阿摩線上測驗
18.有關abciximab的敘述，下列何者錯誤？
(A)屬於glycoprotein IIb/IIIa受器抑制劑，為一種單株抗體生物製劑
(B)只限用於尚未使用血栓溶解治療，而將進行經皮冠狀動脈介入治療（PCI）的急性冠心症病人
(C)不可以與aspirin、clopidogrel或heparin併用
(D)可能引起免疫性血小板減少症（immune-mediated thrombocytopenia）
統計： A(85), B(633), C(3903), D(400), E(0) #1742747
詳解 (共 8 筆)
將進行PCI的病人，會給予aspirin+一種P2Y12(clopidogrel or prasugrel or ticagrelor)+GPIIb/IIIa antagonist(可用apciximab)
王先生長期使用aspirin 100 mg qd，即將接受心導管手術並放置支架（stent），下列何種術前處方最適合？
(A)aspirin 100 mg stat，clopidogrel 300 mg stat，abciximab IV bolus then IV infusion for 12 hrs，unfractionated heparin
(B)aspirin 100 mg stat,clopidogrel 600 mg stat,unfractionated heparin infusion
(C)aspirin 325 mg stat,abciximab IV bolus then IV infusion for 12 hrs,unfractionated heparin
(D)clopidogrel 600 mg stat，abciximab IV bolus then IV infusion for 12 hrs，enoxaparin
Ans : (A) 106-2 藥治 *支持關掉自動販賣*
(A)選項補充
32.下列何種藥品不屬於glycoprotein IIb/IIIa抑制劑？
(A)Abciximab
(B)Adalimumab
(C)Eptifibatide
(D)Tirofiban
Intravenous agents — Glycoprotein (GP) IIb/IIIa inhibitors and cangrelor are intravenous antiplatelet agents that are not routinely used in patients with STEMI.
Glycoprotein IIb/IIIa inhibitors — For patients undergoing primary PCI and who receive early antiplatelet therapy with aspirin and a P2Y12 inhibitor, we do not routinely give an intravenous GP IIb/IIIa inhibitor [20,21]. However, we consider administering one in patients who either have not received pretreatment with a P2Y12 receptor blocker or for whom the duration between P2Y12 inhibitor administration and PCI is short (<30 to 45 minutes). Other patients undergoing primary PCI who might benefit from a GP IIb/IIIa inhibitor include those who are found to have no or slow reflow, large thrombus burden, or intraprocedural bailout for distal embolization, coronary artery dissection, or hemodynamic instability.
Trials that compared GP IIb/IIIa inhibitors with placebo and that found evidence of benefit were performed before the routine use of potent P2Y12 inhibitors (eg, ticagrelor and prasugrel). There is some evidence supporting the use of abciximab in patients who are not pretreated with a P2Y12 inhibitor [7]. Evidence of benefit from either tirofiban or eptifibatide in this setting is less convincing.
●Patients who have received aspirin and a potent P2Y12 inhibitor and who have evidence of ongoing ischemia (eg, persistent chest pain and electrocardiographic evidence of ischemia).
●Patients who have high-risk features during angiography such as large thrombus burden or intraprocedural thrombotic complication, particularly if they have not received prasugrel or ticagrelor.
●In patients for whom CABG is likely to be required urgently after coronary angiography, acute administration of a GP IIb/IIIa inhibitor may be substituted for a P2Y12 inhibitor to stabilize patients until operative indications have been defined.
GP IIb/IIIa inhibitors are not started until after diagnostic coronary angiography in most cases, based on the ACUITY Timing and EARLY ACS trials, which found no benefit from early initiation and an increased risk of bleeding with preangiography use [24,25].