Blood Drugs Flashcards
Anticoagulant drugs
1-Heparin 2-Warfarin 3- alternative heparin -apixaban -dibagatran -rivaroxaban -argatroban 4-low molecular weight heparin Enoxaparin Fundaparin Dalteparin
Heparin
Mechanism
Stimulates antithrombin Ill which inhibits thrombin and factor Xa.(So,
Heparin
Indication
1-Acute anticoagulation. E.g., Ml and Stroke. D V T
2-Chronic anticoagulation in pregnancy (can’t cross placenta).
Heparin
Main side effects
- Anticoagulant: Bleeding tendency.
- Anticollagen: Osteoporosis.
- Heparin-Induced thrombocytopenia (HIT):
Heparin-Induced thrombocytopenia (HIT) Cause Clinical picture Complication What we should do if have been Toxicity
- Cause: IgG against heparin bound to PF4
- C/P: Acute decrease in platelet count on heparin administration.(thrombocytopenia)
- Complication: Thrombosis (due to lysis of platelet allowing Ca** release activating thrombosis process).
- TTT: Stop heparin and start heparin alternatives.
Heparin Antidote is
Protamine SO4
بروتاميين سالفيت
 what test should follow the heparin and why?
PTT (Partial Thrombo time)
In case that we should check the platlet
Low Molecular Weight Heparins drugs is
Enoxaparin. -Dalteparin. - Foundaparinux.
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Low Molecular Weight Heparins Mechanism is
Act more on factor Xa. Also bind and activate antithrombin III like heparin.
Low Molecular Weight Heparins Advantages is
Advantages:
- Longer duration of action, so less frequently administered.
- Highly safe SC administration, so no need to monitor PTT.
Low Molecular Weight Heparins
Disadvantages: If toxicity occurs
What will happen
there’s no antidote (not easily reversed).
Heparin Alternatives drugs is
1-Hirudin Argatroban, dabigatran and bivalirudin. 2-Non-hirudin Apixaban and rivaroxaban.
Note\ Hirudin derivatives inhibit thrombin,
while
non-hirudins inhibit factor Xa.
Heparin Alternatives Mechanismis
Direct factor Xa inhibition or thrombin inhibition.by binding to thrombin active site
Heparin Alternatives Indication
Heparin Alternative in case of HIT (Thromboembolism & atrial fibrillation) DVT
Heparin Alternatives Disadvantages:
If toxicity occurs, there’s no antidote (not easily reversed).
‘Warfarin”Mechanism:
Mechanism:
- Decrease carboxylation step required for hepatic synthesis of factors II, VII, IX, X (1972)and proteins C and S by competing with vitamin K.
‘Warfarin indication
- Chronic anticoagulation. E.g., DVT, Ml and stroke.
- Its action appears after 3 days during which heparin is given (heparin umbrella).
Side-effect of warfarin
‘
• Main S/Es:
- Bleeding tendency due to its anticoagulant effect.
- Skin and Tissue necrosis due to initial hypercoagulability, as proteins C and S are destroyed faster than coag-
ulation factors (11, VI, IX, and X). Prevented by heparin umbrella.
- Teratogenicity, as warfarin can cross the placenta.
How we treat toxicity of warfarin
Fresh frozen plasma. Better than cryoprecipitate. -
Vitamin K (antidote).
What can cause toxicity of a warfarin
1- overdose
2-Rodentsides contain a land of wartarn (proditacoum) = accdental ingesbon can lead (O wanann toyo
3-drug interaction
Some drugs ex. sulfonamide antibiotics can displace warfarin from plasma pt precipitating toxicity
Thrombolytics drugs
- Alteplase (tPA). - Reteplase (rPA).
- Tenecteplase.
- Streptokinase.
Thrombolytics indication
Uses;
- Early MI within 6-8 hours.
- Early Stroke within 2-4 hours.
Thrombolytics side-effect
- Active bleeding.
- Severe HTN.
- History of Intracranial hemorrhage or recent surgery.
If toxicity happened why thrombolytic what is your response
Fresh frozen plasma with cryoprecipitate.
- Amino caproic acid (antidote).
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