Eptifibatide

INTRODUCTION

Indications

Acute coronary syndrome (unstable angina/non–Q-wave MI), including patients who will be managed medically and those who will undergo percutaneous coronary intervention (PCI) that may consist of percutaneous transluminal angioplasty (PCTA) or atherectomy. Treatment of patients undergoing PCI. Usually used concurrently with aspirin and heparin.

Action

Decreases platelet aggregation by reversibly antagonizing the binding of fibrinogen to the glycoprotein IIb/IIIa binding site on platelet surfaces. Therapeutic Effects: Inhibition of platelet aggregation resulting in decreased incidence of new MI, death, or refractory ischemia, reducing the need for repeat urgent cardiac intervention.

Adverse Reactions/Side Effects

Noted for patients receiving heparin and aspirin in addition to eptifibatide

CV: hypotension. Hemat: BLEEDING (INCLUDING GI AND INTRACRANIAL BLEEDING, HEMATURIA, AND HEMATOMAS).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, or a fall in hematocrit or blood pressure (BP). Report these signs to the physician or nursing staff immediately.

• Be especially alert for signs of intracranial bleeds, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, and visual disturbances. Notify physician or nursing staff immediately if these signs occur.

• Assess BP periodically, and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

Interventions

• Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

• Use caution during aerobic exercise and endurance conditioning in patients being treated for unstable angina and coronary artery disease. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient to report immediately 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.

• Counsel patients about additional interventions to help reduce the risk of heart disease, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: 50% excreted by the kidneys.

Half-life: 2.5 hr.