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DRUG Vitamin K

MECHANISM / ACTION Reverses hypocoagulability Factors 2, 7, 9, 10, and Protein C require Vit. K for carboxlyation to bind Ca+ to for clotting (once oxidized, Vit. K is reduced by epoxide reductase for use again)

Desmopressin (DDAVP)

analog of vasopressin increase factor VIII & vWF

INDICATIONS Deficiency caused by: Liver problems(HIV, Hepatitis, EtOH) Malabsorption syndromes ~ CF ~ sprue ~ short bowel syndrome ~ blind loop syndrome Hemorrhagic dz in neonates mild-mod HemA & vWF minor surgery ( bld loss) plt defect

CONTRAINDICATIONS

SE

vWF type IIb precipitate thrombosis & produce thrombocytopenia patients with heart dz

lowers BP raises pulse HA Cant drink water b/c causes hyponatremia

Aprotinin

Aminocaproic acid (tranexamic acid) Aspirin antiplt Dipyridamole antiplt

Serine proteinase inhibitor Complexes w/ plasmin, kallikreins inhibit fibrinolysis Doesnt cross BBB competitively inhibit plasminogen activation (fibrinolytic inhibitor)

High risk coronary bypass surgery lower bleeding & transfusion need hemophilia adjunct post op bleeding bladder hemorrhage intracranial aneurysms primary & secondary MI px DIC Renal/ureteral bleeding pregnancy intravasc thrombosis hypotension myopathy abdominal discomfort diarrhea Too much is bad b/c it inhibits PGI2(which has anti-aggregatory effects) coagulation

blocks cyclooxygenase blocks TXA2 formation effect on plt in circulation = irrev relieved only by new plt formation PDE inhibitor Inhibit plt fxn by: ~ increasing cAMP ~ stim PCI2 ADP receptor antagonist that prevents dec. in cAMP=prevents aggregation on plt by dec. expression of IIb/IIIa

coag defect

Ticlopidine antiplt

With aspirin: more complete effect on plt With warfarin: decrease embolism with prosthetic heart valve TIA Thrombotic strokes With aspirin: angioplasty patients & stents reduce secondary thrombosis

Coag defects

Clopidogrel DRUG Abciximab antiplt

Hemopoietic hemostatic disorders severe liver dz hypersensitivity Drug interactions: cimetidine: lower clearance theophylline: t1/2 & clearance antacids: lower plasma level

Neutropenia ~ delayed onset ~ bld monitor requirement

similar to ticlopidine MECHANISM / ACTION glycoprotein IIb/IIIa antibody inhibitor INDICATIONS Conjuction w/angioplasty inhibit coronary thromboses CONTRAINDICATIONS Coag defects

no neutropenia SE bleeding: freq depends on intensity of heparin anticoag

Eptifibatide antiplt Tirofiban antiplt Recomb tPA 2nd g thrombolytic DRUG Heparin anticoag

Fab fragment of human Ab to glycoprotein oppose glycoprotein IIb/IIIa receptor activation glycoprotein IIb/IIIa inhibitor minimizes allergic rxn expensive

Px recurrent MI (with aspirin & heparin) coag defects

employed plt transfusion reverse effect bleeding thrombocytopenia

coag defects hemostatic thrombi & thromboemboli lysed bleed less than other thrombolytics

works on preformed clots

Lepirudin anticoag Warfarin anticoag

MECHANISM / ACTION rev binds antithrombin III (tx DIC) decreases 2,7,9,10 immediate effect no effect on pre-existing clots; works to prevent new clots Unfractionated is a scaffold to promote binding of thrombin to antithrombin LMWH: enoxaparin ~ longer half life ~ more predictable ~ Not attacked by Ab ~ able to activate antithrombin III hirudin direct thrombin inhibitor in salivary gland of leech inhibits epoxide reductase and depletes reduced Vit. K.blocks synthesis of 2, 7, 9, 10 lag time btwn admin & PT affect 99% bound to serum albumin

INDICATIONS LMW: THR DVT Venous thrombosis Pulm emoblism Initial management: unstable angina or acute MI Coronary angioplasty Stent placement Cardiopulm bypass surgery Pregnancy ~ does not cross placenta

CONTRAINDICATIONS Coag disorders Liver dz Prolonged admin osteoporosis antidote: protamine sulfate

SE Excessive bleeding Thrombocytopenia Purpurae Severe HTN Intracranial hemorrhage

HIT

No antidote antidote is Vit. K Fetal Warfarin syndrome - Hypoplastic nose, low nasal bridge, altered bone growth

long term in DVT, heart valves, post MI Increased Response vit K def liver dz alcoholism Decreased Response Pregnancy ~ crosses placenta ~ secreted in milk

ACTION INHIBITED (PT shorten) enhance degradation barbiturates phenytoin rifampin ACTION POTENTIATED (PT long) displace from protein / lower metab cimetidine

Binding of ADP inhibits adenylyl cyclase which dec. cAMP(aggregation) and dec. PKA= platelet activation, also cAMP is metabilized to AMP by PDE(aggregation) Protein C(activated by thrombomodulin) is anti-coagulant that inhibits Va and VIIIa and dec .inhibitor of plasminogen activation, and inhibits release of TNF from monocytes during septic shock(r-APC)

Ribaroxiban is 10a inhibitor Dabigatran is thrombin inhibitor