Pulmonary Embolism Drugs PDF

Drugs affecting blood Pulmonary embolism  ANGIO – CT PULMONARY ARTERIES GOLD STANDARD PLATELET AGGREGATION TXA2 # Prostacyclin ADP AVP v.Willebrandt factor collagen adrenergic system GP IIb/II...

Drugs affecting blood Pulmonary embolism  ANGIO – CT PULMONARY ARTERIES GOLD STANDARD PLATELET AGGREGATION TXA2 # Prostacyclin ADP AVP v.Willebrandt factor collagen adrenergic system GP IIb/IIIa receptor Aspirin TXA2 (0,075 - 0,5) Ticlopidine ADP (2 x 0,25) Klopidogrel ADP (1 x 0,075) Prasugrel (tabl 5 i 10 mg) wstępnie: 0,3 – 0,6 – 0,9 Abciximab GP IIb/IIIa (0,25 mg/kg 0,125 g/kg/min.) Tirofiban; Lamifiban; Fradofiban GP IIb/IIIa (0,01 mg/kg 0,15 g/kg/min.) Eptifibatyd GP IIb/IIIa (0,18 mg/kg 2 g/kg/min.) Prostacyclin analogues Tikagrelor  Ticlopidine The oldest drug from thienopiridine gr SIDE EFFECT: - Diarrhea - Neutropenia - Hyperlipaemia Anticoagulants  Anticoagulant groups Heparin Low molecular Heparins ( LMH) Hirudin and synthetic analogues Polysaccharide group Antagonists of vitamin K NOAC ( non vit. K antagonist oral anticoagulants) : - Gatranes and Xabanes Coagulation cascade F. XIII F. XII F. Xa Prothrombin (F. II) Ca2+ Thrombin (F. IIa) Fibrinogen Fibrin (F.I) Coagulation cascade and anicoagulants LMH F. XIII F. XII (1-10 kDa) Polysacch.gr Xabanes Heparin F. Xa Hirudin and analogues Gatranes Prothrombin (F. II) Ca2+ Thrombin (F. IIa) Fibrinogen Fibrin (F.I) Anticoagulants - drugs Heparin (APTT monitoring) + ATIII Hirudin and heparinoids – Bivalirudin and Lepirudin (APTT monitoring) effect without ATIII Low molecular Heparins: Enoxaparin; Dalteparin; Nadroparin Polysaccharide group Fondaparinux Idraparinux Antagonists of vitamin K Warfarin (INR monitoring) Acenocumarol Gatranes Xymelagatran (liver toxicity) Dabigatran Xabanes Riwaroksaban Apiksaban Betriksaban Endoksaban  Oral anticoagulants Antagonists of witamin K ( the liver inhibitors of coagulation factors II; VII; IX;X synthetized only in the presence of Vitamin K) INR – international normalate ratio – shoud be used during the treatment (therapeutic arms – 2 – 3,5 Dangerous interactions ! NOAC ( non vit. K antagonist oral anticoagulants) : - Gatranes and Xabanes- well tolerated; side effects reduced; without INR monitoring Thrombolytic( fibrinolitic) Drugs Thrombolytics are the drugs used to lyse clot to recanalize occluded blood vessels Fibrinolytic drugs Plazminogen Site of F. XIII reaction Plazmin Stabilization Fibrin degragation F. Fibrin FIBRYNOLITIC DRUGS ( ANTIGENICITY). Streptokinase Anistreplase Urokinase Alteplase(tPA) Tenecteplase(TNK–tPA)  HALF-LIFE Anistreplase Streptokinase Urokinase Alteplase (tPA) Tenecteplase (TNK–tPA) 0 45 90 min  Fibrinolytic drugs – therapeutic uses Acute ischemic stroke Acute myocardial infartion Acute pulmonary embolism Deep vein thrombosis Arterial thrombosis  Fibrinolytic drugs contraindications Prior ICH Known cerebral vascular lesion IC malignant neoplasm Ischemic stroke – past 3 months Aortic dissection Active bleeding Pregancy