Eptifibatide

Eptifibatide (Integrilin(R))

Class:
  • Glycoprotein IIb/IIIa inhibitor
Actions:
  • Reversibly blocks platelet activation by all mechanisms of activation by blocking glycoprotein IIb/IIIa receptor sites on platelets
  • Decreases platelet aggregation
Indications:
  • Acute coronary syndrome (ACS), especially unstable angina or non ST segment elevation MI (NSTEMI)
  • Percutaneous coronary intervention (PCI)
Pharmacokinetics:
  • Onset: Immediate
  • Duration: 6 – 8 hours after termination of infusion
  • Half-Life: 2.5 hours
Adverse Effects:
  • Bleeding (GI, epistaxis, other)
  • Anemia, thrombocytopenia
  • Cerebral hemorrhage
Contraindications:
  • Active internal bleeding (peptic ulcer, GI bleeding, GU bleeding, epistaxis) within past 6 weeks
  • Hypersensitivity to eptifibatide
  • Recent major surgery or trauma
  • Intracranial neoplasm or hemorrhage within 6 months
  • Renal dialysis
  • Severe hypertension (systolic BP > 200 mm Hg or diastolic BP > 110 mm Hg)
  • Concomitant use of another GP IIb/IIIa inhibitor
  • Thrombocytopenia (platelet count < 150,000/mm3)
Dosages & Routes: Intravenous:

 

  • ACS with or without PCI: 180mcg/kg slow IV bolus with infusion of 2 mcg/kg/min (up to 121 kg patient weight and maixmum duration of 72 hours)
  • PCI without ACS:  135 mcg/kg bolus with infusion of 0.5 mcg/kg/min for up to 24 hours post PCI procedure
Nursing Implications:
  • Drug Interactions:  1) increased risk of bleeding with other anti-clotting drugs (NSAIDS, aspirin, heparin, low molecular weight heparins, fibrinolytic agents, warfarin, dipyridamole, ticlopidine, clopidogrel, some cephalosporins, valproates); 2) increased risk of bleeding with arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, and Panax ginseng
  • Drug Incompatibilities:  Furosemide (compatible at Y site with alteplase, amiodarone, argatroban, atropine, bivalirudin, daptomycin, dobutamine, ertapenem, heparin, lidocaine, meperidine, metoprolol, micafungin, midazolam, morphine, nitroglycerin, palonosetron, KCl, and verapamil).
  • Assess patient for signs of bleeding before administering GP IIb/IIIa inhibitor and frequently during therapy.
  • Prior to treatment, lab work should be assessed for Hgb, Hct, platelets, serum creatinine, PT, aPTT, and activated clotting time (ACT).
  • Maintain aPTT between 50 – 70 seconds for ACS.
  • Maintain ACT between 300 – 350 seconds during PCI procedure.
  • If platelet count drops to < 100,000.mm3, eptifibatide and heparin should be discontinued.
  • Eptifibatide can be used concurrently with aspirin and heparin, but risk for bleeding increases.
  • IV bolus should be given undiluted over 1 – 2 minutes.
  • Do not stop or interrupt IV infusion for other IV interventions.

 

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 54). Salem, MA: AHA.

Deglin, J.H., & Vallerand, A.H. (2009). Davis' drug guide for nurses (11th ed., pp. 490-491).  Philadelphia: F.A. Davis.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 610-611).  St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 612-613).  Upper Saddle River, NJ: Pearson Prentice Hall.

 

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