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Agents used in coagulation disorders
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Agents used in coagulation disorders

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  • 1. Agents Used in Coagulation Disorders
  • 2.  
  • 3. Clot Risk Factors
    • Over 40 years old
    • Obese
    • Best rest > 4 days
    • Estrogen & estrogen with nicotine
    • Pregnancy, surgery, major illness
  • 4. Blood Coagulation Mechanism
    • Definitions
    • GUT
      • Vitamin K role
    • Circulation
      • Clotting factors
      • Prothrombin – Thrombin
      • Fibrinogen -- Fibrin
  • 5. Indications
    • Venous thrombosis
    • Pulmonary Embolism (PE)
    • Prosthetic Heart Valve
    • Myocardial Infarction (MI)
    • Cerebral Vascular Disease
    • Coronary Heart Disease
  • 6. Cascade of Events Leading to Hemostasis Injured Vessel Platelet System Vascular System Coagulation System Clotting Factors  Prothrombin  Thrombin Stimulate Fibrin Vasoconstriction Platelet Aggregation Permanent Fibrin-Platelet Plug
  • 7. Where Do the Drugs Work? Clotting Cascade Platelet System Vascular System Coagulation System Clotting Factors  Prothrombin  Thrombin Stimulate Fibrin Vasoconstriction Platelet Aggregation Heparin Warfarin GIT Anti-Platelets Fibrinolytics
  • 8. Anti-Coagulant Agents (Clot Prevention)
    • Heparin
    • MOA
    • Toxicity
      • Protamine sulfate
    • Dose
    • Administration
    • Enoxaprin
      • (Lovenox)
      • Low molecular weight heparins
    • Warfarin (Coumadin)
    • MOA
    • Toxicity
      • Mephyton(Vitamin K)
    • Dose/Administration
    • Drug interactions
    • Patient education
  • 9. Fibrinolytic Agents (Clot Busters)
    • Pharmacology
      • Streptokinase/Urokinase
      • Anistreplase/TPA (Activase)
    • Indications
      • Pulmonary Emboli (PE)
      • Deep Venous Thrombosis (DVT)
      • Acute Myocardial Infarction (MI)
  • 10.  
  • 11. Anti-Platelets (Glide & Slide)
    • Indications
    • Pharmacology
      • ASA
      • Clopidogrel (Plavix)
      • Ticlopidine (Ticlid)
    • Toxicity
    • Patient Education
  • 12. Stroke
    • Recognize the signs
    • Ask three questions
      • Ask the individual to SMILE
      • Ask him or her to RAISE both arms
      • Ask the person to SPEAK a simple sentence
    • Trouble with any task call 9-1-1
  • 13. Drugs Used in Bleeding Disorders
    • Vitamin K (Mephyton)
    • Protamine Sulfate
    • Plasma Fractions
    • Fibrinolytic Inhibitors
      • Aminocaproic acid (Amicar)
  • 14. Drug Interactions
    • Increase Bleed Time
    • THE most serious are any that increase OAC effect and increase BLEEDING!
    • Decrease Bleed Time
  • 15. Summary Slide
    • Blood Coagulation Mechanism
      • Clot Risk Factors
    • Anti-Coagulant Agents (Clot Prevention)
    • Fibrinolytic Agents (Clot Busters)
    • Anti-Platelets (Glide & Slide)
    • Drug Interactions
    • Drugs Used in Bleeding Disorders
  • 16. Case Study
  • 17.
    • LR is a 37 yr old, female who returned from an Australian vacation 3 days prior to presenting at clinic. She is experiencing deep left calf pain which came on suddenly yesterday. Her left leg is enlarged, warm & tender to touch. A diagnosis of DVT is made and Heparin 5,000 units IV q 4 hr (1am, 5am, 9am, 1pm, 5pm, 9pm) is started.
    • Wt 90kg Ht 5’6” BP 110/80 HR 80 T 37
    • Current Meds: Ortho-novum 1/35 x 25 yr Cimetidine 200mg prn Maalox prn
    • FH: non-contributing
  • 18. Points to Ponder
    • Assess patient condition and etiology.
    • Discuss initial treatment, monitoring and side effects.
    • Discuss chronic treatment, monitoring and side effects.
    • Comments regarding patient education.