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Australian Journal of Pharmacy : March 2005
pharmacy ed counselling casebook Table One: Some properties of the thrombolytic agents (4–7,14–15) Aspirin Mode of action (See Figure One) Inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thomboxane A2 Clopidogrel Inhibits binding of ADP to its platelet receptor, and the subsequent ADP-mediated activation of the glycoprotein (an inducer of platelet aggregation) IIb/IIIa complex, hence for the life of the platelet Indications Acute MI, unstable angina, primary prevention of stroke, secondary prevention of stroke and TIA, secondary prevention of ischaemic heart disease, after coronary by-pass grafting, prevention of venous thromboembolism in hip fracture surgery and in non-rheumatic atrial fibrillation in low risk patients Dose forms and trade names Astrix tablets, capsules 100mg, Cartia tablets 100mg Asasantin SR (aspirin 25mg + dipyradamole200mg) sustained- release capsules Contraindications Precautions Active peptic ulcer, allergy to NSAIDs, bleeding disorders, aspirin-sensitive asthma Asthma, peptic ulcer, surgery, concomitant anticoagulants, pregnancy (C), lactation Adverse reactions Headache, dizziness, gastric upset, bleeding, hypotension, thrombocytopenia Drug interactions Antiplatelet agents (clopidogrel, ticlopidine) ( bleeding Active internal bleeding Patients at risk of bleeding, hepatic and severe renal impairment, acute ischemic stroke, children <18 Iscover 75mg tablets, Plavix 75mg tablets Ticlid 250mg tablets, Ticlopidine Hexal 250mg 100 and 200 tablets/capsules tablets, Tilodene 250mg tablets Persantin and Persantin SR Asasantin SR (aspirin 25mg + dipyradamol 200mg) sustained-release capsules Bleeding disorders, local None when used alone, haemorrhagic lesions, blood when used in combination dyscrasias Monitor blood counts, aspirin, as for aspirin Severe coronary artery liver function, cholesterol, disease, subvalvular aortic surgery, patients at risk of bleeding stenosis, haemodynamic instability Bleeding, myelotoxicity, thrombotic Neutropenia, thrombo- thrombocytopaenia purpura, diarrhoea, chest pain, rash CYP2C9 metabolised drugs, Gastric upset, headache, cytopenia, myelosuppression, dizziness, myalgias, raised serum cholesterol, hypotension, hot flushes, TGs, LFTs, gastric upset bleeding, rash (phenytoin, tamoxifen, fluvastatin) cimetidine,theophylline, other thrombolytics, NSAIDs. Some statins may inhibit the conversion of clopidogrel to its active metabolite carbamazepine Doses 75–150mg daily Asasantin SR capsules, 1 bd 75mg daily Placement of coronary stent, with aspirin, 250/100–150mg daily 250mg bd Other thrombolytics, NSAIDs, Theophylline, caffeine, antihypertensives, cholinesterase inhibitors, pharmacological stress tests (stop 24 hours prior) Prophylaxis of thrombo- embolism: 300–600mg in three or four divided doses, Secondary prevention of stroke or TIA, 200mg SR bd, Asasantin SR, 1 capsule bd Practice points No evidence that enteric coated formulations decrease risk of GI bleeding Cease before surgery APF Extra-Warning 13, A, B Label (s) 10a 10b 13 A B 10a 10b, A, B Do not take more than one aspirin tablet or capsule each day while being treated with this medicine Do not take aspirin while being treated with this medication unless advised by your doctor Do not remove from this original packaging until dose is required add the word ‘whole’ add the words ‘with or soon after food’ ADP = adenosine diphosphate 206 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 — Cease 7 days before planned surgery Risk of neutropenia, advise blood test Used as a pharmacological stress for cardiac stress testing (10–20mg slow IV) tachycardia, worsening of of coronary artery disease inhibiting platelet aggregation Ticlopidine Interferes with platelet with platelet membrane function by inhibiting ADP-induced platelet- fibrinogen binding and subsequent platelet- platelet interactions Prevention of vascular ischaemic Secondary prevention of Prevention of thrombo- events in patients with symptomatic ischaemicstroke and TIA embolism in patients with atherosclerosis (recent ischaemic in patients intolerant of or prosthetic valves (with stroke, recent myocardial infarction unresponsive toaspirin, or peripheral arterial disease with prevention of thrombo warfarin, secondary prevention of ischaemic stroke intermittent claudication), acute -embolism after placement and TIA (with aspirin) coronary syndrome without ST- of stent (with aspirin) segment elevation (with aspirin) Dipyridamole Inhibits platelet function by inhibiting phosphodiesterase thus increasing platelet cAMP