heparin in detail : mechanism of action, pharmacokinetics, clinical uses, adverse effect and contraindication of heparin and low molecular heparin.
for undergraduates.
heparin in detail : mechanism of action, pharmacokinetics, clinical uses, adverse effect and contraindication of heparin and low molecular heparin.
for undergraduates.
Please find the power point on Pharmacology of Anticoagulants, antiplatelets . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Drugs that help prevent the clotting (coagulation) of blood
Coagulation will occur instantaneously once a blood vessel has been severed.
Blood begins to solidify to prevent the excessive blood loss and to prevent invasive substances from entering the bloodstream.
USED IN VIVO
A. PARENTRAL ANTICOAGULANTS
B. ORAL ANTICOAGULANTS
USED IN VITRO
A.HEPARIN
B.CALCIUM COMPLEXING AGENTS
PARENTRAL ANTICOAGULANTS
1. INDIRECT THROMBIN INHIBITORS
Heparin, Low molecular weight heparins, Fondaparinux,Donaparoid
2. DIRECT THROMBIN INHIBITORS
Lepirudin, Bivalirudin, Argatroban
ORAL ANTICOAGULANTS
1. COUMARIN DERIVATIVES
Bishydroxycoumarin (dicumarol), Warfarin sod, Acenocoumarol,
(Nicoumalon), Ethylbiscoumacetate
2.INDANDIONE DERIVATIVES
Phenindione
3.DIRECT FACTOR Xa INHIBITORS
Rivaroxaban
4.ORAL DIRECT THROMBIN INHIBITOR
Dabigatran, etexilate
USED IN VITRO
1.HEPARIN
2. CALCIUM COMPLEXING AGENTS
SODIUM CITRATE
SODIUM OXALATE
SODIUM EDETATE
Heparin is a non uniform mixture of straight chain mucopolysaccharides with molecular weight 10000 to 20000
It contains polymers of two sulfated diasaccharide units
D –glucosamine-L-iduronic acid
D-glucosamine-D-glucoronic acid
Heparin
It is present in all tissues containing mast cells, richest sources are lung, liver and intestinal ,mucosa
Anticoagulants have been thoroughly covered in this SlideShare, including an overview with typical examples, their function in the human body and how they operate (MOA), side effects, contraindications, and uses.
Since they are known to regulate blood clotting, it is crucial to keep an eye on their blood levels lest they have a fatal impact on a patient on anticoagulant treatment.
also we have added novel anticoagulants which got approval in just few years.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
2. INTRODUCTION
Anticoagulants and antiplatelet drugs both reduce the risk
of blood clots.
They are often called blood thinners but actually they do
not really thin blood.
Antiplatelet interferes with the binding of the platelets, or
process that actually starts the formation of blood clots .
Anticoagulants interfere with the proteins in blood that are
involved in coagulation. These proteins are called factors.
3. DEFINITIONS
Anticoagulant is an agent that is used to
prevent the formation of blood clots.
Anticoagulant is a drug that prevents or slows
down the process of blood clotting. They delay
or reduce the process of blood clot formation
12. INDICATION &USAGE
• S/C: In venous thrombosis 15,000 units
injection every 12 hours.
• I/V: In unstable angina and venous
thromboembolism 5000 units ( 10,000 units in
severe pulmonary embolism) IV loading dose
followed by 1000-2000 units/hour continuous
infusion.
• Open heart surgery: 150-300 units per kg.
13. MECHANISM OF ACTION
• Heparin increases the inhibitory action of
antithrombin III (AT III) on clotting factors XIIa,
XIa, IXa, Xa and thrombin.
• This inhibits the conversion of Prothrombin to
thrombin and fibrinogen to fibrin.
• It also inhibits platelet function. It may reduce
the activity of ATIII at very high doses.
14.
15. INDICATIONS
1. Prevention and treatment of venous thrombosis
and pulmonary embolism
2. Treatment of atrial fibrillation with embolization
3. Diagnosis and treatment of DIC
4. Prevention of clotting in blood samples and
heparin lock sets and during dialysis procedures
5. Unlabelled uses: Adjunct in therapy of coronary
occlusion with acute MI, prevention of left
ventricular thrombi and CVA post-MI,
prevention of cerebral thrombosis in the
evolving CVA
16. CONTRAINDICATIONS
Patients predisposed to active bleeding including thrombocytopenia, peptic
ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders,
bacterial endocarditis, severe hypertension, oesophageal varices.
Recent surgery at sites where haemorrhage would be an especial risk.
Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage,
abdominal or thoracic bleeding into closed space, severe traumatic bleed,
hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial
thrombosis with heparin-associated thrombocytopenia. IM admin.
17. SIDE EFFECTS
• Slight fever, headache, chills, nausea, vomiting,
constipation, epistaxis, bruising, slight
haematuria, skin necrosis (SC inj), osteoporosis,
alopecia. Hypersensitivity reactions include
urticaria, conjunctivitis, rhinitis, asthma,
angioedema and anaphylactic shock. Priapism.
• Potentially fatal: Heparin-induced
thrombocytopenia with or without thrombosis;
bleeding.
19. NURSING IMPLICATIONS
• History: Recent surgery or injury; sensitivity to
heparin; hyperlipidaemia; pregnancy.
• P/E: Renal function tests, Blood coagulation
tests, peripheral perfusion, platelet count .
• Adjust tests according to blood coagulation
results.
• Should not give I/M.
• Check for signs of bleeding.
• Use heparin lock needle to avoid repeated
injections.
21. MECHANISM OF ACTION
Enoxaparin is a low molecular weight
heparin with anticoagulant properties.
It acts by enhancing the inhibition rate of
activated clotting factors including
thrombin and factor Xa through its action
on antithrombin III.
22. ROUTE & DOSAGE
• Prevention of venous thromboembolism during
surgical procedures: Low to moderate risk: 20 mg
(2000 units) once daily with the 1st dose 2 hours
postoperatively, In high risk: 40 mg (4000 units) once
daily with the 1st dose 12 hours postoperatively.
• Deep vein thrombosis adult: 1 mg (100 units)/kg every
12 hours for 5 days and until oral anticoagulation are
established.
• Unstable angina: 1 mg/kg (100 units/kg) every 12
hours for 5 days and until oral anticoagulation is
established
23. INDICATIONS
Prevention of DVT after knee, hip or
abdominal surgery
Treatment of DVT and pulmonary
embolism.
Management of acute coronary
syndrome.
25. NURSING CONSIDERATIONS
• Lab tests: Baseline coagulation studies; periodic
CBC, platelet count, urine and stool for occult
blood.
• Monitor platelet count closely. Withhold drug
and notify physician if platelet count less than
100,000/mm3.
• Monitor closely patients with renal insufficiency
and older adults who are at higher risk for
thrombocytopenia.
• Monitor for and report immediately any sign or
symptom of unexplained bleeding.
28. MECHANIMS OF ACTION
Warfarin inhibits synthesis of vit K-dependent
coagulation factors VII, IX, X and II and
anticoagulant protein C and its cofactor protein
S.
No effects on established thrombus but further
extension of the clot can be prevented.
31. SIDE EFFECTS
Hypersensitivity, rash, alopecia, diarrhoea, drop
in haematocrit, purple toes syndrome, skin
necrosis, jaundice, nausea, vomiting, hepatic
dysfunction, pancreatitis, increased LFT.
Potentially Fatal: Haemorrhage.
32. NURSING CONSIDERATIONS
• Do not use drug if patient is pregnant (heparin is
anticoagulant of choice); advise patient to use
contraceptives.
• Monitor PT ratio or INR regularly to adjust
dosage.
• Administer IV form to patients stabilized on
Coumadin who are not able to take oral drug.
Dosages are the same. Return to oral form as
soon as feasible.
• Do not give patient any IM injections.
33. PHENINDIONE
• It is an indandione derivatives.
• It is now rarely used due to its severe adverse
effects.
• Phenindione inhibits vitamin K reductase,
resulting in depletion of the reduced form of
vitamin K (vitamin KH2).
• The synthesis of vitamin K-dependent
coagulation factors II, VII, IX, and X and
anticoagulant proteins C and S is inhibited.
34. INDICATION AND DOSAGE
• Thrombolytic disorders: Initially , 200 mg in 2
equal doses on day 1 followed by 100 mg on
day 2 .
• Maintence : 50- 150 mg daily depending on
the coagulation tests.
37. DIRECT THROMBIN INHIBITORS
• Direct thrombin inhibitors are a class of
anticoagulants drug that act by directly
inhibiting the enzyme thrombin (IIa).
• There are 3 kinds of DTIs:
1. Bivalent
2. Univalent
3. Allosteric inhibitors
38. ARGATROBAN
• Generic name: Argatroban
• Brand name: Acova, Novastan
• Availability: 250 mg/2.5 mL vials
• Action: It is derived from L arginine. It
reversibly binds to the thrombin active site. It
inhibits thrombin reaction, activation of
coagulation factors.
39. INDICATIONS
Prevention and treatment of
thrombosis caused by heparin
induced thrombocytopenia.
also indicated for use in patients with,
or at risk for, HIT who are undergoing
percutaneous coronary intervention.
41. SIDE EFFECTS
• Body as a Whole: Fever, sepsis, pain, allergic
reactions (rare).
• CV: Hypotension, cardiac arrest, ventricular
tachycardia.
• GI: Diarrhoea, nausea, vomiting, coughing,
abdominal pain. Hematologic: Major GI bleed,
minor GI bleeding, haematuria, decrease
Hgb/Hct, groin bleed, Hemoptysis, brachial bleed.
• Respiratory: Dyspnea. Urogenital: UTI.
42. NURSING IMPLICATIONS
• Heparin-Induced Thrombocytopenia: Monitor aPTT. Dose
adjustment may be needed to reach the target aPTT.
• Monitor cardiovascular status carefully during therapy.
• Monitor for and report S&S of bleeding: Ecchymosis,
epistaxis, GI bleeding, haematuria, Hemoptysis.
• Note: Patients with history of GI ulceration, hypertension,
recent trauma, or surgery are at increased risk for bleeding.
• Monitor neurologic status and report immediately focal or
generalized deficits.
• Lab tests: Baseline and periodic ACT (activated clotting
time), thrombin time (TT), platelet count, Hgb & Hct; daily
INR when argatroban and warfarin are co-administered;
periodic stool test for occult blood; urinalysis.
44. FACTOR Xa INHIBITORS
• Factor Xa inhibitors are a type of
anticoagulant that work by selectively and
reversibly blocking the activity of clotting
factor Xa.
• Factor Xa is generated by both the extrinsic
and intrinsic coagulation pathways and is
responsible for activating Prothrombin to
thrombin.
46. ACTION
It acts as a selective,
reversible site inhibitor of
factor Xa, inhibiting both free
and bound factor but does
not affect platelet aggression.
47. INDICATIONS
• Decreases risk of stroke/systemic embolism
• Prevention of deep vein thrombosis following
knee/hip replacement surgery
• Treatment of and reduction in risk of
recurrence of deep vein thrombosis (DVT) or
pulmonary embolism (PE)
49. SIDE EFFECTS
• Ocular haemorrhage, GI bleeding,
hematemesis, Hemoptysis, melena, epistaxis,
thrombocytopenia, Syncope, rash,
menorrhagia.
50. NURSING IMPLICATIONS
• Advice female patient to notify health care
professions if pregnancy is planned.
• Assess patients for the symptoms of stroke
and PVD periodically.