Drugs Used in Cerebrovascular Disorders 1-141010

DRUGS USED IN CEREBROVASCULAR DISORDERS

Dwi Indria Anggraini Medical School Lampung University

CASE

25 year old woman

•R sided numbness and aphasia

•tingling in R face, spreads hand & foot

•after 10 mins–word finding difficulty

•full recovery in 30 mins

•nicotine stained fingers

•bp190/110

•65 year old man

•Found collapsed at home by wife

•Not moving right side very well

•Not speaking

•nicotine stained fingers

•bp190/110

Stroke : Organization of Care

Management of Acute Stroke: Non-specific Treatment

Hypertension

Hypoxia

Hydration / Nutrition

Bladder management

Hyperglycaemia / Pyrexia

Venous thromboembolism

Needs in relation to movement and handling, avoidance of pressure sores

A. Inhibition of clotting cascade in vivo

SPECIFIC THERAPIES

NEUROPROTECTION

ANTICOAGULANTIA

PLATELET INHIBITORS

ANTITHROMBOTIC AGENTS

• Acute thromboembolic disease in selected patients maybe treated by the administration of agents that activate the conversion of plasminogen to plasmin-as serine protease that hydrolyze fibrin and thus dissolves cloth

ANTITHROMBOTIC AGENTS

Activation of plasminogen by fibrinolytic agents

Alteplase (tpA)

Streptokinase

ANTITHROMBOTIC AGENTS

Streptokinase uses as systemic fibrinolytic state that can lead to bleeding

problem

Alteplase acts more locally on the thrombotic fibrin to

produce fibrinolysis

ANTITHROMBOTIC AGENTS

• A comparison of streptokinaseand alteplase.

• Degradation Of an unwanted thrombus And a beneficial hemostatic p lug by plasminogen actlvators.

Mechanismof action of streptokinase