Pharmacology………..Theoretical lecture ………..

Community health department

Drugs and The hematologic system

The hematologic system includes plasma (the liquid component of blood) and blood cells
(formed elements), such as red blood cells (RBCs), white blood cells, and platelets

First: Hematinic drugs:

Hematinic drugs provide essential building blocks for RBC production. They do so by
increasing hemoglobin.

A. iron : Iron preparations include: ferrous fumarate, ferrous gluconate, ferrous sulfate.
Pharmacotherapeutics :

1. Preventing or treating iron deficiency anemia.

2. It’s used to prevent anemia in children ages 6 months to 2 years
3. Pregnant women may need iron supplements
Adverse reactions to iron therapy :
 The most common adverse reactions to iron therapy are:
1. Gastric irritation and constipation.
2. Iron preparations also darken stool.
3. Liquid preparations can stain the teeth.
 The most serious reaction is anaphylaxis, which may occur after administration of
parenteral iron.
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 Pharmacology………..Theoretical lecture ……….. Community health department

A. Vitamin B12: Common vitamin B12 preparations include cyanocobalamin and

hydroxocobalamin
Pharmacotherapeutics:

1. Cyanocobalamin and hydroxocobalamin are used to treat pernicious anemia, a

megaloblastic anemia.
2. Oral vitamin B12 preparations are used to supplement nutritional deficiencies of the
vitamin. The parenteral and intranasal formulations are used to treat patients with pernicious
anemia.
Adverse reactions to vitamin B12 therapy :

Some rare reactions may occur when vitamin B12 is administered parenterally: hypersensitivity
reactions , pulmonaryedema, heart failure, peripheral vascular thrombosis, polycythemiavera,
hypokalemia, itching, transient rash, hives, and mild diarrhea

B. Folic acid: Folic acid is given to treat megaloblastic anemia due to folic acid deficiency.
Pharmacotherapeutics:

1. Folic acid is used to treat folic acid deficiency.

2. Patients who are pregnant or undergoing treatment for liver disease, hemolytic anemia,
alcohol abuse, or skin or renal disorders typically need folic acid supplementation
3. Leucovorin is a folic acid derivative used to treat folic acid deficiencies resulting from
administration of methotrexate
Adverse reactions to folic acid:

Erythema, itching, rash, anorexia and nausea, altered sleep patterns, difficulty concentrating,
irritability, hyperactivity.

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 Pharmacology………..Theoretical lecture ……….. Community health department

Second: Anticoagulants:

Anticoagulants (or sometimes known as “blood thinners”) are medicines that delay the clotting
of blood.They include :

A. Heparin: Heparin, is an anti-thrombolytic agent used to treat and prevent clot formation.
Pharmacotherapeutics:
1. Preventing or treating venous thromboemboli.
2. Treating disseminated intravascular coagulation.
3. Treating arterial clotting and preventing embolus formation in patients with atrial
fibrillation.
4. Preventing thrombus formation and promoting cardiac circulation in an acute myocardial
infarction (MI)
Adverse reactions to heparin: one advantage of heparin is that it produces relatively few
adverse reactions:
1. Bleeding, the most common adverse reaction
2. Other adverse reactions include bruising, hematoma formation, necrosis of skin or other
tissue, and thrombocytopenia
B. Oral anticoagulants: The major oral anticoagulant used is thecoumarin compound
warfarin.
Pharmacotherapeutics: It s are prescribed to treat or prevent thromboembolism.

Adverse reactions to oral anticoagulants:

1. The primary adverse is minor bleeding.

2. Severe bleeding can occur, however, with the most common site being the GI tract.
3. Brain bleeding may be fatal. Bruises and hematomas may form at arterial puncture sites.
4. Necrosis or gangrene of the skin and other tissues can occur.

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 Pharmacology………..Theoretical lecture ……….. Community health department

Third: Fibrinolytics (Thrombolytics):

Fibrinolytic drug, also called thrombolytic drug, any agent that is capable of stimulating the
dissolution of a blood clot (Thrombosis or Embolism) of recent onset (as in myocardial
infarction or peripheral arterial thrombosis). They include:

1. Streptokinase
2. Urokinase
3. Tissue plasminogen activator [Alteplase]
4. Reteplase - Tenecteplase4:Anistreplase [APSAC]
Indications: Early STEMI, early ischaemic stroke, Massive pulmonary embolism

Side effects: Bleeding (The most important & most common), Allergy (especially with
Streptokinase) , Fever

Contraindications: Persistent hypertension, Aortic dissection , Trauma , Pregnancy , History

of recent: surgery or cerbrovascular stroke , Active GIT bleeding.

Forth: Antifibrinolytics:

A type of drug that helps the blood clot. It prevents the breakdown of a protein called fibrin,
which is the main protein in a blood clot. Example: Aprotinin

Indications:

It may be used to prevent or treat serious bleeding in patients who have certain conditions, such
as hemophilia, very heavy menstrual bleeding, or some types of vascular tumors, and may also
be used to prevent or control bleeding during or after surgery or after a traumatic injury.
Adverse effects :

A. Adverse effects attributable to the mechanism of action:

1. Venous thromboembolism: clots that are able to cause an obstruction of the venous system,
including pulmonary thromboembolism and deep vein thrombosis

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 Pharmacology………..Theoretical lecture ……….. Community health department

2. Acute myocardial infarction and coronary bypass occlusion.

3. Stroke and acute renal failure
B. Adverse effects not attributable to the mechanism of action
1. Serious adverse effects (seizures, myopathy and muscular necrosis ,
2. Mild adverse effects (nausea, dizziness, vomiting, abdominal pain and diarrhoea,
Sixth: Antiplatelet drugs:

An antiplatelet drug (antiaggregant), also known as a platelet agglutination inhibitor or platelet

aggregation inhibitor .

Drug class Example Indications Adverse effect

COX inhibitors Aspirin Risk reduction for Stomach pain, Heartburn,
ischemic stroke, TIA, nausea, Constipation, Blood in
ACS, PAD, stable stool, Slight gastric blood loss,
angina.
Phosphodiesterase Dipyridamole after cardiac valve Headache, Dizziness, Nausea,
inhibitors replacement, coronary Flushing, Weakness , Fainting,
artery bypass grafts or Mild GI distress
prosthetic heart valves
ADP receptor clopidogrel ACS after PCI, MI, Headache, Skin ulceration, Joint
antagonists stroke, PAD pain, Flulike symptom, Upper
respiratory tract infection,
bleeding
Glycoprotein Eptifibatide ACS , PCI Excessive bleeding ( bleeding
IIb/IIIa receptor from GI and urnary tract
antagonstis
*TIAs: transient ischemic attacks, PCI: percutaneous coronary intervention , ACS : acute
coronary syndrome, MI: myocardial infarction, PAD: peripheral arterial disease.