Glycoprotein gp iibiiia inhibitors such as abciximab

 Glycoprotein (GP) IIb/IIIa inhibitors such as abciximab (ReoPro), eptifibatide
(Integrilin), or tirofiban (Aggrastat) may be administered IV to prevent
fibrinogen from attaching to activated platelets at the site of a thrombus
 used in unstable angina and NSTEMI
 given before and during percutaneous coronary intervention (PCI) to maintain
patency of an artery with a large clot and are given with fibrinolytic agents
after STEMI.
 When giving GP IIb/IIIa inhibitors, assess the patient closely for bleeding or
hypersensitivity reactions. If either occurs, notify the health care provider or
Rapid Response Team immediately. Monitor the platelet level 4 hours after

starting the drug and daily thereafter. Notify the cardiologist if the patient
experiences a significant decrease in platelet count per agency protocol.
 Antiplatelets, such as clopidogrel (Plavix) or ticagrelor (Bri linta) , also known
as P2Y12 platelet inhibitors ,
 work to prevent platelets from aggregating (clumping) together to form clots
 vorapaxar (Zontivity), is shown to decrease the risk of recurrent MI when
added to the regimen of aspirin and clopidogrel.
 The main side effect is bleeding, including an increased risk of intracranial
hemorrhage.
 anticoagulation therapy to prevent clot formation
 Anticoagulation is stopped before cardiac catheterization and is usually not
continued following coronary intervention unless a high risk for clot
reformation exists following the intervention
 Once-a-day beta-adrenergic blocking agents (e.g., metoprolol XL [Toprol XL],
carvedilol CR [Coreg CR]), sometimes just called beta blockers
(BBs), decrease the size of the infarct, the occurrence of ventricular
dysrhythmias, and mortality rates in patients with MI
 Beta blockers slow the heart rate and decrease the force of cardiac
contraction
 monitor for:
 • Bradycardia
 • Hypotension
 • Decreased level of consciousness (LOC)
 • Chest discomfort
 Assess the lungs for crackles (indicative of heart failure) and wheezes
(indicative of bronchospasm). Hypoglycemia, depression, nightmares, and
forgetfulness are also problems especially in older patients
 Do not give beta blockers if the pulse is below 55 or the systolic BP is below
100 without first checking with the health care provider. The beta-blocking
agent may lead to persistent bradycardia or further reduction of systolic BP,
leading to poor peripheral and coronary perfusion.
 (ACEIs) or (ARBs) within 48 hours of ACS if the ejection fraction is equal to or
less than 40% in those with hypertension, diabetes mellitus, or stable chronic
kidney disease to prevent ventricular remodeling and the development of
heart failure.
 Both ACEIs and ARBs increase survival after an MI. Monitor the patient for
decreased urine output, hypotension, and cough.
 Check for changes in serum potassium, creatinine, and blood urea nitrogen
 For patients with angina, calcium channel blockers (CCBs) to promote
vasodilation and myocardial PERFUSION.