Clopidogrel
Names: brand name- Plavix
Generic name- clopidogrel
Drug class: antiplatelet
Mode of action: it works by inhibiting platelet aggregation: it selectively inhibits adenosine diphosphate binding to its platelet receptor and subsequent activation of glycoprotein GPIIb/IIIa complex leading to platelet aggregation inhibition.
Uses; to prevent heart attack in people with heart disease, peripheral disease, or recent stroke. It is used with aspirin to treat unstable angina.
Side effects: easy bleeding or bruising, stomach pains, constipation, and allergic reaction (rare)
Patient information: taken regularly by mouth without or with food as directed. Avoid grape fruits or juice as they increase side effects chances.
Contraindications: allergic to it, bleeding disease e.g., hemophilia, and liver disease
Interactions: proton pump inhibitors and azoles
Nitroglycerin
Names: brand name- GoNitro, Nitromist, Nitrostat
Generic name- nitroglycerin (oral/sublingual)
Drug class: nitrate
Mode of action: it works by relaxing the blood vessels’ smooth muscles, dilating them, helping relieve chest pains due to blood vessels’ narrowing and reduces work of the heart.
Uses: to prevent or treat chest pain (angina) attacks.
Side effects: bloating, headache, dyspnea, and burning sensation
Patient information: take the drug when you experience chest pain signs.
Contraindications: sublingual Nitroglycerin is C/I in severe anemia, increased intracranial pressure, circulation problems, and shock signs. Nitroglycerin should not be used when one is under erectile dysfunction and pulmonary artery hypertension medications
Interactions: fluticasone, ibuprofen, naproxen, aspirin, and tadalafil
Streptokinase
Name: brand name- kabikinase, streptase
Generic name- streptokinase
Drug class: fibrinolytics
Mode of action: it creates a complex that causes cleavage of Val/Arg plasminogen bond forming a proteolytic enzyme that degrades fibrin in a thrombus matrix, thus exerting its thrombolytic action.
Uses: pulmonary embolism, acute myocardial infarction, deep vein thrombosis, arterial thrombosis
Side effects: bleeding, allergic reactions such as shivering and fever, respiratory depression
Patient information: seek doctor attention if you develop any respiratory symptom, any skin rash, or if you become pregnant.
Laboratory monitoring: before its use in thrombolytic therapy, obtain prothrombin time, thrombin time and APTT.
Contraindications: active internal bleeding, intracranial neoplasm and uncontrolled severe hypertension
Interactions: anticoagulants and antiplatelets
Heparin
Names: brand names: Hep-Pak, Heparin sodium ADD-Vantage
Generic names: heparin
Drug class; anticoagulants (blood thinners).
Mode of action: heparin binds to antithrombin III (AT), leading to a conformational change that causes increased flexibility of its site loop that is reactive. The activated AT inactivates thrombin, proteases, and factor Xa, hence the anticoagulant effects.
Uses: to treat blood clots related to certain medical procedures or conditions. It is also used before surgery to reduce blood clots risk.
Side effects: osteoporosis, constipation, bleeding from gums, back pains, and headaches
Nurse note: do not use heparin to clear a catheter clot as it can cause severe bleeding.
Patient information: heparin increases bleeding risk hence the need for frequent lab tests such thrombin time and APTT. One should call a doctor if he experiences any drug side effects.
Contraindications: peptic ulcer disease, hypersensitivity, active bleeding, hypertension, renal dysfunction, thrombocytopenia, and hyperkalemia
Interactions: acetaminophen, ibuprofen, alcohol, aspirin, lorazepam, and warfarin
References
Oduah, E., Linhardt, R., & Sharfstein, S. (2016). Heparin: Past, Present, and Future. Pharmaceuticals, 9(3), 38. https://doi.org/10.3390/ph9030038
RxList. (2020). Streptase (Streptokinase): Uses, Dosage, Side Effects, Interactions, Warning. RxList. Retrieved from https://www.rxlist.com/streptase-drug.htm.
Drugs.com. (2020). Nitroglycerin (oral/sublingual) Uses, Side Effects & Warnings – Drugs.com. Drugs.com. Retrieved from https://www.drugs.com/mtm/nitroglycerin-oral-sublingual.html.