Module 4

• Agents that prevents hemorrhage or bleeding

  hemostatic drugs
• required (as a cofactor) for the synthesis of the functional molecules g-carboxylic acid in certain coagulating proteins

  Vitamin K: phytomenadione
• The absorption of vitamin K may be inhibited by intestinal disorders
• Its utilization in the synthesis of the clotting factors is impaired in liver disease
• Coumarin anticoagulants and warfarin interfere with the role of vitamin K in the synthesis of active clotting factors II, VII, IX and X
• Vitamin K counteracts the effects of anticoagulant such as Coumarin and warfarin except heparin-induced anticoagulation
• It is used to antagonize heparin-induced hemorrhages

  Protamine sulfate
• what is used for emergency treatment in cases of of acute hemorrhagic syndrome due to deficiency of clotting factors and in thrombocytopenia

  fresh plasma
• Local hemostatic in surgery, as spray or direct application sponge

  Thromboplastin USP
• Used for bleeding from parenchymatous tissues, calcellous bone, dental sockets, laryngeal and nasal surgery

  Used as powder or solution

  One NIH unit equals thrombin required to clot 1 ml of standard fibrinogen solution in 15 minutes

  Thrombin
• Sponge like material prepared by action of thrombin on human fibrinogen, may be applied directly with pressure

  Fibrin foam
• This denaturized gelatin usually is soaked in bovine thrombin and left in bleeding area following closure of operative wounds

  Absorbable gelatin sponge
• Treated surgical gauze or sponge that aids coagulation in reaction between hemoglobin and cellusic acid, upon interaction with blood and tissue fluids, forms gummy matrix for clot formation

  Oxidized cellulose USP
• this causes hemostasis by vasoconstriction

  epinephrine or norepinephrine
• The only anticoagulant drug used parenterally

  heparin sodium
• Endogenous heparin is present in mast cells along with histamine and serotonin
• •Warfarin and bishydrocoumarin are used as systemic anticogulants in humans

  •Toxic in animals
• •Vacuum-dried powder containing streptococcal enzyme

  •In humans, it is use to activate human plasminogen to become plasmin

  •Plasmin liquefies fibrin or clotted blood

  •Indicated in hematoma , pneumonia

  streptokinase
• •Enzyme preparation derived from a fraction of human plasma

  •It is prepared by action of streptokinase on human profibrinolysin

  •Indicated for thrombi and embolism

  Fibrinolysin
• •Excreted in human urine, activates plasminogen

  •Prevents serosal post-operative adhesion

  Urokinase
• are agents that improve the quality of blood by increasing the hemoglobin level and number of RBC

  hematinics
• Ferrous salts are absorbed more efficiently than ferric form
• Factors that enhance absorption of iron in the intestine are erythropoietic activity, bodily iron stores, and anemia
• localized process of abnormal iron pigmentation cause by increased hemosiderin in the tissue

  hemosiderosis
• a systemic disease of uncertain etiology, is characterized by systemic hemosiderosis accompanied by cirrhosis of the liver

  Hemachromatosis
• Treatment of iron toxicosis

  systemic antidote Deferoxamine mesylate chelates iron

  Prevent absorption of iron through gastric lavage using sodium bicarbonate
• its MOA is it Increase formation of erythropoietin by the kidneys and perhaps direct acceleration of heme synthesis and red cell proliferation

  ANDROGENIC-ANABOLIC STEROIDS: Testosterone
• Essential nutrient for nuclear maturation and cell division by converting ribose nucleotide to deoxyribose nucleotides

  •Vitamin B12 (cyanocobalamin)

  •Folic acid
• Deficiency of B12 and folic acid produce large short leave macrocytes since the precursor cells (megaloblast) failed to divide
• Increase the force of myocardial contraction and increase cardiac output of failing heart(dsb)

  POSITIVE INOTROPHIC DRUGS aka Cardiac tonics
• increase the availability of calcium to contractile proteins by competitively binding to and inhibiting the Na+ -K + pump at the myocardial cell membrane. The intracellular accumulation of sodium promotes calcium entry via the Na+ -Ca2+ exchanger

  digitalis glycosides
• Digitalization is usually accomplished in 7 to 14 days
• Examples of sympathomimetics that are used in the treatment of heart failure are:

  •Epinephrine

  •Dopamine

  •dobutamine
• •recommended for short-term use in animals with myocardial failure and in the management of acute oliguric renal failure

  •precursor of norepinephrine

  stimulates cardiac alpha and beta adrenergic receptors as well as peripherally located dopaminergic receptors

  dopamine
• •In clinical situation dobutamine can be used to treat heart failure due to myocardial failure until inotropic support is no longer needed or until other longer-acting drugs have taken effect.•used to treat acute exacerbations of chronic heart failure requiring acute inotropic support
• •rapid clearance of dobutamine is due to degradation of the drug by catechol-o-methyltransferase (COMT)
• They act as inhibitors of Phosphodiesterase III (PDE III).

  BIPYRINE COMPOUNDS
• •is an intracellular enzyme that specifically hydrolyses cAMP in myocardial and vascular tissue. When PDE III is inhibited, intracellular cAMP concentration increases.

  This increase results in the same type of inotropic effect in the myocardium as is produced by sympathomimetics

  Phosphodiesterase III
• what is the pharmacological effect of bipyrine compounds on the arteries

  arteriolar dilatation
• true or false.Amrinone is compatible with dextrose

  false