Antiplatelets

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Antiplatelets — Antiplatelet; P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel); dipyridamole.

Identification

• Therapeutic class: Antiplatelet.
• Pharmacologic class: P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel); dipyridamole.

Pharmacology

• Mechanism of action: Block platelet activation to prevent arterial clots; used after stents and in acute coronary syndrome, usually with aspirin.
• Onset / peak / duration: Onset hours; clopidogrel and prasugrel irreversible (lasts platelet lifespan); ticagrelor reversible and twice daily.
• Half-life / therapeutic level: Varies; no routine level.

Clinical use

• Indications: Acute coronary syndrome, coronary stents, stroke and peripheral arterial disease prevention.
• Usual dose, route, frequency: PO once daily (ticagrelor twice daily), often with low-dose aspirin.
• Maximum dose / adjustments: Ticagrelor requires low-dose aspirin (higher aspirin doses reduce its effect).

Safety

• Contraindications: Active bleeding; prasugrel with prior stroke or TIA.
• Black box warning: Clopidogrel is less effective in CYP2C19 poor metabolizers (consider testing); prasugrel carries a boxed warning for significant and sometimes fatal bleeding (contraindicated with prior stroke or TIA); ticagrelor carries a boxed warning for bleeding and for reduced effectiveness with higher maintenance aspirin doses.
• Interactions: Other anticoagulants and NSAIDs (bleeding), proton pump inhibitors (omeprazole reduces clopidogrel activation), CYP interactions.
• Pregnancy / lactation: Use only if clearly needed.
• High-alert: No.

Adverse effects

• Common side effects: Bruising, minor bleeding, dyspnea (ticagrelor).
• Serious effects to report: Major bleeding, thrombotic thrombocytopenic purpura (rare with clopidogrel).
• Antidote / reversal: No specific reversal; platelet transfusion in emergencies.

Nursing process

• Assessment before administration: Bleeding risk, stroke history (prasugrel), concurrent aspirin dose.
• Interventions during therapy: Hold before surgery as directed (typically 5 to 7 days); avoid omeprazole with clopidogrel.
• Monitor: Signs of bleeding, hemoglobin.
• Evaluation / expected outcome: Prevention of arterial clots.

Patient teaching

• Patient teaching: Do not stop before procedures without provider guidance (stent thrombosis risk); report bleeding; ticagrelor needs low-dose aspirin.
• Notify provider if: Unusual bleeding or bruising, black stools, sudden shortness of breath (ticagrelor).
• Administration tips: Consistent timing; coordinate holds before surgery.