thrombolytics notes
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
What are anti-coagulants?
What are the difference between antiplatelet, anticoagulants and thrombolytics?
Coagulation cascade
Virchows Triad
Classification of anti-coagulants?
Indications of anti-coagulants?
Mechanism and site of action of different anti-coagulants?
Dr. Nathania Marliani Kristanti, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
A detailed information Thrombolytic or fibrinolytics. Comes under the Drugs affecting the blood and blood forming category. These drugs are used to lyse the clot.
Dr. Nathania Marliani Kristanti, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com
A detailed information Thrombolytic or fibrinolytics. Comes under the Drugs affecting the blood and blood forming category. These drugs are used to lyse the clot.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
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disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
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from mild to severe. A diagnosis of AUD requires that at least two of
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. THROMBOLYTICS
Thrombolytics or fibrinolytics
Definition :
These drugs are used to breakdown of thrombin or clot to reanalyze including
blood vessels .
There are curative rather than prophylactic work by activating the nature
fibrinolytic system.
Venous thrombin are lysed more easily than arterial and recent thrombi respond
better :little effect on thrombin >3days old.
Mechanism:
Fibrinolytics examples :
Streptokinase ,urokinase ,alteplase,reteplase,tenecteplase.
Streptokinase:
2. It is obtained from beta hemolytic Streptococcus Group C.
It is inactive as such combines with circulating plasminogen to
form an active Complex which then causes limited proteolysis of
the Other plasminogen molecules to plasmin. It plasma half life is
estimated to be 30 to 80 minutes.
Streptokinase is antigenic , can cause hypersensitivity reactions
and anaphylaxis, especially when used second time in a patient .
Repeated doses are also less effective due to neutralization by
antibodies. Fever is common , hypertension and arrhythmia are
reported.
Use:
It is least expensive and is still widely used in India and other developing
countries.
Dose :
For Myocardial Infarction: 7.5to 15lac IU
For deep venous thrombosis and pulmonary embolism : 2.5lac IU.
Urokinase :
It is an enzyme isolated from human urine now prepared from
cultured human kidney cells which activates plasminogen directly
and has a plasma half life of 10 to 15 minutes.
It is a non antigenic fever occurs during treatment but
hypotension and allergic phenomena are rare indicated in patients
in home streptokinase has been used for an earlier episode use has
now declined due to introduction of newer fibrinolytics.
Dose:
2.5lac to 10lac IU/vial.
3. Ateplase:
It is also referred as tissue plasminogen activator which is
produced by Recombinant DNA technology from human tissue
culture is specifically activates gel face plasminogen already
bound to fibrin and has little action on circulating plasminogen.
It is rapidly cleared by liver and has a plasma half life of 4to 8
minutes because of the short half life it needs to be given by slow
intravenous infusion and often requires heparin co-administration.
It is known antigenic but nausea and mild hypotension and fever
may occur.
Dose:
50mg vial with 50ml water.
Reteplase :
It is a modified rt-pa that is longer acting but somewhat less
specific for fibrin bound plasminogen .
The longer duration of action enables Bolus dose administration .
Tenecteplase:
It is a mutant variant of rtpa with higher fibrins selectivity and
longer duration of action.
Dose:
A single IV bolus dose of 0.5mg/kg.
Use of Thrombolytics:
1. Acute myocardial infarction :
4. Fibrinolytics are an alternative first-line approach to
emergency percutaneous coronary intervention with stent
placement.
2. Deep vein thrombosis:
Thrombolytics can decrease subsequent pain and
swelling in leg pelvis shoulder and up to 60%
patients can be successfully treated.
3. Pulmonary embolism:
Fibrinolytic therapy is indicated in large and life-
threatening pulmonary embolism.
4. Peripheral arterial occlusion :
fibrinolytics recanalize 40% Limb artery occlusion
especially those treated within 72 hours.
5. Stroke:
Used in the treatment of stroke.
Contraindications :
It is contraindicated in all situations where the risk of bleeding is
increased such as recent trauma surgery biopsies hemorrhagic stroke or
peptic ulcer.
Anti Fibrinolytics
These are the drugs which inhibit plasminogen activation and dissolution of clot.
Epsilon amino caproic acid (EACA) :
It is an analogue of amino acid lysine combines with lysine
binding site of plasminogen and plasmin so it is unable to bind
fibrin and Lysine.
5. It is a specific antidotes for fibrinolytic agent and has been used in
many hyper plasmin anemic states excessive intravascular
fibrinolysis resulting in bleeding.
For example overdose of streptokinase or Uro kinase or ateplase
and to prevent re occurrence of subarachnoid and gastrointestinal
hemorrhage and certain traumatic and surgical bleedings .
Dose:
Tab0.5gm
Tranexaemic acid:
It binds to the Lysine binding site on plasminogen and prevents is combination with
fibrin and is 7 times more potent.
Use:
It is used in the prevention for excessive bleeding in overdose of fibrinolytics and after
cardio pulmonary bypass surgery.
Side effects :
Nausea ,diarrhoea, headache and thrombophlebitis.
Aprotinin:
It is a polypeptide isolated from bovine tissues with polyvalent serine protease inhibitory
activity.
Use:
It reduces blood loss in traumatic hemorrhagic and endotoxic shock.
Dose :
2-5lac KIU. .
6. Reference :
KD Tripathi - textbook of essentials of medical Pharmacology 6th edition pg. no.
605-608.
Thrombolytics haematology by med bullets.
Submitted by
P.Vara lakshmi
PharmD