Chapter 48 and 49 : Drugs Affecting Blood Coagulation and treat anemias

Aspirin

Antiplatelet Agents

Alter platelet aggregation and formation of platelet plug

Heparin

Anticoagulants

Indications: Prevention and treatment of venous thrombosis and PE, treatment of A-fib with embolization, treatment of DIC, prevention of clotting of blood sample:s adjunct in treatment of MI and stroke.

Adverse effects: thrombocytopenia ( immune reaction that results in low platelets)

Continuous IV infusion: Measurement of aPTT (usually every 6 hours until therapeutic effects are seen) is necessary.

▪ Subcutaneous use: ➢ DVT prophylaxis: 5000 units subcutaneously two or three times a day; does not need to be monitored when used for prophylaxis

Enoxaparin

Anticoagulants

LMWH (Low Molecular Weight Heparin)

Inhibit thrombus and clot formation. Used for prophylaxis and treatment: DVT, Bedrest, postop prophylaxis. ➢ does not greatly affect thrombin or prothrombin times= fewer systemic adverse effects and Lab monitoring is not necessary

administered subcutaneously: Pre-filled syringes- Do not expel air bubble

Warfarin

Anticoagulants

Indications:Treatment of A-fib, artificial heart valves, or valvular damage that make a patent susceptible to to thrombus or embolus formation; venous embolism, PE, and embolism after MI.

Adverse effects: induced skin necrosis

Contraindication: Pregnancy . Cautions Renal or hepatic disease, PUD, Should not be used during (eye, spinal cord or brain surgery, lumbar puncture or regional anesthesia)

Many herbal products have potential interactions; increased bleeding may occur ➢ Garlic, Ginger, Ginkgo(3-Gs)

Protamine sulfate

can be given as an antidote in case of excessive anticoagulation by heparin.

Vitamin K

can be given as an antidote in case of excessive anticoagulation by warfarin

Alteplase

Thrombolytic Agents

Therapeutic Actions o Work to activate natural anticlotting system o Activate tissue plasminogen

indication: Dissolution of formed thrombus (e.g., formed during acute MI, PE, or ischemic stroke)

Aminocaproic acid

Hemostatic Agents

Indications o Systemic: prevent body-wide or systemic clot breakdown to prevent blood loss

Topical: for surface injuries that involve so much damage to the small vessels in the area that clotting does not occur and blood is slowly and continually lost

Ferrous sulfate AND Iron dextran

Agents Used for Iron Deficiency Anemia

Contraindications: peptic ulcer, colitis, or regional enteritis( iron can cause irritation of GI tract and worsening of condition)

Adverse effects: Oral iron: effects related to GI irritation N/V, constipation, dark tarry stools ▪ Parental iron (IV or IM): severe anaphylactic reactions, local irritation, staining of the tissues, phlebitis

Drug-Drug Interactions:Fluoroquinolones or tetracyclines

Food that Impair absorption o Milk products ( calcium) o Eggs (yolk proteins) o Coffee, tea ( tannins)

Foods that enhance absorption o Orange juice ( vitamin C)

Folic acid

Agents for Megaloblastic Anemias

Therapeutic Actions: necessary for production of DNA, RBCs, WBCs, platelets

Indication: Treatment of megaloblastic anemia, also used as a rescue drug for cells exposed to some toxic chemotherapeutic agents

Vitamin B12: Cyanocobalamin

Agents for Megaloblastic Anemias

necessary for the maintenance of the myelin sheath in nerve tissue

Indications: Treatment of megaloblastic anemia, (parenteral: IV OR IM ) Lack of intrinsic factor in the stomach

Contraindications: Caution nasal route: presence of nasal erosion or ulcers

Epoetin alfa

Erythropoiesis-Stimulating Agents

Indications: Anemia associated with chronic renal failure or kidney disease ( Anemia of Chronic Disease), Medication induced aplastic anemias ( chemotherapy or HIV antiviral drugs).

Adverse effects: increased risk for DVT when hemoglobin is higher than 11 g/dL, Hypertension

Black Box Warnings: increased risk of death, myocardial infarction, stroke, venous thromboembolism, thrombosis of vascular access