Acute Coronary syndrome

Question 1

Ticagrelor

Indications

Answer 1

• Prevention of atherothrombotic events in patients with ACS (in combo with aspirin)
• Prevention of atherothombotic events in patients with a history of MI and high risk of atherothrombotic events (in combo with aspirin)
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Question 2

Ticagrelor

MOA

Answer 2

• Direct acting, a selective antagonist of P2Y12 receptors that prevent ADP-mediated P2Y12 dependent platelet activation and aggregation
• Ticagrelor does not prevent ADP binding, but it prevents ADP-induced signal transduction when bound to P2Y12 receptors.
• Since platelets participate in the initiation and/or evolution of thrombotic complications, inhibition of platelet function has been shown to reduce the risk of CV events

Question 3

Ticagrelor

Warnings

Answer 3

• Contra-indicated in
  
  • Active bleeding
  • History of intracranial haemorrhage
• Cautioned in
  
  • Asthma
  • Bradycardia- increase in ventricular pauses
  • COPD- Dyspnoea
  • Pts high risk of bleeding- e.g. surgery/trauma
  • AV block
  • Hyperuricaemia-

Question 4

Ticagrelor

Adverse events

Answer 4

• NB- had higher incidents of adverse events/dicontinuation than clopidogrel
• Bleeding disorders
• Hyperuricaemia
• Dysponea
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Question 5

Ticagrelor

Interactions

Answer 5

• CYP inhibitors- very dependent on CYP metabolism
• CYP inducers
• Cyclosporin- increases exposure of ticagrelor
• Other anticoagulant drugs
• Digoxin- Increased dig exposure
• NSAIDs