC injections for 5–9 days 10,000–20,000 units SC, then 8000–10,000 units q 8 hours; 5000–10,000 units IV q 4–6 hours Paediatric: 50 units/kg IV bolus, then 100 units/kg IV q 4 hours

heparin (generic)