Aspirin, Mechanism Of Action, Acute Coronary Syndrome discussed on Real Life Pharmacology - Pharmacology Education for Health Care Professionals


They all air christianson here. Host of the real life pharmacology podcast today. I'm gonna cover aspirin and specifically with aspirin. I'm I'm going to talk more. So about the anti platelet activity that the the drug house, and how we use that in clinical practice, and some factors that you might want to think about as well as mechanism of action. And and all that good stuff as well. So other brand names that aspirin goes by Eka Tren bear, it's in some excedrin products as well when and I think this brings up a really important point. When you when you talk with patients about over the counter medications, you have got to be sure you're on the same page with them, and, you know, take excedrin, for example, excedrins generally considered for headache. But if you go look at different excedrin products, they've all got different ingredients. So. So very very important to understand what's in a medication and over the counter medication and make sure that info is relate back to the patient as to what to look for as far as the active ingredients go on the back of that label because so many brand names have different variations of products. And I after I've often often have to look myself to make sure I'm getting what, you know, giving something to a patient that I think they should be getting because you can often be deceived by brand name over the counter products, and what's in them. So with that we've got the mechanism of action for aspirin in. I did talk about end saids. More broadly in a previous podcast. So definitely go. Check that one out more at talk about some of the concerns with ensigns as a whole but its primary mechanism of action as far as the anti platelet active. Vity goes aspirin like other ends heads can inhibit Cox one and Cox two, and I'm and primarily this is going to block the production of thrombosis seen eighty two and this thrombosis in eighty two is important because it stimulates basically blood clotting it initiates that process in stimulates platelets to aggregate together in and stop bleeding. So I think you can kind of understand by that mechanism that aspirins going to increase the risk of bleeding there. So it is classified as an end said in addition to that anti platelet activity. We do have some analgesic anti paramedic anti inflammatory properties. These are generally at much. Much higher doses. Than the anti platelet activity, the anti platelet activity. We're looking at, you know, eighty one milligrams to three twenty five some of sometimes you will see patients, it seems like it's more geriatric patients use aspirin as their go to headache medicine and things like that. Generally, not something I I recommend. But you will see patients do that over the color sometimes and in the headache pain relief. Anti inflammatory type of fact, it's generally going to take higher doses with that. So maybe open six fifty and in more in that range as far as the the milligram dosage, so yeah, primary use in clinical practice is going to be that anti platelet activity. This is what you're going to see patients on eighty one milligrams once a day in the morning, for example, maybe three twenty five depending upon the situation. And what we're using the higher dose for. But again, if you see a patient usually dose down at once-daily, it's probably not for pain. It's probably four courteous, vascular prophylaxis, preventing heart attacks strokes and things of that nature. But we always want to make sure to ask patients what were using something for to make sure they know as well. Now, there's been some controversies and pushing Paul on cardiovascular prophylaxis, what doses appropriate is eighty one milligrams fine is three twenty five fine. And I will say probably in the majority of situations. Eighty-one milligrams of aspirin is okay. But there are some risk factors and and patients who have maybe had multiple events. There are some clinical factors in situations where you may get a provider that wants to do a higher dose. So there can be a little bit of leeway. There can be some exceptions there. But Eighty-one milligrams is probably acceptable for most patients one for sure situation where we're going to use that higher dose. Maybe a three twenty five milligram tablet is in ACS type situation. So that's. Acute coronary syndrome. It's a situation where you're maybe a patients presenting to the emergency department, or you know, with EMS the ambulance comes in a heart attack is suspected. In aspirin three. Twenty five milligrams is recommended over in eighty one milligram tablet in that acute situation where a heart attack is suspected. So that's one clinical situation where you might see the higher dose used and preferred over the eighty one milligram dose surgical procedures. This is always a question that patients Askar that I've seen patients ask a lot, and it can be difficult to end. There's no good blanket answer for whether an aspirin should be held or should be not held because different clinical situations and the intensity the aggressiveness of the surgery in what we're doing the invasiveness of the surgery, and how much blood loss is an -ticipant did. Does dictate whether aspirin should be held. You know, if it's a a minor, you know topical skin procedure. Aspirin might be appropriate to continue in that situation. And what you're going to want to lean on his the surgeon and in what they're doing with the patient and their determination of what the bleed risk is in that situation. So if it's going to be held typically aspirins going to be held in that five to ten day range, I would say most commonly in practice. I've seen about seven days maybe up to ten days in rare situations, but seven seems to be the number that I've seen most common. So again, whatever we hold aspirin. You know, the obvious risk is that, you know, cardiovascular event, if that's what we're using the aspirin for does maybe have the potential to happen, or you know, that's the perceived risk at least of stopping a medication like aspirin. That's a preventative type medication. So always important to to think about the the risk of the surgery the risk of blood loss as well as the risk of stopping that medication for a period of time as well. I adverse drug reactions with aspirin. I I would say with a baby dose aspirin adverse effects, particularly other than bleeding or bruising typically, aren't that common? So if I do see a patient, that's. That's maybe having trouble with aspirin. I might be a little bit of stomach upset or things of that nature or bruising and bleeding. That's probably the most common thing. I see with patients, maybe even more. So with geriatric patients that maybe have a little more frail skin and things of that nature. The the bruising maybe really really bothersome to patients. This is something that you're probably gonna come across. So we're always kind of juggling that risk versus benefit of aspirin. And we can certainly monitor hemoglobin in Amata Krit t to make sure that the patients aren't losing blood aren't having a blood loss. Maybe through the stool or something of that nature. GI bleed out. We can also check platelets to make sure that you know, this patient doesn't have some sort of underlying issue or or anything else that's dropping their platelets further which may put them at higher risk. For bleeding another thing to to monitor look out for with that bleed risk is other medications. So I and I played Litz antiquated, and I'll I'll touch on that with drug interactions a little bit there. So Jay upset, you know, you might get some some mild issues there GI bleed bleed risk in general is probably the thing. I see most common with aspirin because of that anti platelet activity. And and really what we're trying to do with the drug in preventing some of those those blood clots are rare things that you might see on like a pharmacology exam. But I can't say you see him too often in clinical practice so ringing in the years tonight is can happen with the overuse of aspirin or high dose aspirin, again, not incredibly common. But, you know, something to think about if you've got a patient presenting with ringing in the ears. Tonight is definitely asked them about over the counter us because there is a small segment of patients out there that will take some aspirin on their own for and pains or as nati- inflammatory, and then rise syndrome is associated with aspirin. That's always kind of a classic test question. So generally aspirins going to be avoided in pediatrics due to that risk. So let's take a quick break. From our sponsor men at one one dot com has a growing list of resources, nap, lex BCP SBC GP ambulatory care as well as good books that are clinically oriented great for nurse practitioners, PA's med, students physicians. Just good information clinical real world information in education that you can stop by. And check out. They're so mad at one one dot com. Slash store finishing up on drug interactions here. When I think of you know, particularly low dose aspirin. I'm looking at drugs that are going to have additive of facts or put ten she ate that risk of bleeding or thinning the blood. So other anti platelet medications. So something like cl- integral Presa grow which is typically used with aspirin post 'em. I for example. But you've got to remember that when we start using multiple agents that do similar things you can have that additive effect and bleed Rhys does go up so very important to remember that as we add more those anti platelet agents. Same thing with anti-coagulants. There's lots of geriatric patients with atrial fibrillation who are on a pixel ban or friend river rock Sebastian. And they may also be on baby aspirin, or you know, maybe higher does aspirin as well. And you've got to remember that that risk as we add those anticoagulant medications of bleed Kengo up as well. End saids notorious for causing GI bleed, I generally cautioned my patients on that. If they're taking aspirin on a dose of aspirin. If you use an end said in over the counter medication like pro or naproxen, you've got to remember that this is going to increase that risk for things like GI bleed. So I think that wraps up the podcast for today. Hopefully, you picked up a few pearls. It reminded yourself of a few clinical pearls with

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