eptifibatide

eptifibatide /ep·ti·fib·a·tide/ (ep″tĭ-fib´ah-tīd) an inhibitor of platelet aggregation used for the prevention of thrombosis in patients with acute coronary syndrome or undergoing certain percutaneous coronary procedures.

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eptifibatide,

an antiplatelet agent.

indications It is used to treat acute coronary syndrome, including patients with percutaneous coronary intervention.

contraindications The following factors prohibit its use: known hypersensitivity to this drug, active internal bleeding, history of bleeding, stroke within 1 month, major surgery with severe trauma, severe hypotension, history of intracranial bleeding, intracranial neoplasm, arteriovenous malformation/aneurysm, aortic dissection, and dependence on renal dialysis.

adverse effects Life-threatening effects of this drug are stroke and bleeding. Hypotension is another serious adverse reaction.

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eptifibatide

Integrilin

Pharmacologic class: Platelet aggregation inhibitor

Therapeutic class: Antiplatelet agent

Pregnancy risk category B

Action

Decreases platelet aggregation by binding to platelet-receptor glycoprotein, preventing binding of fibrinogen to platelets, which causes thrombus formation

Availability

Injection: 10-ml vial (2 mg/ml), 100-ml vial (0.75 mg/ml)

⊘Indications and dosages

➣ Acute coronary syndrome (unstable angina or non-Q-wave myocardial infarction)

Adults: 180 mcg/kg I.V. bolus (to maximum of 22.6 mg) over 1 to 2 minutes, followed by a continuous infusion of 2 mcg/kg/minute (to a maximum of 15 mg/hour) for up to 72 hours

➣ Prevention of thrombosis related to percutaneous coronary intervention (PCI)

Adults: 180 mcg/kg (to a maximum of 22.6 mg) I.V. bolus immediately before PCI, then a continuous infusion of 2 mcg/kg/minute (to a maximum of 15 mg/hour), followed by a second 180-mcg/kg bolus 10 minutes after first bolus. Continue infusion until discharge or for up to 24 hours.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug or its components
• Severe hypertension
• Bleeding disorders
• Renal dialysis or creatinine level of at least 4 mg/dl
• Recent cerebrovascular accident
• Recent surgery

Precautions

Use cautiously in:
• renal insufficiency
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Withdraw single bolus dose from 10-ml vial into syringe, and give by I.V. push over 1 to 2 minutes. Follow single I.V. bolus dose with continuous I.V. infusion given undiluted from 100-ml vial spiked with infusion set connected to infusion control device.
• Don't administer through same I.V. line as furosemide.

Route	Onset	Peak	Duration
I.V.	Immediate	Immediate	4-6 hr

Adverse reactions

CNS: headache, dizziness, asthenia, syncope

CV: hypotension

GI: nausea, diarrhea, constipation

GU: hematuria

Hematologic: bleeding tendency, thrombocytopenia

Skin: flushing

Other: bleeding at femoral access site

Interactions

Drug-drug. Clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs, oral anticoagulants, thrombolytics, ticlopidine: increased risk of bleeding

Other platelet aggregation inhibitors: serious bleeding

Drug-diagnostic tests. Platelets: decreased count

Drug-herbs. Most commonly used herbs: increased anticoagulant effect of eptifibatide

Patient monitoring

• Monitor vital signs and assess cardiovascular status, especially for syncope and hypotension.
• Monitor coagulation studies, CBC, and platelet count. Watch for signs and symptoms of abnormal bleeding or bruising and hematuria.
• Check carefully for bleeding at all sites of invasive procedures, particularly femoral access site.

Patient teaching

• Tell patient drug may cause serious adverse effects but can help prevent a heart attack. Reassure him that he'll be closely monitored during therapy.
☞ Instruct patient to immediately report fainting or abnormal bruising or bleeding.
• Teach patient safety measures to avoid bruising or bleeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

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eptifibatide

Integrilin^® Cardiology An antithrombotic GP IIb/IIIa receptor antagonist that blocks fibrinogen and von Willebrand factor from binding to the surface of activated platelets