Ticagrelor

Question 1

Ticagrelor - Drug class

Answer 1

Antiplatelet

Question 2

Ticagrelor - Pharmacology

Answer 2

Ticagrelor is a reversibly binding, direct acting adenosine diphosphate (ADP) receptor antagonist that inhibits platelet activation and aggregation.

Question 3

Ticagrelor - Metabolism

Answer 3

Hepatic

Question 4

Ticagrelor - Indications

Answer 4

Patients with STEMI (as defined by the relevant QAS coronary artery repercussion checklist) who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) AND the receiving interventional cardiologist is requesting ticagrelor administration.

Question 5

Ticagrelor - Contraindications

Answer 5

• KSAR or hypersensitivity to ticagrelor
• Patient currently taking ticagrelor OR clopidogrel
• Patient < 18yo
• Active bleeding (excluding menses)
• Prior intercranial haemorrhage
• History of hepatic impairment

Question 6

Ticagrelor - Precautions

Answer 6

• Concomitant medication known to induce bradycardia (e.g. B blocker, calcium channel blocker, digoxin).
• Symptomatic bradycardia (HR <60)

Question 7

Ticagrelor - Side Effects

Answer 7

• Haemorrhage

- Bradycardia

Question 8

Ticagrelor - Presentation

Answer 8

Tablet (yellow) 90mg ticagrelor

Question 9

Ticagrelor - Onset, duration, half life

Answer 9

Onset - 30 minutes
Duration - 7 days (anti platelet)
Half-life - 7 hours

Question 10

Ticagrelor - Schedule

Answer 10

S4 restricted drugs

Question 11

Ticagrelor - Routes of administration

Answer 11

PO

Question 12

Ticagrelor - Adult dose

Answer 12

< 18yo - 180mg. Swallowed with a small sip of water.

Question 13

Ticagrelor - Special notes

Answer 13

15-48% of patients have a poor platelet inhibition response to clopidogrel. Therefore the interventional cardiologist may request the administration of ticagrelor in preference to clopidogrel for selected patients.