HEMO PHARM.pptx.............................

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1. HEMOSTATICS Drugs used in bleeding disorders.

2. INTRODUCTION   Are generally drugs used to control or stop bleeding (bleeding disorders). Exert their effects on intrinsic and extrinsic cascades.     DRUGS INCLUDE Vitamin K. Plasma fractions Fibrinolytic inhibitors Serine protease inhibitors   VITAMIN K Essential in the final steps of the synthesis of clotting factor II, VII, IX, and X. Vitamin k 1 (phytonadione) is found in diet (leafy green vegetables), Vitamin k 2 (menaquinone) is found in humans and is synthesized by bacteria in the intestines (eg E.Coli). Administration is parenteral or oral as subcutaneous is erratic (low bioavailability) and I.V route should be slow as rapid bolus can produce dyspnea, chest and back ache.     Clinical uses Rx of warfarin overdose (major use). Premature new borns. Multiple /long term antibiotic therapy. Hospitalized patients on parenteral nutrition. Recent surgery.    

3. VITAMIN K Essential in the final steps of the synthesis of clotting factor II, VII, IX, and X. Vitamin k 1 (phytonadione) is found in diet (leafy green vegetables), Vitamin k 2 (menaquinone) is found in humans and is synthesized by bacteria in the intestines (eg E.Coli). Administration is parenteral or oral as subcutaneous is erratic (low bioavailability) and I.V route should be slow as rapid bolus can produce dyspnea, chest and back ache.     Clinical uses Rx of warfarin overdose (major use). Premature new borns. Multiple /long term antibiotic therapy. Hospitalized patients on parenteral nutrition. Recent surgery.     Adverse Effects . Intravascular thrombosis . May cause excessive clotting if used in DIC or upper GIT bleeding.    

4. PLASMA FRACTIONS; Used to treat deficiencies in plasma coagulation factors for example in Hemophiliacs A and B, also known as classical or factor VIII deficiency and Christmas disease or factor IX deficiency respectively.   Examples; Recombinant factor VII and IX products for Hemophilia A and B . Desmopresin acetate – used in Rx of mild hemophilia A and Von Willbrand disease, act by increasing factor VIII activity Ant- inhibitor coagulation complex (Autoplex) – Rx of patients with factor VIII inhibitors . FEIBA (Factor eight inhibitor by passing activity) indication same as for Autoplex . Recombinant activated factor VII (Novosen) – in liver disease and major blood loss in trauma and surgery Cryoprecipitate – obtained from whole blood and used to Rx deficiencies in qualitative abnormalities in fibrinogen as in DIC and liver disease . FFP (Fresh frozen plasma).  

5.   FIBRINOLYTIC INHIBITORS Aminocaproic acid – available as oral and parenteral forms. Chemically similar to lysine and is a synthetic inhibitor of fibrinolysis by competitively inhibiting plasminogen activation. Dose; 6g qid oral.   Tranexamic acid. Analog of aminocaprioic acid. Dose; 15mg/kg loading dose followed by 30mg/kg qid orally.       Clinical uses of Aminocaprioc acid. Rx of bleeding from fibrinolytic therapy. Prophylaxis for re-bleeding from intracranial aneurysms. Adjunct in hemophilia. Decrease bleeding postprostatectomy and post GIT surgery.  

6. SERINE PROTEASE INHIBITORS (Eg Aprotinin). It inhibits fibrinolysis by free plasma and also the plasmin-streptokinase complex (in patients on streptokinase therapy ). Uses ; Coronary artery bypass grafting. Streptokinase overdose . Adverse effects ; Increase risk of myocardial infarction. Stroke. Renal damage. Anaphylaxis. Therefore small test dose is recommended before institution of full therapy.     THANK YOU FOR LISTENING