So, if you thought that other medication was hard to say, look at this one abciximab -- that is a mouthful.
It’s in a different family though, right? GPIIb/IIIa receptor blockers; so this is again a medication that’s going to block a receptor.
It’s the most effective antiplatelet drug available but it’s got to be given IV
because it inhibits the last step when these platelets are all getting together by blocking glycoprotein IIb/IIIa,
that’s why it gets its name -- those are the specific receptors that it blocks and therefore it stops fibrinogen
and the Von Willebrand factors from binding on activated platelets.
Whoa, what on this slide is need to know, which one is good to know?
You need to know that this medication is the most effective antiplatelet and it needs to be given IV.
As far as the very specific mechanism of action, that’s nice to know
but it’d be the most important that you know that it’s the most effective,
we have to give it IV and that’s gonna keep those platelets from clumping together.
So putting it in the category of antiplatelet, having to be given a IV
and knowing it’s the most effective, those are the most important points to know about this medication.
So it’s plasma half-life is about 10 minutes, but it’s platelet aggregation recovery period can take 24 to 48 hours,
so half-life is the amount of time that half of that drug is out of the system, that’s ten minutes -- really short,
but the effect is gonna last for one to two days.
So you can use it short term for patients that we did some type of coronary intervention with.
Percutaneous means through the skin, coronary intervention -- that’s like talking placing a stent or not placing a stent,
but it’s a percutenous coronary intervention. Also we use it with acute coronary syndrome,
someone has unstable angina, that’s a non-STEMI, that’s a non-ST segment elevated MI, that’s what non-STEMI means.
Okay, so these are really good drugs, the most effective, have to be given IV.
It’s a short half-life but a one to two day experience and we used it for percutaneous coronary interventions in acute coronary syndromes.
Okay, now there’s special populations I want to be really careful with when they receive this medication.
They're even more likely to have bleeding problems.
Anyone of the drugs in these three families that we’re talking about in this video series
can cause a patient to have inappropriate bleeding -- bleeding that’s problematic,
but for abciximab, this medication in particular the elderly,
people who have renal disease or even women may have a higher rate of problematic bleeding.
For some of the other medications we have reversal agents,
something that you give when the patient is in danger or having a toxic effect.
For warfarin we use Vitamin K, for heparin we use protamine sulphate, for abciximab we don’t have a reversal agent,
so that’s something to keep in mind. Remember it has a short half-life
that can last one to two days. That can be a nail biting one to two days if the patient is bleeding too much.
Now if you try and transfuse platelets that won’t work, that won’t help us.
So if the patient needs to have surgery, we want to discontinue the infusion and wait at least 8 to 12 hours before you go to surgery.
Now, what’s the rationale behind that? Well, the reason we want to delay surgery
is because we know this is an antiplatelet and if we’re gonna cut on the patient,
we need them to form clots that will help that wound seal back up,
that’s why you wanna delay it for 8 to 12 hours after the infusion has been stopped.
Okay, the sad part when a drug is the most affective is that usually it has some special risks so we wanna watch these closely.
The special ones to remember with this abciximab is make sure you get your patient’s platelet count
and hemoglobin levels before you start the therapy.
So platelet count and hemoglobin levels, underline those two.
Now, remember, we’re dealing with antiplatelets so we wanna watch those two lab works specifically with this medication.
It’s the most affective, it has to be given IV, we've got those special populations, right?
The elderly and women more than men, but everyone needs lab drawn before we start the medication.
Now, these patient have the same contraindication that we’d used on patients with thrombolytics.
We want to make sure that they don’t have some risk of bleeding before we give them the medication
so we wanna make sure they don’t have a platelet disorder
because if their platelets are already problematic, giving them an antiplatelet -- not a good idea.
If they have coagulopathy or bleeding disorders, we don’t wanna give them any anti-platelet.
If they have a history of a stroke, we wanna be really careful with giving them this medication.
If they’ve recently had surgery, they’re uncontrolled hypertension meaning they haven’t been medicated
or treated to keep that blood pressure under control, or they’ve had recent trauma, all of these things put your patient at risk.
Remember, we're always asking why? Why would it be a problem for a patient to get abciximab with a platelet disorder?
Because it’s an antiplatelet, put him in an extreme risk for bleeding.
Same thing with each one of these factors, make sure you’re always answering the question why
when a patient on this medication, why it would not be safe for them to receive it.
So here’s a review slide again. You’ve got the three families -- anticoagulants, antiplatelets and thrombolytics.
Looking here at the bottom, they’ve got the two giant drops of blood remind us for all of these medications,
we give them to people who are really good at making clots and anything a drug does well help us
prevent new clots or break them up like thrombolytics, it can do over well, so it puts your patient at risk for bleeding.