Stroke

Question 1

ADP receptor antagonists; name them

Answer 1

ticagrelor, clopidogrel, prasugrel

Question 2

indications of ADP receptor antagonists

Answer 2

1. treat ACS
2. prevent occlusion of coronary artery stents
3. 2* prevention of thrombotic events in those with CVS, cerebrovascular and PAD

Question 3

MOA of ADP receptor antagonists

Answer 3

• prevent platelet aggregation and reduce risk of arterial occlusion by binding irreversibly to ADP receptors of plts. It is dependant on COX pathway so works well with aspirin

Question 4

SE of ADP receptor antagonits

Answer 4

bleeding
GI upset including dyspepsia, abdo pain and diarrhoea.

thrombocytopenia

Question 5

who should you not prescribe ADP receptor antagonists to?

Answer 5

• active bleeders

- stop 7 days before elective surgery

Question 6

who should you use ADP receptor antagonists cautiously in

Answer 6

renal and hepatic impairment especially in those who have increased risk of bleeding

Question 7

Clopidogrel = pro drug. reduced efficacy by what drugs

Answer 7

cyp 450 inhibitors;

- Omeprazole, ciprofloxacin, erythromycin, some SSRI and antifungals.

Question 8

what PPI do you not give with clopidogrel

Answer 8

omeprazole

Question 9

is prasugrel a pro drug

Answer 9

yes

Question 10

is ticagrelor a pro drug, and what are its interactions

Answer 10

• no

- cyp 450 inhibitors and inducers.

Question 11

what should you not prescribe ADPR receptor antagonists with

Answer 11

• other anticoagulants e.g. heparin or NSAIDs or antiplatelets

Question 12

how long do you carry on dual antipaltelet therapy for in drug eluting stents

Answer 12

12months

Question 13

Aspirin MOA

Answer 13

Antiplatelet drug

• irreversible inhibition of COX to reduce plt aggregation and risk of arterial occlusion . Antiplt effect of aspirin = low doses and lasts lifetime of plt.

Question 14

Aspirin indications

Answer 14

1. ACS and acute ischaemic stroke
2. LTM secondary prevention of thrombotic arterial events in patients with CVS, Cerebrovascular and PAD
3. less used now but - mild to moderate pain and fever

Question 15

SE of aspirin

Answer 15

GI irritation;
peptic ulcer;
GI bleed
hypersensitivity reactions - bronchospas,

high dose and regular? tinnitus

Question 16

OD aspirin effects

Answer 16

• hyperventilation
  hearing changes
  metbaolic acidosis and confusion, cv collapsse and rep arrest

Question 17

who should you not give aspirin to

Answer 17

under 16s due to reyes

those with hypersensitivity

Question 18

who should you avoid aspirin in

Answer 18

3rd trimester pregnancy - PG inhibition = premature close of ductus arteriosus.

aspirin caution in peptic ulcer disease or gout

Question 19

when is aspirin best taken

Answer 19

after a meal

Question 20

name the fibronyltic drugs

Answer 20

alteplase

streptokinase

Question 21

alteplase and streptokinase indications

Answer 21

• stroke - ischaemic as thrombolysis
• in STEMI - but PCI is used now
• Massive PE and heamodynamic instability

Question 22

MOA of alteplase and streptokinase

Answer 22

Catalyse conversion of plasminogen to plasmin = dissolve fibrin clots and recanalises occluded vessels

Question 23

SE of alteplase and streptokinase

Answer 23

• n and v
• bruising at injection site
• hypotension

SE which need treating

• serious bleed
• allergy
• cardiogenic shock
• cardiac arrest

Question 24

contraindications to thrombolysis

Answer 24

• bleeding in any form
• severe hypetension
• peptic ulcer
• if stroke is haemorrhagic

previous streptokinase rx = CI to repeat dosing as can get antibodies

Question 25

which drugs should u not combine streptokinase and alteplase with and why

Answer 25

• anticoagulants
• antiplt
  both = increased bleeding risk

ACE-i - increase risk of anaphylaxis

Question 26

in what way can you administer alteplase and streptokinase

Answer 26

• injectable prep

give bolus then IV infuse