Therapeutic: antiplatelet agents
Pharmacologic: glycoprotein IIb/IIIa inhibitors
Used with heparin and aspirin to decrease cardiac ischemic complications before or after percutaneous coronary intervention (PCI), including percutaneous transluminal coronary angioplasty (PTCA). Unlabeled Use: In combination with heparin and and/or low-dose alteplase or reteplase to enhance coronary perfusion in patients with acute coronary syndromes (ACS).
Binds to glycoprotein (GP) receptors on platelet surfaces (GP IIb/IIIa), resulting in decreased platelet aggregation. Therapeutic Effects: Decreased incidence of restenosis of coronary arteries and improved myocardial perfusion.
Adverse Reactions/Side Effects
CNS: abnormal thinking, dizziness, headache. CV: hypotension, atrial fibrillation/flutter, bradycardia, complete AV block, supraventricular tachycardia, vascular disorder, chest pain, peripheral edema. Hemat: BLEEDING, thrombocytopenia. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess for signs of bleeding and thrombocytopenia, including bleeding gums, nosebleed, unusual bruising, black/tarry stools, hematuria, and a decrease in hematocrit or blood pressure. Notify physician or nursing staff immediately if these signs occur.
Be alert for signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendixes G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.
Assess blood pressure periodically, and compare to normal values (see Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (see Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Assess dizziness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.
Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.
Because of the risk of cardiac arrhythmias (bradycardia, atrial fibrillation, others), use caution during aerobic exercise and endurance conditioning. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (see Appendix L).
Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.
Remind patients to take medication as directed to reduce the risk of coronary infarction, even if they are asymptomatic.