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Blood

Blood

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Published by sarguss14

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Published by: sarguss14 on Jan 09, 2009
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SUBJECT :TOPIC :DATE :
PHARMACOLOGY 
Blood
20 February 2008
BY : PAGE :
 Yna and Kring1 of 4
4th Shifting C.N. __ 
I. Drugs on Blood and HematopoieticOrgans
Hematinic
1. Fe
2+
oral
a.
Fe fumarate
– 100 mg is absorbedb.
Fe sulfate
c.
Fe gluconate
60-65 mg isabsorbed-taken daily-induration: minimum of 3 months andmaximum of 6 months-disadvantage: only 1/3 is absorbed(elemental iron content)-prescription drugs-
overdose toxicity and antidotes
:a. Deferoxamine – 500/2000 mg/vial- chelates Feb. Deferasirox – 125/250/500 mg tabNotes…
Iron –Deficiency Anemia – “Hypochromicmicrocytic anemia”
- pallor, weakness-confirmed by: CBC (RBC <4.5 M andHeoglobin <12 g)-double reduction of the iron can lead tosevere IDA-treatment: 3-6 mos.
If you lack 1-2 g hemoglobin = 3 mos.tx
If too low hemoglobin = 5-6 mos tx-
if taken IV 
: in gluteus muscle: which causes pain and muscledystrophy: due to daily administration, canlead to brown and blackdiscoloration of gluteus-
effects of food on the absorption of these drugs
:
a. High protein diet (meat)
-
 
enhance the iron absorption in smallintestines- vegetarians (who eat phosphate-containing veggies) can’t absorbiron
b. Antacids
- Magnesium aluminum hydroxide inhibitsiron absorption (chelation)
c. Antibiotic
- eg. Tetracycline inhibits iron absorption(chelation)
d. Vitamin C/ Ascorbic acid 
-potentiates
2. Fe parenterala. Imferon/ Fe Dextran
- technique of injxn: “Z” track IM / IVafter ANST (a negative skin test)- IV can produce allergy- disadvantage: painful if IM
b. Fe sucrose/ Fe-Na gluconatecomplex IV
- alternative for imferon/Fe dextran-sensitive patients- by IV only- there may be allergy, but less- Adverse effects:i. chronic iron overloadii. hemorrhagic gastroenteritisiii. melena (due to excess of injectibleiron)- Antidote: phlebotomy (popliteal/femoralveins)Notes…
 Transferrin – free iron
Myoglobin – iron in the muscles
Ferritin – stored iron
Hemosiderosis increased iron inreticuloendothelial cells
Hemochromatosis increased ironin pancreas, liver
 
BY : PAGE :
 Yna and Kring2 of 4
Medicine I- Hemiplegia Yna and Kring
3.
Others
Cu
– supplements
Co
as Vitamin B
12
; combined withfolic acid to treat megaloblasticanemia
Blood Products
1. Whole Blood – best; if px did notrespond to oral/parenteral ironpreparations2. RBC mild anemia3. Platelet concentrate – hemorrhagicdengue; <50,000 platelts4. plasma expanders or LRS –100,000-200,000 platelets
Notes…
Megaloblastic Anemia
- dse: due to lack of Vit B
12
and folicacid-caused primarily by drugs such as:methotrexate, 5-FU, phenytoin,antifolate drugs-prophylaxis: Leucovorin Ca (Folinicacid)-clinical correlation (Vit B
12
def):neurologic (ataxia, paresthesia,sensory deficits)
 
Pernicious Anemia
- due to Vit B
12
deficiency (operation ingastric mucosa where secretion of Vit B
12
takes place and due tooperation in the ileum whereabsorption takes place)- results to atrophy of the stomachand severe anemia-diagnosis: “Schilling Test” useradioactive Vit B
12
II. Drugs for Coagulation Disorders-Goal of anticoagulants:
 To
 
maintainfluidity
A. Anticoagulants
1. Indirect Antithrombin - parenterals
a
. Heparin
– high MWb.
Enoxaparin
c.
Delteparin
new low MWd.
Tinzaparin
- monitor dose (aPTT and PT)- toxicity: hemorrhage-safe in pregnancy-reversal of toxicity/antidote for heparin:
Protamine Sulfate
2. Direct Anti-thrombin
-crosses the BBB; contraindicated forpregnancya.
Hirudin
[blocks thrombin]
 
(
Lepiridin
– from leech)/
Bivalirudin
b
. Argatrotan
(synthetic drug)
/Ximelagatran
(active form “melagatran”)-antidote for a & b is Protamine Sulfatec.
Warfarin/Coumarin
– oral- adverse effects: hemorrhage, and eventhe infant is affected (givephytonadione or Vit K 
1
10 mL)- Toxicity: hemorrhage, affect infants,infarction esp in lower extremity
purple toe infarction- monitor: PTDrug Interactions:- PT: Cimetidine, Amiodarone,Metronidazole, Fluconazole,Cotrimoxazole, ASA, 3
rd
GenCephalosporins- PT: Barbiturates, Cholestyramine,Rifampin, Vitamin K, Diuretics(Furosemide and Thiazide)- reversal/antidote: Vit K 
1
(Phytonadione)
B. Thrombolyitc / Fibrinolytic-
IV lahat-MOA: enhance plasminogen conversionto plasmin-From streptococci and urine
 
BY : PAGE :
 Yna and Kring3 of 4
Medicine I- Hemiplegia Yna and Kring
-DOC for AMIa.
Anistreplase
b.
Reteplase
c.
Alteplase
d.
Tenecteplase
(a,b,c, and d are tPAs + synthetics)e. tPAs (endogenous) – natural-
Antithrombotic
: prophylaxis against acutecoronary syndrome- ASA: inhibit TXA2, PG (irreversible)
80mgdaily-Clopidogrel/ticlopidine: inhibit ADPpathway of coagulation
75mg/daily-Tirofiban(available in the Philippines) /Abciximab / Eptifibatide: InhibitGPIIBIIIA receptor-Dipyridamole: inhibit phosphodiesteraseand CGMP, enhance endogenousadenosine (di na ginagamit)-Cilostazol: antiplatelet vasodilator
intermittent claudication-Doctors recommend combination:ASA+clopidogrel orClopidogrel+tirofiban-
Favors Clotting:
Hemorrhage-Coagulant: Vit. K 
MOA: favors clottingof factors II, VII, IX and X-Vit K1: phytonadione
warfarin antidote,for newborn-Vit K2: menaquinone
synthesized bybacteria in small intestine-Vit K3: menadione
synthetic-plasma fraction: if one of the above isnot effective-monitor: fibrinogen, PT- Cryoprecipitate/Humate-P,Desmopressin acetate,Antoplex+FEIBA (factor VIII inhibitorybypassing action)
tx for hemophiliaA
C. Fibrinolytic Inhibitors-
MOA: inhibit plasminogen to plasmin
-
 
Traxenamic acid (Hemostan)- Aminocaproic acid (Amicar)
CI: DIC/Gut bleeding-
Serine-Protease-Inhibitor (SERPIN)
-Aprotinin-open heart surgery
D. Hemopoietic Growth Factor-Erythropoietin (Epoietin-A)
in JG cell
-
DOC for chronic renal failure with anemia
-Myeloid Growth Factor-
DOC for aplastic anemia-
G-CSF (Filgrastin)
: ADR is bone pain-
GM-CSF (Sargramostim):
better buthas fatal ADR which is capillary leaksyndrome-
Megakaryocyte Growth Factors-IL-11 (Oprelvekin):
DOC forthrombocytopenia
-ThrombopoietinIMMUNOLOGICALS (Vaccines)
ACTIVE Immunizations
-
Bacteria
Typhoid 21-A livebacteria
Typhoid Vi Bacterialpolysaccharide
Typhoid heat-phenolinactivated bacteria
PTAP InactivatedBacterial toxoid
Cholera InactivatedBacteria
Hib conjugatedbacteriapolysaccharide
Meningococcalbacteriapolysaccharide
Pneumococcal bacteriapolysaccharide
-
VIRUS
Live
MMR

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