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Blood and Blood Forming Agents (Insert Dari) EO 003.01 Part 18 AFAMS Lesson Overview (Insert Dari) • A Review of Components of the blood. Insert Dari • Overview of therapeutic classes • Antithrombotics - Anti-platelets - Anticoagulants - Fibrinolytic • Antihemmorhagics - Antifibrinolytics - Vitamin K • Antianemics - Iron preparations - Vitamin B 12 and folic acid - Other antianemics AFAMS Lesson Overview (Insert Dari) Insert Dari • Blood Substitutes and solutions for perfusion - Plasma Proteins - IV solutions - Irrigating solutions - Other hematologic agents AFAMS Blood خون • Composed of plasma and a variety of cells • Transports nutrients and wastes • Contains elements used in repairing damage to blood vessels = clot formation. • متشکل از پالزما (مايع) و حجرات مختلف • مواد مغذى و فضله را انتقال ميدهد Insert Dari • AFAMS AFAMS AFAMS What I need to know as a pharmacy technician (Insert Dari) In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under (B) Blood and Blood Forming Products Insert Dari For each of these medications/classes students must obtain an understanding of: (1) Mechanism of Action (2) Indications (Uses) (3) Efficacy (4) Side Effects AFAMS A01 Antithrombotic Agents (Insert Dari) AFAMS AFAMS Blood clotting is achieved via platelet adhesion, and activation of clotting factors. If an inappropriate blood clot becomes lodged in a vessel the following can occur: (1) (2) (3) (4) Stroke – interruption of blood supply to the brain Heart Attack – interruption of blood supply to the heart Venous Thromboembolism – blood clot in the vein of a limb Pulmonary Embolsim – blood clot in the lung Antithrombotics prevent a blood clot from lodging in a vessel and causing damage via one of two mechanism: (1) Preventing clot formation (2) Breaking down an existing clot AFAMS Insert Dari AFAMS Patient with a DVT of the left leg. Notice the swelling and condition of the skin. Insert Dari AFAMS Anti-platelet Agents (Insert Dari) This class of drug includes both aspirin and clopidogrel. Insert Dari Mechanism of Action Anti-platelets prevent the adhesion of platelets to one another, preventing clot formation. AFAMS Anti-platelet Agents (Insert Dari) Indications (Uses) Insert Dari • To prevent heart attacks and strokes from occuring. • It is used after a heart procedure where stents are inserted to prevent clots from occuring. Note: Aspirin also works as an antiinflammatory and can be prescribed to a patient for that reason aswell. AFAMS Stent (Insert Dari) AFAMS Anti-platelets (Insert Dari) Side Effects •Heartburn •Upset Stomach •Easy bruising •Abnormal bleeding (i.e. bleeding of the gums, blood in the stool or black tarry stools). Insert Dari Important Points •Patients should take this medication around the same time each day. •Check with patients to make sure that they do not have an allergy to aspirin. •Patients should not stop taking these medications unless directed by their doctor. AFAMS Anticoagulants (Insert Dari) This class of drugs includes heparins and warfarin. Insert Dari Mechanism of Action Anticoagulants interfere with the activating of clotting factors which assist in clot formation. Indications (Uses) To prevent inappropriate blood clotting from occuring. Inappropriate clotting can lead to blockages, which can cause heart attacks, strokes and decreased blood supply to limbs and other organs. Patients who are prescribed these medications usually have conditions which put them at increased risk for inappropriate clot formation. AFAMS Anticoagulants (Insert Dari) Indications (Uses) - Continued Insert Dari Heparins: • Unfractionated Heparin (Heparin) • Low Molecular Weight Heparin (i.e. Enoxaparin) Generally used to prevent clot formation in patients who are not mobile (i.e. bedridden in hospital). With lack of movement there is decreased blood blow, which increases the risk of inappropriate clot formation. Warfarin: Generally used to prevent clot formation in patients that have cardiac disorders such as atrial fibrillation, which increases the risk of inappropriate clot formation. AFAMS Side Effects Anticoagulants (Insert Dari) Insert Dari Common • Abnormal bruising • Abnormal bleeding (i.e. gums, blood in stool) • Feeling light headed or dizzy Rare but serious • Heparin Signs of a serious reaction to heparin: - Skin necrosis - A blood clot, warmth, or pain in the leg or arm. • Warfarin - Symptoms of a stroke Change in strength on 1 side is greater than the other, trouble speaking or thinking, change in balance, or blurred AFAMS Anticoagulants (Insert Dari) Important Points Insert Dari Administration: - Heparin (IV or subcutaneous injection) - Enoxaparin (subcutaneous injection) - Warfarin (oral) • Take care to avoid injury or falls as these medications disrupt the normal blood clotting process and subsequent healing. • Warfarin often requires dosage adjustments and laboratory testing of blood. It is very important that patients follow the directions given to them by the doctor or pharmacist. AFAMS Fibrinolytic (Insert Dari) Fibrinolytic: Streptokinase Insert Dari Mechanism of Action A ‘clot buster’. This drugs breaks down existing blood clots. Indication A suspected blood clot in the lungs or a limb. Side Effects Increased risk of major bleeding. AFAMS B02 Anti-hemorrhagics (Insert Dari) AFAMS AFAMS Tranexamic Acid (Insert Dari) Mechanism of Action Prevents the bodies natural process of breaking down blood clots from occuring. Insert Dari Use • To prevent or reduce hemorrhage due to trauma. • Often used in hemophiliacs (blood clotting disorder). • May be used to prevent blood loss during heavy menstruation. AFAMS Tranexamic Acid (Insert Dari) Side Effects • Headache • Muscle pain • Nose stuffiness • Upset Stomach • Diarrhea Insert Dari AFAMS Vitamin K (Insert Dari) Mechanism of Action Promotes production of clotting factors. Insert Dari Indications • May be used to counteract the effects of warfarin if too much warfarin is given. Side effects • Upset stomach if taken orally. • Flushing of the skin. • skin reaction : red pin point dots = a rash AFAMS Antianemics (Insert Dari) AFAMS AFAMS Iron Supplements (Insert Dari) Mechanism of Action Minerals are chemical elements required by living organisms other than (carbon, oxygen, hydrogen and nitrogen). Insert Dari Indications (Use) Used to treat iron-deficient anemia. Side Effects Constipation and nausea. Important Points Good to tell patients to take with food if they have stomach upset. AFAMS Vitamin B12 and Folic Acid (Insert Dari) Vitamins are vital nutrients that our body obtains from food (our body cannot produce these compounds on its own). Insert Dari Indications Used to treat pernicious anemia which is caused by a deficiency in B12 and folate. The body needs vitamin B12 for many things. For example, you need vitamin B12 to make new cells, such as red blood cells, and for your nervous system to work normally. The body needs folic acid to make new cells. It is especially important that pregnant women get enough folic acid, so that their baby can develop normally in the womb. AFAMS Vitamin B12 and Folic Acid (Insert Dari) Side Effects Minimal side effects to include nausea and upset stomach Insert Dari Important Points • Vitamin B12 can be administered as an injection or as an oral tablet. • Folic acid is administered as an oral tablet. AFAMS Other Antianemic Preparations (Insert Dari) Erythropoietin Occurs naturally in our body and regulates the production of red blood cells. Insert Dari Mechanism of Action Erythropoietin (EPO) is the growth factor the simulates the production of red blood cells. Indications Used to treat anemia in patients who are receiving hemodialysis. The kidneys produce EPO, so when kidney function decreases so does EPO production. AFAMS Other Antianemic Preparations (Insert Dari) Erythropoietin Insert Dari Side Effects •Headache •Flu like symptoms (chills, fever etc) •Hypertension Important Points •Administered via intravenous administration. •The use of EPO has been shown to reduce deaths in chronic kidney disease. AFAMS B05 Blood Substitutes and Perfusion Solutions (Insert Dari) AFAMS AFAMS These products are generally managed by the laboratory or blood bank services. Pharmacy is not responsible for providing these products. Insert Dari AFAMS Blood Substitutes and Plasma Protein Fractions (Insert Dari) Plasma In blood, the serum is the component that is neither a blood cell nor a clotting factor. Insert Dari Basically it is the blood plasma with the blood cells removed. Albumin Abundant protein in the serum. Generally used in patients with blood loss/trauma, where the blood volume needs to be replaced and clotting factors replaced. These are administered intravenously. AFAMS AFAMS IV Solutions (Insert Dari) Small volume solutions (50 – 100ml) are typically used for delivering medications. Insert Dari Large volume solutions (250 ml, 500 ml,1000 ml) are used to: - replenish fluids - to provide electrolytes - to provide nutrients such as vitamins and glucose. AFAMS IV Solution Bags (Insert Dari) AFAMS Fluid Replacement Solutions (Insert Dari) These are administered intravenously to patients for the purpose of treating dehydration or maintaining hydration. These solutions can also have medications added to provide an infusion of medication (1) NaCl 0.9% (2) Ringer’s Lactate AFAMS Other Solutions (Insert Dari) Pre-made solutions are available commercially. Insert Dari The composition of pre-made solutions can contain added electrolytes and other molecules. For example: (1) Solutions with added electrolytes/minerals would be given to patients who are deficient in that electrolyte/mineral. (2) Nutrients (amino acids, glucose) would be given to maintain good nutritional status. AFAMS AFAMS Sodium Bicarbonate (Insert Dari) Mechanism of Action Decreases acidity. Insert Dari Indications •To treat electrolyte imbalances (high acid level in the blood). •To treat overdoses of certain medications. •This is no longer used for wound irrigation – Sodium Chloride (NaCl) is preferred. AFAMS AFAMS Chymotrypsin (Insert Dari) An enzyme that aids in the digestion of proteins. Insert Dari AFAMS Questions? (Insert Dari) AFAMS In-class Assignment (Insert Dari) This assignment will consist of 8 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari AFAMS 1. Which of the following is NOT a result of inappropriate clot formation? (Insert Dari) A)Stroke B)Heart Attack C)Constipation D)Swelling of a limb Insert Dari AFAMS 1. Answer: Which of the following is NOT a result of inappropriate clot formation? (Insert Dari) A)Stroke B)Heart Attack C)Constipation D)Swelling of a limb Insert Dari AFAMS 2. Which of the following correctly describes the mechanism of action for anti-platelets? (Insert Dari) A)prevent the adhesion of platelets to one another, preventing clot formation. B)Prevent the activation of clotting factors which assist in clot formation. C) Breaks down existing clots. D)Prevents the body from breaking down existing clots. (Insert Dari) AFAMS 2. Answer: Which of the following correctly describes the mechanism of action for antiplatelets? (Insert Dari) A)prevent the adhesion of platelets to one another, preventing clot formation. B)Prevent the activation of clotting factors which assist in clot formation. C) Breaks down existing clots. D)Prevents the body from breaking down existing clots. (Insert Dari) AFAMS 3.Match the following drugs with their correct class? (Insert Dari) A)Warfarin B)Asprin C)Heparin D)Streptokinase Insert Dari Drug classes can be used more than once 1)Antifibrinolytic 2)Anti-coagulant 3)Anti-platelet AFAMS 3. Answer: Match the following drugs with their correct class? (Insert Dari) A)Warfarin (2) Anti-coagulant B)Asprin (3) Anti-platelet C)Heparin (2) Anti-coagulant D)Streptokinase (1) Antifibrinolytic Insert Dari AFAMS 4. Which of the following can be used to reverse the effects of warfarin? (Insert Dari) A)Vitamin D B)Tranexamic Acid C)Vitamin K D)Sodium Bicarb Insert Dari AFAMS 4. Answer: Which of the following can be used to reverse the effects of warfarin? (Insert Dari) A)Vitamin D B)Tranexamic Acid C)Vitamin K D)Sodium Bicarb Insert Dari AFAMS 5. Which of the following best describes the common side effect(s) of iron? (Insert Dari) A)Diarrhea B)Constipation and nausea C)Increased heart rate D)Drowsiness Insert Dari AFAMS 5. Answer: Which of the following best describes the common side effect(s) of iron? (Insert Dari) A)Diarrhea B)Constipation and nausea C)Increased heart rate D)Drowsiness Insert Dari AFAMS 6. Which of the following is NOT an antianemic preparation? (Insert Dari) A)Iron (ferrous) B)Folic Acid (folate) C)Vitamin K D)Vitamin B12 Insert Dari AFAMS 6. Answer: Which of the following is NOT an antianemic preparation? (Insert Dari) A)Iron (ferrous) B)Folic Acid (folate) C)Vitamin K D)Vitamin B12 Insert Dari AFAMS 7. True or False: The pharmacy department is responsible for supplying blood products to the hospital. (Insert Dari) AFAMS 7. True or False: The pharmacy department is responsible for supplying blood products to the hospital. (Insert Dari) Answer: False, the laboratory or blood bank services are responsible for providing blood prodcuts to the hospital. Insert Dari AFAMS 8. Large volume IV solutions are used to do the following except for? (Insert Dari) A)Rehydrate B)Deliver nutrients C)Replace electrolytes D)Deliver medications Insert Dari AFAMS 8. Answer: Large volume IV solutions are used to do the following except for? (Insert Dari) A)Rehydrate B)Deliver nutrients C)Replace electrolytes D)Deliver medications (generally smaller IV bags are used) Insert Dari AFAMS