00:01
Aspirin, so we know that it irreversibly inhibits COX pathway both one and two,
and so therefore without this, you don't have the thromboxane,
guess what you'd lose?
Platelet aggregation.
00:16
Bleeding time is the only thing to be affected,
and increase in, but no change in PT, PTT, why please? Why?
Because we're only dealing with platelets.
00:28
Is that clear?
May I ask another important question?
Will there be a decrease in platelet count if all that you do
is inhibit thromboxane formation, of course not.
00:39
The platelet count will be perfectly normal.
00:42
Clinical use, antipyretics, so for example,
patient has fever, analgesia, anti-inflammatory, and antiplatelet.
00:50
Toxicity here, you're thinking about bleeding.
00:53
Now, this is interesting.
00:54
I need you to memorize this.
00:56
In physiology and in a patient that unfortunately may be popping in too many aspirin pills,
over the counter, popping these like crazy
maybe because they're wishing to take care of a headache
and unfortunately, the first thing that may happen for reasons that we're quite unsure of
but please memorize that aspirin up in the respiratory center will stimulate it.
01:22
Yes, stimulate it acutely.
01:26
So one of the first things that you're going to find with aspirin toxicity
if a patient is taking too many, it actually stimulates the respiratory center
which means that the patient has hyperventilation.
01:37
Now, what does that mean to you?
On your labs, what are you looking for?
An ABG has been done.
01:42
An ABG, what are you going to find in terms of your carbon dioxide?
Decrease in carbon dioxide. Welcome to respiratory alkalosis.
01:53
Keep that in mind, very important.
01:55
In addition, they're taking aspirin.
01:58
Who is? A child.
02:00
Maybe the child has, who's this patient?
The child, eight years of age, fever, big time.
02:07
Take a look at the tongue, it looks like a peel of a strawberry in a child.
02:12
Fever, strawberry tongue.
02:15
Take a look at the skin of this child.
02:17
It looks like the skin is falling off.
02:20
It's called a desquamating rash.
02:22
Maybe you have lymphadenopathy.
02:24
You put all this together, you should be thinking Kawasaki.
02:26
But with Kawasaki, maybe this child has been taking aspirin.
02:30
Right? It could be.
02:31
Now, I know in clinical practice, we use IVIG granted.
02:35
However, you might be given a situation where such a child is given aspirin.
02:39
You think that child may ever, ever experience a viral infection?
Influenza, maybe chicken pox, what have you, and the patient's taking aspirin.
02:51
Now, for reasons that once again are unclear but yet we know is that in that child,
a virus plus aspirin may result in death of the liver,
highlight, it makes you pay attention to Reye's syndrome
and it also has a side effect, Tinnitus.
03:07
It may affect your vestibulocochlear nerve.
03:10
Told you earlier whenever you see the letters GREL, G-R-E-L, what exactly are you doing?
Good, you are then inhibiting your P2Y12 receptors.
03:23
You see where it says irreversibly blocking ADP receptors?
The name of those receptors are P2Y12 receptors.
03:29
Once you inhibit those receptors and then, what are you doing?
You're inhibiting the activation of the platelet.
03:37
If you inhibit the activation of platelet, obviously,
I am going to then inhibit aggregation.
03:42
Welcome to Clopidogrel, Prasugrel, Ticagrelor, or Ticlopidine.
03:48
Clinical use once again as an alternative for aspirin.
03:52
So therefore, you're thinking about acute coronary syndrome once again.
03:55
Let it be unstable angina, maybe coronary stenting,
and increased incidence of recurrence of thrombotic stroke, a thrombotic stroke.
04:04
Not embolic but thrombotic.
04:05
In other words, maybe a thrombi formation in the middle cerebral artery.
04:10
Those are clinical uses.
04:11
The toxicity especially Ticlopidine, would be neutropenia.
04:16
Look for a patient that has susceptibility to infection.
04:19
Let's take a look at Abciximab here.
04:22
Abciximab is going after what?
A glycoprotein IIb/IIIa, picture that for me one more time.
04:29
You have one IIb here and we have another IIb/IIIa here.
04:34
And you have Dr. Roger's ugly face.
04:36
My ugly face is fibrinogen.
04:39
You'll never forget that.
04:41
Welcome to Abciximab.
04:43
Clinical use, as an alternative for aspirin would be acute coronary syndrome.
04:47
It could be part of the regimen of percutaneous coronary angioplasty when you need to go in there
and open up and balloon your coronary to make it easier.
04:57
And then, toxicity here may be bleeding and thrombocytopenia.