Prasugrel

INTRODUCTION

Indications

Reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome who will be managed with PCI, including patients with unstable angina or non–ST-elevation myocardial infarction (NSTEMI). Reduction of thrombotic cardiovascular events (including stent thrombosis) in patients with STEMI when managed with either primary/delayed PCI.

Action

Acts by irreversibly binding its active metabolite to the P2Y₁₂ class of ADP receptors on platelets; inhibiting platelet activation and aggregation. Therapeutic Effects: Decreased thrombotic event, including cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke.

Adverse Reactions/Side Effects

CNS: dizziness, fatigue, headache. Resp: cough, dyspnea. CV: atrial fibrillation, bradycardia, hypertension, hypotension, peripheral edema. GI: diarrhea, nausea. Derm: rash. Hemat: BLEEDING, THROMBOTIC THROMBOCYTOPENIC PURPURA, leukopenia. Metab: hyperlipidemia. MS: back pain, extremity pain. Misc: fever, noncardiac chest pain

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of bleeding, including bleeding gums, nosebleeds, unusual bruising, hematuria, blood in stools, and a fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if these signs occur.

• Monitor signs of thrombotic thrombocytopenic purpura, such as purplish spots on the skin, decreased consciousness, fatigue, weakness, shortness of breath on exertion, and tachycardia. Report these signs to the physician or nursing staff immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, 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 or syncope.

• 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.

• Watch for signs of leukopenia, including fever, sore throat, mucosal lesions, or other signs of infection. Report these signs to the physician or nursing staff.

• Assess any breathing problems, and report severe or prolonged cough or difficult, labored breathing.

• Assess any back pain or extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• 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.

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 ...