Blood Drugs Flashcards
MOA of Heparin
- Accelerates binding of Antithrombin III to Factor Xa and Thrombin (Factor IIa)
- Inhibits Aldosterone secretion
- Increases concentration free Throxine
Antidote for Heparin
Protamine
Uses of Heparin
- DVT
- Pregnancy (DOC)
- PE
- Acute MI
- dialysis tubing
- blood containers
Enoxaparin
- Formed by depolymerizing Heparin
- More anti Factor Xa activity
High Protein binding LMW Heparins
- Dalteparin
- Ardeparin
small synthetic drug with key pentasaccharide (LMW Heparin)
Fondaparinux
Adverse drug reactions of Heparin
- Transient Thrombocytopenia
- Hemorrhagic stroke
- Osteoporosis
- platelet aggregation
- anti platelet antibodies
Contraindications of Heparin:
- Brain surgery, Head trauma, Recent major sugery
- Active PTB
- Bacterial Endocarditis
Direct Thrombin Inhibitors
- Oral
- Ximelgatran
- Dabigatran
- Parenteral
- Hirudin
- Lepirudin
- Bivalirudin
- Argatroban
Recombinant form of the leech protein (hirudin)
MOA: binds to active site of Thrombin and its substrate
Lepirudin
inhibits both soluble and enmeshed thrombin
Bivalirudin
MOA of Warfarin
Inhibits Vitamin K dependent synthesis of Factors 2,7,9 and 10
Adverse reactions from Warfarin (2)
-
Warfarin necrosis
- Painful erythematous patch
- w/in 3-10 days of treatment
-
Purple toe syndrome
- 3-8 wks of treatment
Contraindications of Warfarin
Pregnancy
Antidote to Warfarin overdose
- Vitamin K1 (Phytonadione)
- FFP (Fresh Frozen Plasma)
Drugs that increase Warfarin’s anticoagulation response
- Acetylsalicylic acid
- Cimetidine
- Clofibrate
- Disulfiram
- Metronidazole
- Trimethoprim-Sulfamethoxazole
- Phenylbutazone
Drugs that decrease Warfarin’s anticoagulation response
- Barbiturates
- Glutethimide
- Cholestyramine
- Phenobarbital
- Rifampin
MOA of Antiplatelet Drugs (4)
- (-) Cyclooxygenase
- Aspirin
- Ibuprofen
- (-) Phosphodiesterase
- Dipyridamloe
- Pentoxifylline
- Cilostazole
- (-) Adenosine 5’ diphosphate binding
- Clopidogrel
- Ticlopidine
- (-) Glycoprotein IIB/IIIA receptor
- Abciximab
- Eptifibatide
- Tirofiban
Decreases levels of fibrinogen
Improves RBC flexibility
Used for Intermittent Claudication
Pentoxifylline
Increases cellular uptake of adenosine and uptake of cAMP
Dipyridamole
Thrombolytic/Fibrinolytic Drugs
- 1st Generation
- Streptokinase
- Urokinase
- 2nd Generation
- Alteplase
- Anistreplase
- 3rd Generation
- Reteplase
- Tenecteplase
MOA of Streptokinase
binds to Plasminogen and forms activator proteins that will convert Plasminogen to plasmin
MOA of Urokinase
Activates Plasminogen directly
MOA of Alteplase
converts trapped plasminogen (tPA) to plasmin
less effect on circulating plasminogen
Alteplase is the DOC for patients who?
- previously received streptokinase
- are given APSAC
- have been treated for Streptococcal infection w/in the previous year
Anistreplase
- Anisoylated plasminogen streptokinase activator complex (APSAC)
- Active complex of strpetokinase and plasminogen
- work equally on systemic plasminogen activator
- blocked by anisoyl group
Recombinant drug that catalyzes the conversion of Plasminogen to plasmin
Tenecteplase
Oral Iron Drugs
- Ferrous Sulfate
- Ferrous Fumarate
- Ferrous Cholne citrate
- Ferrous Gluconate
Ferrous sulfate
- DOC: IDA
- 20% elemental iron
Ferrous fumarate
- 30% elemental Iron
Contains 12% elemental Iron (Oral Iron)
- Ferrous choline citrate
- Ferrous gluconate
Adverse Drug reactions of oral Iron
- Hemochromatosis
- N/D/C Heartburn
type of Iron given to patients who cannot tolerate oral iron and for patients with malabsorption syndromes
Parenteral Iron
Ferric Hydroxide + LMW Dextran
Iron Dextran
Deferoxamine
Antidote for Iron toxicity (Hemochromatosis)
2 forms of Vitamin B12
- Cyanocobalamin
- Hydroxocobalamin
useful in treating anemic patients with AIDS
Erythropoietin
165-amino acid glycoprotein
Erythropoietin
synthethic erythropoietins
- Epoetin alpha
- Darbopoetin alpha
Myeloid Growth factors
- Filgrastim (G-CSF)
- Sargramostim (GM-CSF)
Adverse reactions from Filgrastim
- Bone pain
- Splenomegaly
Adverse drug reaction from Sargramostim
- Fever
- Arthalgia
- edema
- capillary damage
- fluid accumulation
- pleural and pericardial effusions
Treatment for patients with aplastic anemia
Sargramostim
Oprelvekin
- IL-11
- Stimulate growth of primitive megakaryocyte progenitors
- increase number of peripheral platelets
Causes of inadequate blood clotting:
- Vitamin K deficiency
- Errors of Clotting factor synthesis
- Thrombocytopenia
symptoms of rapid phytonadione infusion
dyspnea, chest and back pains, death
agents used to treat heamophillia
- Fresh plasma
- Purified human blood clotting factors (FVIII and FIX)
Sclerosing drugs/agents:
- Ethanolamine oleate
- Hypertonic saline
- Morrhuate sodium
MOA of sclerosing agents
Traumatize endothelial lining of distended veins and cause thrombosis within the vessel
treatment used for varicose veins and esophageal varices
Morrhuate sodium
Octreotide
Anti hemorrhagic drug
MOA: suppression of vasoactive GI hormones; vasocontriction within splenic circulation
(control bleeding: esophageal varices, acromegaly, GI endocrine tumors)
[Bradycardia, Abdominal cramps, Diarrhea, Flushing]
CI: Arrhythmia, Hypoglycemia Pancreatitis
Amino caproic acid (EACA)
Fibrinolytic Inhibitors
MOA: competitive inhibition of plasminogen activation (chemichally similar to lysine)
(Adjunct to hemophilla, therapy for bleeding from fibrinolytic therapy, rebleeding from intracranial aneurysms)
[Intravascular thrombosis, hypotension, myopathy, abdominal discomfort, diarrhea, nasal stuffiness]
CI: GU bleeding, DIC
Analog of EACA
Tranexamic Acid
Aprotinin
Serine protease inhibitor
direct plasmin inhibitor
increase risk: Renal failure, Heart attack, stroke
