Agents used in coagulation disorders

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Agents used in coagulation disorders

  1. 1. Agents Used in Coagulation Disorders
  2. 3. Clot Risk Factors <ul><li>Over 40 years old </li></ul><ul><li>Obese </li></ul><ul><li>Best rest > 4 days </li></ul><ul><li>Estrogen & estrogen with nicotine </li></ul><ul><li>Pregnancy, surgery, major illness </li></ul>
  3. 4. Blood Coagulation Mechanism <ul><li>Definitions </li></ul><ul><li>GUT </li></ul><ul><ul><li>Vitamin K role </li></ul></ul><ul><li>Circulation </li></ul><ul><ul><li>Clotting factors </li></ul></ul><ul><ul><li>Prothrombin – Thrombin </li></ul></ul><ul><ul><li>Fibrinogen -- Fibrin </li></ul></ul>
  4. 5. Indications <ul><li>Venous thrombosis </li></ul><ul><li>Pulmonary Embolism (PE) </li></ul><ul><li>Prosthetic Heart Valve </li></ul><ul><li>Myocardial Infarction (MI) </li></ul><ul><li>Cerebral Vascular Disease </li></ul><ul><li>Coronary Heart Disease </li></ul>
  5. 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
  6. 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
  7. 8. Anti-Coagulant Agents (Clot Prevention) <ul><li>Heparin </li></ul><ul><li>MOA </li></ul><ul><li>Toxicity </li></ul><ul><ul><li>Protamine sulfate </li></ul></ul><ul><li>Dose </li></ul><ul><li>Administration </li></ul><ul><li>Enoxaprin </li></ul><ul><ul><li>(Lovenox) </li></ul></ul><ul><ul><li>Low molecular weight heparins </li></ul></ul><ul><li>Warfarin (Coumadin) </li></ul><ul><li>MOA </li></ul><ul><li>Toxicity </li></ul><ul><ul><li>Mephyton(Vitamin K) </li></ul></ul><ul><li>Dose/Administration </li></ul><ul><li>Drug interactions </li></ul><ul><li>Patient education </li></ul>
  8. 9. Fibrinolytic Agents (Clot Busters) <ul><li>Pharmacology </li></ul><ul><ul><li>Streptokinase/Urokinase </li></ul></ul><ul><ul><li>Anistreplase/TPA (Activase) </li></ul></ul><ul><li>Indications </li></ul><ul><ul><li>Pulmonary Emboli (PE) </li></ul></ul><ul><ul><li>Deep Venous Thrombosis (DVT) </li></ul></ul><ul><ul><li>Acute Myocardial Infarction (MI) </li></ul></ul>
  9. 11. Anti-Platelets (Glide & Slide) <ul><li>Indications </li></ul><ul><li>Pharmacology </li></ul><ul><ul><li>ASA </li></ul></ul><ul><ul><li>Clopidogrel (Plavix) </li></ul></ul><ul><ul><li>Ticlopidine (Ticlid) </li></ul></ul><ul><li>Toxicity </li></ul><ul><li>Patient Education </li></ul>
  10. 12. Stroke <ul><li>Recognize the signs </li></ul><ul><li>Ask three questions </li></ul><ul><ul><li>Ask the individual to SMILE </li></ul></ul><ul><ul><li>Ask him or her to RAISE both arms </li></ul></ul><ul><ul><li>Ask the person to SPEAK a simple sentence </li></ul></ul><ul><li>Trouble with any task call 9-1-1 </li></ul>
  11. 13. Drugs Used in Bleeding Disorders <ul><li>Vitamin K (Mephyton) </li></ul><ul><li>Protamine Sulfate </li></ul><ul><li>Plasma Fractions </li></ul><ul><li>Fibrinolytic Inhibitors </li></ul><ul><ul><li>Aminocaproic acid (Amicar) </li></ul></ul>
  12. 14. Drug Interactions <ul><li>Increase Bleed Time </li></ul><ul><li>THE most serious are any that increase OAC effect and increase BLEEDING! </li></ul><ul><li>Decrease Bleed Time </li></ul>
  13. 15. Summary Slide <ul><li>Blood Coagulation Mechanism </li></ul><ul><ul><li>Clot Risk Factors </li></ul></ul><ul><li>Anti-Coagulant Agents (Clot Prevention) </li></ul><ul><li>Fibrinolytic Agents (Clot Busters) </li></ul><ul><li>Anti-Platelets (Glide & Slide) </li></ul><ul><li>Drug Interactions </li></ul><ul><li>Drugs Used in Bleeding Disorders </li></ul>
  14. 16. Case Study
  15. 17. <ul><li>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. </li></ul><ul><li>Wt 90kg Ht 5’6” BP 110/80 HR 80 T 37 </li></ul><ul><li>Current Meds: Ortho-novum 1/35 x 25 yr Cimetidine 200mg prn Maalox prn </li></ul><ul><li>FH: non-contributing </li></ul>
  16. 18. Points to Ponder <ul><li>Assess patient condition and etiology. </li></ul><ul><li>Discuss initial treatment, monitoring and side effects. </li></ul><ul><li>Discuss chronic treatment, monitoring and side effects. </li></ul><ul><li>Comments regarding patient education. </li></ul>

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