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I.

DRUG THERAPY OF THE MUSCULAR SYSTEM:

A. CENTRALLY ACTING SKELETAL MUSCLE RELAXANT:  Actions: exact mechanism of action is still unknown, except that they act by CNS depression. All of these muscle relaxants produce some degree of sedation & most physicians believe that the benefits from these agents come from the sedative effect rather from the actual muscle relaxing effect  Uses: for relief from muscle spasm (spinal cord injuries, rheumatic d/o)  Side Effects: sedation, weakness, GIT upset  Adverse effects: liver damage, blood dyscracias  Drug interactions: Alcohol, narcotics, barbiturates, anticonvulsants, sedative hypnotics, tranquilizers and anti depressants can ENHANCE its depressive effect  Agents: carisoprodol, chlorzoxazone, metaxalone, methocarbamol, tizanidine B. DIRECT ACTING SKELETAL MUSCLE RELAXANT; DANTROLENE  Actions: this agent acts directly on skeletal muscles producing generalized mild weakness of skeletal muscles & decreases the force of reflex muscle contraction, hyperrelfexia, clonus, muscle stiffness, involuntary muscle movements & spasticity  Uses: Cerebral palsy, multiple sclerosis, stroke syndrome, Malignant hyperthermia  Side effects: weakness, diarrhea, drowsiness, dizziness  Adverse effects: photosensitivity. Liver damage  Drug interactions: CNS DPRESSANT: alcohol, analgesics, tranquilizers, potentiates the sedative effect of dantrolene C. NEUROMUSCULAR BLOCKING AGENTS:  Actions: Acts by interrupting transmission of impulses from motor nerves of muscles at the NMJ. Neuromuscular blocking agents have no effect on consciousness, memory or pain threshold  Uses: used during induction of anesthesia, intubation and electroshock therapy  Side effects: salivation, discomfort  Adverse effects: signs of respiratory distress, diminished cough reflex, & inability to swallow  Drug interactions: Drugs that enhance Therapeutic & toxic effect: anesthetics, the aminoglycosides, beta blockers, quinidine, diuretics.  Agents: atracurium, cisatracurium, doxacurium, mivacurium, succinylcholine, tubocurarine Cl.

niacin. Ranitidine. The reduction in liver cholesterol increases the removal of LDL from the circulating blood. warfarin. tetracyclines & beta blockers: reduces absorption. A water soluble vitamin B. abdominal discomfort. resulting in the net reduction in total cholesterol levels  Uses: used in conjunction with dietary therapy to decrease elevated cholesterol concentration. NIACIN:  Actions: this is also called nicotinic acid. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM A. Also for treating pruritus in biliary stasis. fatigue  Adverse effect: myopathy. nausea. nausea  Adverse effects: Flatulence  Drug interactions: digitoxin. NSAIDS. Bile acid binding agents reduces absorption of fat soluble vitamins 2. & V hyperlipidemias  Side effects: flushing. in type II hyperlipidemia. fullness. They competitively inhibit the enzyme responsible for converting HMG-CoA to mevalonatein the biosynthetic pathway to cholesterol in the liver. liver dysfunction  Drug interactions: Cyclosporine. omeprazole & cimetidine.  Actions: also called statins. III. increases statin levels . the resin forms a non-absorbable complex with bile acids. Because of the removal of the bile acid. preventing enterohepatic recirculation of the bile acid. IV. liver cells compensate by increasing metabolism of cholesterol to p[roduce more bile acids . bloating. abdominal discomfort. eryhthromycin increases the incidence of myopathy.  Uses: For hypelipidemia/cholesterolemia  Side effects: head ache. headache. itra/keto/fluco nazoles.  Adverse effects: Myopathy. pruritus. DRUGS USED TO TREAT HYPERLIPIDEMIAS: 1.II. diarrhea  Side effects: constipation. anorexia  Drug interactions: Lovastatin if combined w/ niacin enhances the myopathic effect 3. nausea. After oral administration. the exact mechanism of action is unknown. BILE ACID-BINDING RESIN:  Actions: cholestyramine & colestipol are resins that bind bile acids in the intestines. diuretics. These agents are more effective if administered at night because peak of production of cholesterol during this period. Phenobarbital. HMGCoA REDUCTASE INHIBITORS. thyroxine. dizziness. but it appears to inhibit the formation of VLDL which in turn lowers the LDL levels  Uses: used in conjunction with dietary therapy to reduce cholesterolin type II. verapamil.

teratogenesis  Drug interactions: lithium. dizziness. ANGIOTENSIN CONVERTING ENZYMES INHIBITORS (ACEI)  Actions: these act by inhibiting angiotensin I converting enzyme (dipeptidyl dipeptidase). Probenecid increases its toxic effect B. ramipril 4.) carbonic anhydrase inhibitors. enalapril. (c. It has 4 classes: (a. hyperkalemia  Drug interactions: Enhanced effect with: diuretics. diarrhea  Adverse effects: Orthostatic hypotension.  Uses: antihypertension  Side effects: head ache. blocking the very potent vasoconstrictor.) potassium sparing diuretics. neutropenialiver damage. chronic cough.) Thiazide & thiazide like agents. (b. capsaicin reduces therapeutic effects  Agents: captopril. Fibric acids are not recommended in combination with statins due to the risk of rhabdomyolysis  Side effects: nausea. may be a teratogenic agent. quinipril. digoxin. FIBRIC ACID:  Actions: exact action is unknown  Uses: for hypertriglyceridemia. DIURETICS:  Actions: causes volume depletion. beta blockers . & vasodilatation of peripheral arterioles. 2. simvastatin.) loop diuretics. hyperkalemia. fatigue  Adverse effects: myopathy. alcohol. DRUGS USED TO TREAT HYPERTENSION 1. facial edema. sodium excretion. These are the most commonly prescribed antihypertensive agents because it is proven to lower cardiovascular morbidity & mortality associated with hypertension  Uses: antihypertensive. BETA BLOCKERS:  SEE MIDTERM NOTES 3. dyspepsia. fluvastatin. abdominal discomfort. (d. diarrhea  Adverse effects: orthostatic hypotension. lovastatin 4. the substance responsible for conversion of angiotensin I to angiotensin II  Use: antihypertensive  Side effects: nausea. diarrhea. ANGIOTENSIN II RECEPTOR ANTAGONISTS: (AT1receptor antagonist)  Actions: binds to angiotensin II receptor sites. jaundice  Drug interactions: enhanced Warfarin effect. Agents: atorvastatin. enhanced insulin effect.

 Agents: candesartan. ALPHA 1 BLOCKING AGENTS:  Actions: blocks post-sympathetic alpha1 adrenergic receptors to produce arteriolar & venous dilatation. BPH  Side effects: headache drowsiness. antihistamines  Agents: Doxazin. hypotension  Adverse effect: edema  Drug interactions: enhanced effect with. histamine antagonists  Agents: amlodipine. nifedipine. resulting in a reduced sympathetic outflow from the CNS with a decreased HR. nicardipine.diuretics. beta blockers  Agents: Clonidine. A hypotensive effect results that is greater in the standing than . Because of the presence of alpha 1 receptors in the prostate gland & bladder. CENTRALLY ACTING ALPHA 2 ANTAGONISTS  Actions: stimulates the alpha adrenergic receptors in the brain stem . PERIPHERALLY ACTING ADRENERGIC ANTAGONISTS:  Actions: causes release & subsequent depletion of NE from adrenergic nerve endings. CALCIUM ION ANTAGONIST:  Actions: inhibits the movement of calcium ions across a cell membrane. reducing peripheral vascular resistance w/o reducing cardiac output or inducing a reflex tachycardia. methyldopa 8. resulting in vasodilatation & reduced BP  Uses: antihypertensive  Side effects: syncope. tranquilizers alcohol. tachycardia. This causes a relaxation of vascular smooth muscle which decreases TPR & venous return. barbiturates. verapamil 6. dizziness  Adverse effects: DEPRESSION  Drug interaction: enhanced effect with.digitalis. These agents do not increase catecholamines therefore there is no increase in heart rate or myocardial oxygen consumption.  Uses: hypertension. irbesartan. guanethidine. beta blockers. valsartan 5.alcohol. TERAZOSIN & DOXAZIN are also able to reduce urinary outflow resistance in men with BPH. phenothiazines. barbiturates. resulting in BP drop  Uses: Antohypertensive  Side effects: drowsiness. this results in fewer arrhythmias a slower rate of cardiac contraction & relaxation of smooth muscles of blood vessels. terazosin 7. losartan. fainting  Adverse affects: lethargy  Drug interactions: Enhanced effect with. tranquilizers. & PVR. mouth dryness.

guanadrel 9. n/v  Adverse effects: HypoK. orthostatic hypotension  Drug interactions: enhanced effect with.  Uses: for stage 2 & 3 hypertension. alcohol. hydralazine.nifedipine. antibiotics. DRUGS USED FOR THE TREATMENT OF HEART FAILURE: 1. tachycardia. & renin release with sodium & water retention. fever. nitroprusside sodium C. beta blockers  Agents: minoxidil. digoxin 2. The excat mechanism of action is unknown. PHOSPHODIESTERASE INHIBITORS:  Actions: increases the force & velocity of myocardial contractions by inhibiting CAMP phosphodiesterase activity & increases cellular level of CAMP in heart muscles. The reduction in peripheral resistance causes a reflex increase in HR. DIRECT VASODILATORS  Actions: causes direct arteriolar smooth muscle relaxation resulting in a decreased PVR. this agent increases the force of contraction & slows down the heart rate. HypoMg. DIGITALIS GLYCOSIDES: DIGOXIN  Actions: derived from the foxglove plant. Sedation occurs due to depletion of NE in the brain Uses: Hypertension Side effects: sedation Adverse effects: orthostatic hypotension. reducing the conduction velocity & prolonging the refractory period at the AV node. reducing preload & after load  Uses: for short term treatment of heart failure . It is also a vascular smooth muscle relaxantthat causes vasodilatation. CO. diuretics. Heart rate is decreased & fluid retention occurs.barbiturates. verapamil.     in the supine position. baldness  Side effects: nausea. dizziness.  Uses: heart failure  Side effects: bradycardia. antihistamines. alcohol Agents: guanethedine.diuretics. reserpine. arthralgia. tranquilizers. HypoCa  Drug interactions: Enhanced effect with. edema Drug interactions: Enhanced effect with. betablockers  Agents: digitoxin. tachycardia. chills  Adverse effects: myalgia.

bradycardia-tachycardia syndrome. Agents: amrinone. BP & CO reduces  Uses: sinus tachycardia. ADENOSINE:  Actions: it has a variety of roles including energy transfer. abdominal discomfort Adverse effects: arrhythmias. AMIODARONE:  Actions: action is unknown. thus delaying repolarization  Uses: SVT. dyspnea. hypotension. syncope. dyspnea. thrombocytopenia. paroxysmal atrial tachycardia. nausea. Used in paroxysmal supraventricular tachycardia  Side effects: flushing. ANGIOTENSIN CONVERTING ENZYME INHIBITORS  Actions: Reduces afterload & help reduce circulating blood volume by inhibiting the secretion of aldosterone  Uses: reduces BP & increases renal blood flow D.    Side effects: N/V. atrial fibrillation & flutter. photosensitivity & liver damage 3. inhibition of platelet aggregation. palpitations. confusion. This is a class III agent that acts by prolonging the action potential of atrial and ventricular tissues and by increasing the refractory period w/o altering the RMP. & hypertrophic cardiomyopathies  Side effects: chest pain. PVC 4. edema  Adverse effects: narrowing of pulse pressure. antiadrenergic effects coronary artery dilatation & suppression of heart rate  Uses: strong depressant of SA & AV node. head ache  Adverse effects: Are short lived because the half life of adenosine is only 10 seconds  Drug interactions: Enhanced effect with. as a result. They block the cardiac response to sympathetic nerve stimulation by blocking the beta receptors. ataxia.dipyridamole & carbamazipines 2. liver damage Drug interactions: digitalis & furosemide. bluured vision. promotion of prostaglandin release. yellow brown pigments in the cornea. DRUGS USED TO TREAT ARRHYTHMIAS 1. This is a class III agent Uses: ventricular arrhythmias Side effects: dizziness. n/v . chest pressure. BETA ADRENERGIC BLOCKING AGENTS:  Actions: Class II agents. the HR. milrinone 3.    BRETYLIUM Actions: inhibits the release of norepinephrine. fatigue.

nausea  Adverse effects: arrhythmias. MORICIZINE:  Actions: inhibits the influx of sodium ions into the myocardial cells. beta blockers 8. syncope. & propranolol 10. making it a class I agent  Uses: ventricular arrhythmias  Side effects: dizziness. disopyramide 7. arrhythmias  Drug interactions: agents that enhance its effect: amiodarone. LIDOCAINE:  Actions: Class Ib agent  Uses: most commonly used drug for ventricular arrhythmias & the drug of choice for ventricular arrhythmias secondary to AMI  Side effects: muscle twitching. urinary hesitancy.  Uses: ventricular tachycardias. Wolf-Parkinson-White syndrome.  Side effects: dizziness. procainamide. tocainide. dyspepsia Adverse effects: neurotoxic. arrhythmia Drug interaction: reduced effect with phenytoin 9. increasing dyspnea. PHENYTOIN: . constipation 6. DISOPYRAMIDE:  Actions: class Ia antiarrhythmic agent  Uses: for atrial fibrillation.      MEXILETINE: Actions: Class Ib anti-arrhythmic agent similar to lidocaine Uses: PVC’s. headache. euphoria  Drug interactions: enhanced effect with digoxin. This agent has a negative inotropic effect that can lead to worsening of heart failure.phenytoin. FLECAINIDE:  Actions: Class Ic antiarrhythmic agent. cimetidine. hypotension. ventricular tachycardias Side effects: n/v. n/v  Adverse effects: edema. light-headedness  Adverse reactions: respiratory depression  Drug interactions: Enhanced effect with. cimetidine. blurred vision. ventricular tachycardias  Side effects: dryness of mouth & throat  Adverse effect: bradycardia/heart failure. PVCs. Adverse effects: hyper/hypotension  Drug interactions: digitalis glycosides 5.

dizziness. disopyramide. PROCAINAMIDE:  Actions: Class Ia drug that has many cardiac effects similar to quinidine  Uses: ventricular & supraventricular arrhythmias  Side effects: drowsiness sedation. dizziness  Adverse effects: Cinchonism. phenothiazines. constipation  Adverse effects: arrhythmias  Drug interactions: Enhanced effect with quinidine & cimetidine 13. quinidine. irregular pulse to a slow regular pulse  Uses: atrial fibrillation.     Actions: Class Ib drug Uses: paroxysmal atrial tachycardia. It is a class Ia agent. dermatologic manifestations Drug interactions: enhanced effect with. wheezing. that has a weak beta blocking & calcium channel blocking effect  Uses: Paroxysmal atrial fibrillation. drowsiness. QUINIDINE:  Actions: derived from the cinchona bark. TOCAINIDE:  Actions: Class Ib agent. dizziness  Adverse effects: myalgia. DRUGS USED FOR ANGINA PECTORIS 1. procainamide. chloramphenicol. sulfonamides 11.histamine receptor blockers. & ventricular tachycardia  Side effects: n/v. quinidine E. dizziness.warfarin. carbamazipine. trimethoprim & beta blockers 12. It slows down the heart rate & changes a rapid. NITRATES: . PROFAPENONE:  Actions: Class Ic agent. PSVT. ventricular arrhythmias Side effects: n/v. PVC  Side effects: diarrhea. chills. digitalis. atrial flutter.fever. This is the first available derivative of lidocaine  Uses: ventricular tachycardia  Side effects: n/v.cimetidine. blurred vsion Adverse effect: Confusion. beta blockers 14. amiodarone. cofusion. thrombocytopenia  Drug interactions: enhanced effect with. verapamil.procainamide. skin eruptions  Drug interactions: Enhanced effect with. numbness  Adverse effects: dyspnea. arthralgias. INH. tinnitus  Drug interactions: enhanced effect with. sedation. disulfiram.

Nitrates also increase myocardial oxygen supply by dilating large coronary arteries & redistributing blood flow. They relieve angina by inducing relaxation of peripheral vascular smooth muscles. nitroglycerine 2.    ISOXSUPRINE HCL Actions: vasodilator.DOC for angina pectoris  Side effects: headache. resulting in dilatation of arteries & veins. CALCIUM ION ANTAGONISTS  Actions: inhibits the movement of calcium ions across cellular membranes  Agents: amlodipine. nifedipine. tolerance  Adverse effects: excessive hypotension  Drug interactions: alcohol. DRUGS USED FOR PERIPHERAL VASCULAR DISEASES 1. dyspepsia. theophylline 2. Reynaud’s disease  Side effects: flushing. Uses: Buerger’s disease. It increases RBC flexibility. tingling. n/v  Adverse effects: diaphoresis  Drug interactions: no known drug interactions 3. BETA BLOCKERS:  Actions: reduces myocardial oxygen demand by blocking the beta receptors of the heart. arterial occlusive disease Side effects: same as (2) . Directly relaxes smooth muscles in blood vessels  Uses: intermittent claudication. leg cramps. dizziness. ISMN. ISDN. verapamil F. thromboangitis obliterans. this reduces venous blood return to the heart leading to a decreased oxygen demand in the heart. CYCLANDELATE:  Actions: Vasodilator.  Uses: for angina 3. beta blockers  Agents: amyl nitarite. PENTOXIFYLLINE  Actions: hemorrheologic agent. decreases the concentration of fibrinogen in blood & prevent aggregation of RBc & platelets  Uses: for intermittent claudication  Side effects: n/v. dyspnea  Drug interactions: Antihypertensive agents. HA  Adverse effects: chest pain arrhythmias. calcium ion antagonist. Actions: oldest effective therapy for angina pectoris. enhancing oxygen supply to ischemic areas  Uses: Ntroglycerine. Reynaud’s disease.

dizziness  Adverse effects: chest pain. arrhythmias  Drug interactions: dilatiazem. Inhibits CAMP phosphodiesterase III resulting in vasodilatation. It promotes the excretion of potassium water & bicarbonates  Uses: for glaucoma patients. frostbite Side effects: nasal stiffiness. omeprazole. erythromycin.     5. sweating. diarrhea. fluconazole. leg ulceration. palpitations. Not commonly used 2. sertraline. tachycardias. anginal pain. Drug interactions. tachycardia Adverse effects: hypotension Drug interactions: antihypertensives TOLAZALINE: Actions: vasodilator Uses: Reynaud’s disease. tingling.      PAPAVERINE HCL Actions: vasodilator Uses: cerebral & peripheral ischemia Side effects: same as 2 & 3 Drug interactions: antihypertensive agents PHENOXYBENZAMINE HCL: Action: vasodilator Uses: Reynaud’s disease. n/v Adverse effects: arrhythmias.      6. grapefruit juice G. DRUGS USED FOR DIURESIS 1. hallucination Drug interactions: antihypertensives 7. METHYLXANTHINES: AMINOPHYLLINE:  Actions: acts by improving blood flow to the kidneys  Uses: rarely used as a diuretic . & inhibited platelet aggregation  Uses: Intermittent claudication  Side effects: dyspepsia. brain and eyes. CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE  Actions: a weak diuretic that acts by inhibiting the enzyme. CILOSTAZOL  Actions: Platelet aggregation inhibitor. ketoconazole. Antihypertensive agents 4. frost bite gangrene Side effects: flushing. carbonic anhydrase w/in the kidneys. chronic leg ulcers.

Effect starts 5-10 minutes after IV administration peaks after 30 minutes and lasts for 2 hours  Uses: liver & renal diseases. ETHACRYNIC ACID:  Actions: acts on the ascending limb of the loop of Henle to prevent sodium and chloride reabsorption. LOOP DIURETICS: a.  Uses: renal & liver diseases. HTN  Side effects: oral irritation.3. hyperglycemia  Drug interactions: aminoglycosides. steroids b. including nephritic syndrome  Side effects: gastric irritation. hypotension  Adverse effects: Electrolyte imbalance. Diuretic activity starts 30-60 minutes after administration  Uses: CHF. hives  Adverse effects: hypokalemia. CHF. NSAIDS. Its effect starts 30min. barbiturates. digitalis. aminoglycosides. deafness. chloride. change in mental status. aminoglycosides. It also acts by increasing renal blood flow into the glomeruli & inhibits electrolyte absorption in the proximal tubule. hyperuricemia. HCO3 excretion in the urine. gastric irritation . CHF  Side effects: orthostatic hypotension  Adverse effects: Hypokalemia. NSAIDS. GIT bleeding. premenstrual syndrome  Side effects: hypotension. BUMETAMIDE:  Actions: a potent diuretic that acts by inhibiting sodium & chloride reabsortion from the ascending loop of Henle in the glomeruli of the kidneys. FUROSEMIDE:  Actions: acts on the ascending loop of Henle but also affects the proximal & distal tubules to prevent sodium & chloride reabsorption. PO3. difitalis. propranolol. dehydration. salicylates. enhancing Na. cisplastin. cisplastin. changes in mental status  Drug interactions: alcohol. phenytoin d. TORSEMIDE  Actions: sulfonamide type loop diuretic 4. steroids c. cisplastin.  Uses: CHF. hyperglycemia  Drug interactions: Digitalis. obesity. renal & liver disease. constipation. peaks after 2 hours and lasts for 6-8 hours. renal & liver disease. n/v. THIAZIDES:  Actions: Benzothiadiazides acts primarily on the distal tubules of the kidneys to block the reabsorption of sodium & chloride ions. NSAIDS.

SPIRONOLACTONE:  Actions: blocks the sodium retaining & potassium & magnesium excreting properties of aldosterone. resulting in K retention & Na excretion  Uses. It also shows reduction in morbidity & mortality in a CHF patient  Side effects: diarrhea. Combined with thiazides  Side effects: leg cramps. flatulence  Adverse effects: electrolyte imbalance (HyperK)  Drug interactions: Lithium. anorexia. AMILORIDE:  Actions: exact mechanism of action is unknown. hyperuricemia. Adverse effects: Electrolyte imbalance. steroids. electrolyte imbalance. K supplements b. PLATELET INHIBITORS a. POTASSIUM SPARING DIURETICS: a. TRIAMTERENE:  Actions: blocks the exchange of potassium for sodium in the distal tubule of the kidneys. but it acts on the distal renal tubule to retain K & excrete Na resulting in a mild diuresis  Uses: combined with other diuretics. dehydration  Drug interactions: DO NOT ADMINISTER WITH POTASSIUM SUPPLEMENTS= HYPERKALEMIA 6. salt substitute c. oral hypoglycemic agents 5.    COMBINATION DIURETIC PRODUCTS: Spironolactone + HCTZ Triamterene + HCTZ AMILORIDE + HCTZ H. NSAIDS. For CHF  Side effects: n/v. hyperglycemia  Drug interactions: digitalis. lithium. reduced libido. breast tenderness  Drug interactions: K supplements. headache. resulting in loss of water with increased sodium excretion  Uses: used in relieving edema & ascites.  Adverse effects: electrolyte imbalance. ASPIRIN . nausea. headache  Adverse effects: mental confusion. DRUGS USED TO TREAT THROMBOEMBOLIC DISORDERS 1. gynecomastia.

ARDEPARIN  Actions: this is a LMWH that enhances antithrombin activity against factor Xa and thrombin which prevents completion of the coagulation cascade. DO NOT INJECT IM  Uses: DVT  Adverse effects: Bleeding b. peripheral arterial disease. unstable angina Adverse effect: bleeding e. The metabolite of this drug acts to inhibit platelet aggregation. Post MI. warfarin. tamoxifen. thromboembolism  Side effects: dizziness. stroke  Adverse effects: Neutropenia. increases CAMP in platelets. DVT. DALTEPARIN:  Action: same as ardeparin  Use: DVT  Adverse effect: bleeding d. NSAIDS c. antithrombin III (heparin cofactor). HEPARIN:  Actions: acts as catalyst to accelerate the rate of action of a naturally occurring inhibitor of thrombin. (Ardeparin). agranulocytosis. GIT blleding  Drug interactions: phenytoin. torsemide. fluvastatin. CLOPIDOGREL:  Actions: chemically related to ticlodipine. Antiplatelet activity is seen after 3. potentiating prostacyclin-mediated inhibition  Uses: TIA. GIT distress  Adverse effects: postural hypotension 2. PE  Side effects: BLEEDING  Antidote is protamine . Angina pectoris. DIPYRIDAMOLE  Actions: inhibits Thromboxane A2.    ENOXAPARIN: Actions: same as a and b Uses: DVT.  Uses: cerebral embolism. ANTICOAGULANTS: a. Actions: Inhibits thromboxane A2  Uses: TIA  Side effects: see midterm lecture notes b.7 days  Uses: TIA.

alteplase. dissolving the clot  Uses: Stroke. PE Adverse effect: Bleeding Antidote: Vit K 3. VII.     WARFARIN: Actions: inhibits activity of vitamin K ( Factors II. urokinase.X) Uses: DVT. w/c digests fibrin. FIBRINOLYTIC AGENTS:  Actions: activates the conversion of plasminogen to plasmin/ fibrinolysin. MI  Agents: streptokinase. IX . Anistreplase/APSAC. reteplase .f. atrial fibrillation with embolism.