General
High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.
Pronunciation
ep-ti-FIB-a-tide
Trade Name(s)
Integrilin
Pregnancy CategoryCategory BTher. class.antiplatelet agentsPharm. class.glycoprotein iib iiia inhibitors
Indications
Acute coronary syndrome (unstable angina/nonQ-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 Effect(s):
Inhibition of platelet aggregation resulting in decreased incidence of new MI, death, or refractory ischemia, reducing the need for repeat urgent cardiac intervention
Pharmacokinetics
Absorption: IV administration results in complete bioavailability
Distribution: Unknown
Metabolism and Excretion: 50% excreted by the kidneys
Half-life: 2.5 hr
TIME/ACTION PROFILE (effects on platelet function)
| ROUTE | ONSET | PEAK | DURATION |
| IV | immediate | following bolus | brief |
Inhibition is reversible following cessation of infusion
Contraindication/Precautions
Contraindicated in:
Hypersensitivity
Active internal bleeding or history of bleeding within previous 30 days
Severe uncontrolled hypertension (systolic BP >200 mmHg and/or diastolic BP >110 mmHg)
Major surgical procedure within 6 wk
History of hemorrhagic stroke or other stroke within 30 days
Concurrent use of other glycoprotein IIb/IIIa receptor antagonists
Platelet count <100,000/mm³
Severe renal insufficiency (serum creatinine >=4 mg/dl) or dependency on renal dialysis
Use Cautiously in: Geri:
risk of bleeding
Renal insufficiency (
infusion rate if CCr < 50 ml/min)
OB: Pregnancy, lactation, or children (safety not established; use in pregnancy only if clearly needed)
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).
*CAPITALS indicates life-threatening.
*italic indicates most frequent.
Interactions
Drug-Drug
risk of bleeding with other drugs that affect hemostasis (heparins, warfarin, NSAIDs, thrombolytic agents, abciximab, dipyridamole, ticlopidine, clopidogrel, some cephalosporins, valproates)
Drug-Natural Products
bleeding risk with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, and Panax ginseng
Route/Dosage
Acute Coronary Syndrome
IV (Adults <=121 kg): 180 mcg/kg as a bolus dose, followed by 2 mcg/kg/min until hospital discharge or surgical intervention (up to 72 hr).
Percutaneous Coronary Intervention IV (Adults): 180 mcg/kg as a bolus dose, immediately before PCI, followed by 2 mcg/kg/min infusion; a second bolus of 180 mcg/kg is given 10 min after first bolus; infusion should continue for 1824 or hospital discharge (minimum of 12 hr).
Renal Impairment (Adults CCr <50 mL/min): 180 mcg/kg bolus followed by 1 mcg/kg/min infusion; second bolus of 180 mcg/kg is given 10 min after first bolus for patients undergoing PCI.
Availability
Solution for injection: 20 mg/10 ml, 75 mg/100 ml, 200 mg/100 ml
Assessment
Assess for bleeding. Most common sites are arterial access site for cardiac catheterization or GI or GU tract. Arterial and venous punctures, IM injections, and use of urinary catheters, nasotracheal intubation, and NG tubes should be minimized. Noncompressible sites for IV access should be avoided. If bleeding cannot be controlled with pressure, discontinue eptifibatide and heparin immediately
Lab Test Considerations Prior to eptifibatide therapy, assess hemoglobin or hematocrit, platelet count, serum creatinine, and PT/aPTT. Activated clotting time (ACT) should also be measured in patients undergoing PCI
» Maintain the aPTT between 50 and 70 sec unless PCI is to be performed. Maintain ACT between 300 and 350 sec during PCI
» Arterial sheath should not be removed unless aPTT <45 sec
» If platelet count decreases to <100,000 and is confirmed, eptifibatide and heparin should be discontinued and condition monitored and treated
Potential Nursing Diagnoses
Ineffective tissue perfusion (Indications)
Implementation
High Alert: Accidental overdose of antiplatelet medications has resulted in patient harm or death from internal hemorrhage or intracranial bleeding. Have second practitioner independently check original order, dose calculations, and infusion pump settings
Most patients receive heparin and aspirin concurrently with eptifibatide
» After PCI, femoral artery sheath may be removed during eptifibatide treatment only after heparin has been discontinued and its effects mostly reversed
» Do not administer solutions that are discolored or contain particulate matter. Discard unused portion
IV Adminstration: Direct IV:
High Alert: Diluent: Withdraw appropriate loading dose from bolus vial (20 mg/10ml vial) into a syringe. Administer undiluted.
Concentration: 2 mg/ml
Rate:
Administer over 12 min
Continuous Infusion:
Diluent: Administer undiluted directly from the 100-ml vial via an infusion pump.
Concentration: 0.75 mg/ml or 2 mg/ml (depends on vial used)
Rate:
Based on patient's weight (see Route/Dosage section)
Y-Site Compatibility:
» alteplase
» amiodarone
» argatroban
» atropine
» bivalirudin
» daptomycin
» dobutamine
» ertapenem
» heparin
» lidocaine
» meperidine
» metoprolol
» micafungin
» midazolam
» morphine
» nitroglycerin
» palonosetron
» potassium chloride
» verapamil
Y-Site Incompatibility:
» furosemide
Solution Compatibility:
» 0.9% NaCl
» D5/0.9% NaCl
Patient/Family Teaching
Inform patient of the purpose of eptifibatide
Instruct patient to notify health care professional immediately if any bleeding is noted
Evaluation/Desired Outcomes
Inhibition of platelet aggregation, resulting in decreased incidence of new MI, death, or refractory ischemia with the need for repeat urgent cardiac intervention
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