(Write Research Objective)

Questionnaire

Name: Specialty:

Address:

Contact no. : Adjacent pharmacy:

1. What is the average no. of AMI patients admitted to you in a month?

a. 1-5 b. 6-10 c. 11-15 d. 16-20 e. More than 20

2. What is the treatment given to STEMI patient in your hospital/clinic?

a) Thrombolysis (% of patient) ………………

b) P.C.I. (% of patient) ………………
c) Referred to other hospital ………………
d) Other (please specify)………………………………………………………..

3. Reason for referring the patient to other clinic/hospital?

……………………………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………………………
……………

4. If thrombolysis done, which drug do you prefer in your clinical practice?

a) Streptokinase c) Urokinase
b) Reteplase d) Tenecteplase

5. If undergoing the Primary PCI, please give reason?

…………………………………………………………………………………………………………………………………...

6. According to you, what are the properties of an ideal thrombolytic agent?

…………………………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………

7. Please rank the following properties of an ideal thrombolytic agent?

Long half life Rapid action

Single bolus administration Reduction in 30 day mortality

High fibrin specificity No effect on BP

Resistance to pai-1 No antigenicity

 Compatible with other iv agents No re-occlusion

8. Are you aware of 3rd generation thrombolytic agent, Tenecteplase?

a. Yes b. No.

9. If yes, which brand you prefer as 3rd generation thrombolytic agent?

. …………………………………………………………………………………………………………………………………….

10. Are you aware of Pharmacoinvasive management of STEMI patient?

a) Yes b) No

11. If yes, what is the source of information for the same?

a) Company representative b) Conference /CME

c) Medical publication.
d) Others (Please specify) …………………………………………………………………………………………………..

12. In Indian scenario, how far do you agree with the pharmacoinvasive approach for thrombolysing
the STEMI patient prior to P.C.I.?

a) Strongly agree
b) Agree
c) Disagree
d) Strongly Disagree

13. Which thrombolytic drug you prefer in your clinical practice & reason for selected drug?
…………………………………………………………………………………………………………………………………

14. In Pharmacoinvasive approach, what is the ideal time for doing P.C.I. after thrombolysis?

a) 3-6 hrs. b) 6-9 hrs c) 9-12 hrs. d) More than 12 hrs.

15. How do you manage the patient during off time (6 PM to 8 AM)?

a) Call for the doctor for PCI

b) Thrombolysing the patient
c) Referring the patient to other hospital
d) Others please specify……………………………………………………..
16. Where do you rate the drug Tenecteplase overall?

+1 +2 +3 +4 +5 +6 +7

17. According to you, what should be the cost of Tenecteplase in India?

a. Tenecteplase 30mg: …………………..
b. Tenecteplase 40mg: …………………..
c. Tenecteplase 50mg: …………………..

THANK YOU