It inhibits the enzyme adenosine deaminase which normally breaks down adenosine. This inhibition leads to increased levels of adenosine. Adenosine activates the enzyme adenylate cyclase which leads to increased cyclic AMP (cAMP) synthesis.
Dipyridamole also inhibits the enzyme phosphodiesterase which normally breaks down cAMP.

Both of these mechanisms lead to increased levels of cAMP within platelets. cAMP impairs platelet aggregation.

Modified release dipyridamole is used in conjunction with aspirin (Aggrenox®) in the secondary prevention of stroke and transient ischemic attack.

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DRUG CHALLENGE
From Nursing, 10/1/04 by Gever, Marcy Portnoff

You routinely administer combination drugs. . . but do you know what's in them? To find out, match each combination of ingredients in Section II with its correct name in Section I.

SECTION I

_____1. Nucofed (Monarch Pharmaceuticals)

_____2. Combivir (GlaxoSmithKline)

_____3. Aggrenox (Boehringer Ingelheim)

_____4. Metaglip (Bristol-Myers Squibb)

_____5. Lessina (Barr)

SECTION II

a. lamivudine, 150 mg; zidovudine, 300 mg

Prescribed to treat HIV infection, this combination contains the synthetic nucleoside analogues lamivudine and zidovudine. Taking it can cause the patient to develop neutropenia and severe anemia, so stress the importance of regular blood counts.

b. glipizide, 2.5 mg, 5 mg; metformin, 250 mg, 500 mg

Someone with type 2 diabetes may take this combination to improve glycemic control. Glipizide stimulates insulin release from the pancreas; metformin improves glucose tolerance. Tell your patient to report light-headedness, dizziness, shakiness, weakness, muscle pain, trouble breathing, increasing drowsiness, or abdominal distress.

c. aspirin, 25 mg; extended-release dipyridamole, 200 mg

Prescribed to reduce the risk of stroke, this combination contains aspirin and dipyridamole, both of which reduce platelet aggregation. Advise your patient to take the capsules with food to prevent gastrointestinal upset.

d. levonorgestrel, 0.1 mg; ethinyl estradiol, 0.02 mg

The pink tablets in the 28-pill pack of this oral contraceptive contain the progestin levonorgestrel and ethinyl estradiol and can be used as a "morning after pill." (The white tablets are placebos.) The woman should take five pink tablets within 120 hours after unprotected sex and five more 12 hours later. Taking the antiemetic meclizine, 50 mg 1 hour before each dose, can help minimize nausea and vomiting, but the patient may become very drowsy.

e. codeine phosphate, 20 mg; pseudoephedrine HCl, 60 mg

The opioid antitussive codeine and the decongestant pseudoephedrine in these capsules help relieve coughing and congestion due to an upper respiratory infection. Warn your patient that the drug can cause dizziness, drowsiness, and constipation and not to take more than one capsule every 6 hours.

ANSWERS: 1e, 2a, 3c, 4b, 5d.

BY MARCY PORTNOFF GEVER, PHARMD, MED

Marcy Portnoff Gever is an independent pharmacist consultant and educator in Ringoes, NJ.

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