Acute Chest Pain therapeutics

Question 1

What drug type would you use ,mainly for MI’s?

Answer 1

Heparin for a non STEMI and STEMI

Thrombolytics for a STEMI

Question 2

How do thrombolytics work and what is an example of them?

Answer 2

They work by converting serum plasminogen to plasmin which breaks down fibrin.

e.g. streptokinase, alteplase and tenecteplase

Question 3

What is the risk of thrombolytics?

Answer 3

Can cause bleeding locally and potentially cerebrally.

Question 4

What do LMWH’s do?

Answer 4

They inhibit factor Xa (stops prothrombin to thrombin formation. Anti coagulant, so can cause bleeding.

e.g. enoxaparin

Question 5

What is aspirin?

NB another type is clopidogrel

Answer 5

An anti platelet agent that inhibits platelet aggregation.
Inhibits COX1 (acetylates) and thus thromboxane production inhibited.
Also anti-inflammatory.

Question 6

What are aspirin side effects?

Answer 6

GI symptoms so upper GI ulceration (inhibits prostaglandin synthesis.

Question 7

How does clopidogrel work?

Answer 7

Anti platelet activity, by inhibiting P2Y12 (some platelet receptor who cares)
Can cause GI symptoms such as bleeding and ulceration.

Question 8

What is ticagrelor?

Answer 8

Anti platelet agent also, more modern.

Question 9

Why must you be careful admisitering these kinda drugs?

Answer 9

LMWH’s are anti-coagulants
Anti platelet aggregators
fibrinolysis

=BLEEDING susceptibility