Pharmacology Session 10:

Hemophilia – decreased number of RBC’s

Causes

  • blood loss
  • Iron deficiency
  • RBC lysis
  • ?
  • Most common is iron deficiency
  • microcytic, hypochromic
  • pale RBC
  • the oral iron supplement is taken through as straw
    • so it doesnt stain teeth
  • can cause chelation
  • S/E constipation, use with caution in kids (toxicity)
  • Use z-track for IM
  • antidote is deferoxamine for OD
  • B12 deficiency Anemia (pernicious anemia and people did die from it in the olden days)
    • need b12 to catalyze folic acid
      • dark red meats
    • need intrinsic factor (IF) to absorb b12
    • neurologic and GI issues:
      • hallucinations, memory issues,
    • used to be given IM only, now can be given po routes as well
    • megaloblastic – big RBC
  • Folic acid anemia (similar to b12)
    • get folic acid from dark leafy greens
  • RBC production
    • EPO – Epoetin A
      • mimics erythropoietin
    • chronic renal failure, anemia of chronic disease or from chemo.
      • these people can use EPO
    • cyclists take this (illegally) to improve performance.
  • WBC production
    • Filgrastim (neupogen)
      • very expensive
      • stim growth of WBC
  • Thrombopoietic GF (thrombocyte production)
    • Oprelvekin (interleukin) thrombopoietin

Hemostasis is important to stop the loss of blood through a cut, and allow the tissues to start the repair process.

Virchow’s triad – stasis, vessel injury, and hypercoagulability

Thrombosis (clot) – from a local tissue ingury in the artery, and in the vein it often comes from blood that is too slow so a clot can form, and eventually break of the vessel wall.

Anticoags effect Clotting cascade in these ways:

  • Platelet aggregation

do not give an anticoag in active hemorrhage, hemophilia, and pregnancy*.

  • Heparin through sq or IV
    • blocks the clotting cascade at Xa and XIa
    • used for the prevention of more clots, and post op thrombous
      • ***only giving in pregnancy (SQ) if the mom has a preexisting bleeding disorder
      • These do not dissolve the clot, but only prevent the clot
    • S/E: Hemorrhage, HIT, petechiae, BLEEDING GUMS,
    • if OD use Protamine sulfate
    • Test:
      • aPTT normal is 40 sec, Normal range on heparin or coumadin is sixty to eighty seconds
    • Lovenox is low molecular weight heparin.
    • Measured in Units/ml
      • can be as high as 10,000 units per mil
    • HIT – heparin induced thrombocytopenia
      • if this process occurs the patient can NEVER get heparin again
      • use Argatroban if HIT occurs
  • LMWH – low molecular weight heparin
    • Enoxaparin (lovenox) -heparin
      • patient can do self injections sq
      • no need for
  • Dabigatran (pradaxa)
    • Direct thrombin inhibitor
    • Very expensive
    • for reduction of stroke risk in an patient without  nonvalvular atrial fibrillation
  • Xarelto – Xa inhibitor
  • Warfarin (coumadin)
    • works in the liver to inhibit production of the clotting factors
    • Highly absorbed and bound to proteins
    • for long term prevention of thrombosis, Afib, pulmonary embolism
    • Vit K is antidote not K + not potassium.
    • TERATOGENIC
      • pregnant moms that need this drug should switch to heparin
    • lots of DD interactions
      • quinidine, antibi, NSAIDS, cimetidine, and T hormones
    • INR test on coumadin between 2-3 for heart valve 3-4.5
    • takes days for effect
      • heparin only takes about one and a half hours
  • Thrombolytics
    • bleeding is a big problem
      • so put in all of your lines first then give the drug.
    • only give in early clot development so to not create an embolis
  • antiplatelet
    • ASA – suppresses platelet aggregation by blocking the enzyme that makes the platelets “sticky”
      • prevention of MI
    • Clopidogrel (plavix)
      • can be used with ASA
      • Herbs that increase bleeding time
        • ginger, ginseng, garlic
  • peripheral neuropathy is unique to vincristine
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