Tirofiban

INTRODUCTION

Indications

Treatment of acute coronary syndrome (unstable angina/non–Q-wave MI), including patients who will be managed medically and those who will undergo percutaneous transluminal angioplasty (PCTA) or atherectomy. 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 ↓ incidence of new MI, death, or refractory ischemia with the need for repeat cardiac procedures.

Adverse Reactions/Side Effects

Noted for patients receiving heparin and aspirin in addition to tirofiban

CNS: dizziness, headache. CV: bradycardia, coronary dissection, edema, vasovagal reaction. GI: nausea. Derm: hives, rash. Hemat: BLEEDING, thrombocytopenia. MS: leg pain. Misc: fever, hypersensitivity reactions, pelvic pain, sweating.

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. Notify physician or nursing staff immediately if tirofiban causes excessive anticoagulation.

• Monitor signs of hypersensitivity reactions, 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 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 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 any pelvic or leg 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.

• Because of the risk of cardiac arrhythmias (bradycardia) and a vasovagal response, 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).

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood ...