Pharmacology-2 2021-2022 PDF

# Pharmacology-2 2021-2022 ## Dietitian Program, Prof Dr Manar A Nader & Dr Ahmed Ramadan ### Drug for Deep Vein Thrombosis and Clotting #### Antiplatelet Drugs Include: * Cyclooxygenase inhibitors (Aspirin) * Adenosine diphosphate (ADP) receptor inhibitors * Clopidogrel * Phosphodiesteras...

# Pharmacology-2 2021-2022 ## Dietitian Program, Prof Dr Manar A Nader & Dr Ahmed Ramadan ### Drug for Deep Vein Thrombosis and Clotting #### Antiplatelet Drugs Include: * Cyclooxygenase inhibitors (Aspirin) * Adenosine diphosphate (ADP) receptor inhibitors * Clopidogrel * Phosphodiesterase inhibitors * Cilostazol * Glycoprotein IIB/IIIA inhibitors (intravenous use only) * Abciximab * Adenosine reuptake inhibitors * Dipyridamole #### Anticoagulant: * Oral Anticoagulants * Warfarin and dicumarol * Parenteral Anticoagulants * Heparin (natural) * Enoxaparin (fractionated heparin) * Deltaparin ### Fibrinolytic Drugs: * Alteplase, urokinase & streptokinase * Pharmacologic uses: administered parenterally to dissolve clots. * Adverse Effects and Interactions: * Hemorrhage and hypersensitivity reactions. * Treatment of Bleeding: * Aminocaproic acid or tranexamic acid inhibits fibrinolysis. #### Aspirin: * The prophylactic treatment of transient cerebral ischemia * To reduce the incidence of recurrent myocardial infarction * To decrease mortality in pre- and post-myocardial infarct patients #### Side Effect: * Bleeding, especially in the gastrointestinal tract due to inhibition of prostaglandin synthesis. * High doses of aspirin and other salicylates have a direct hypoprothrombinemic effect that may increase the anticoagulant effect and thereby increase the likelihood of bleeding. ### Ticlopidine and Clopidogrel: * Prevent the progression or recurrence of acute deep vein thrombosis or pulmonary embolism * Side Effects: bleeding, which may range in severity from mild nosebleed to life-threatening hemorrhage. * Drug-drug interaction: Rifampin or barbiturates induces cytochrome P450 enzymes and thereby decreases the anticoagulant effect of warfarin. Cholestyramine inhibits the absorption of warfarin from the gut. #### Adverse Effect: * Bleeding. Thrombocytopenia and hyperkalemia. #### Indications: * Acute thromboembolic disorders, e.g: peripheral and pulmonary embolism and venous thrombosis. * It is used prophylactically to prevent clotting in arterial and heart surgery, during blood transfusions, and in renal dialysis and blood sample collection. * In vitro to prevent blood or plasma clotting in or on medical devices. #### Treatment of Bleeding: 1. Administering protamine sulfate intravenously (antidote) 2. Severe bleeding might require the administration of fresh frozen plasma. ### Antithrombotic Therapy: Choices **Nonpharmacologic (Prophylaxis)** **Pharmacologic (Prophylaxis and Treatment)** ----------------------------------------------------------------------------------------- Intermittent Pneumatic Compression Unfractionated Heparin (UH) Elastic Stockings Low Molecular Weight Heparin (LMWH) Inferior Vena Cava Filter Oral Anticoagulants * New Agents: e.g. Fondaparinux, Direct anti-Xa inhibitors, Direct anti-lla, etc. 1. **Unfractionated Heparin (UFH)** 2. **Low-Molecular Weight Heparin (LMWH)** * Lovenox (enoxaparin), Fragmin (dalteparin) 3. **Pentasaccharide-Direct Factor Xa Inhibitor** * Arixtra (fondaparinux) ### Hirudins * Alternatives to heparin in case of HIT: Lepirudin, Bivaluridin. * Acts as a direct thrombin inhibitor. * Heparinoids → Danaparoid ### Oral Anticoagulants * Vitamin K antagonists (VKA): Coumadin (warfarin) #### Drug-Drug Interactions: (Most common drug interactions) | Rx ↑ INR | Rx ↓ INR | OTC ↑ Risk of Bleeding | |----------|----------|--------------------------| | Metronidazole | Rifampin | NSAIDS | | Bactrim/Septra | Carbamazepine | Aspirin | | Cipro | Phenytoin | Ginger | | Levaquin | Vitamin K | Gingko biloba | | Fluconazole | | Garlic | | Amiodarone | | | ### New Oral Anticoagulants & New oral anticoagulants (NOAs or NOACs) * Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban) Savaysa (edoxaban) ### Foods: **HIGH** **MODERATE** **LOW** ------------------------------------------ --------------------------------------------------------- ----------------------------------------------------- Broccoli (cooked) Abalone Alfalfa Brussel sprouts Aspargus Beans (green) Cabbage (raw) Avocado Breads, cereal Canola oil Beans (snap) Capscicium Endive (raw) Cabbage (cooked) Carrot Kale Cheese (blue) Cauliflower Lettuce (gourmet) Margarine Celergy Liver Olive oil Cheese (cheddar), milk Parsley Peas Chickpeas (cooked) Silver beet (cooked) Pickle, dill Corn (sweet, kernels. cooked) Soybean oil Red cabbage Eggs and butter Spinach Lettuce (iceberg) Mushrooms Potatoes Pumpkin Rice Sunflower and sesame oil Sweet potato