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Blood and Blood Forming Agents(Insert Dari)

EO 003.01 Part 18

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Lesson Overview(Insert Dari)

• A Review of Components of the blood.

• Overview of therapeutic classes

• Antithrombotics- Anti-platelets- Anticoagulants- Fibrinolytic

• Antihemmorhagics- Antifibrinolytics- Vitamin K

• Antianemics- Iron preparations- Vitamin B 12 and folic acid- Other antianemics

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Lesson Overview(Insert Dari)

• Blood Substitutes and solutions for perfusion

- Plasma Proteins - IV solutions- Irrigating solutions- Other hematologic agents

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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.

• ) حجرات ) و مايع پلازما از متشکلمختلف

ميدهد • انتقال را فضله و مغذى مواد•Insert Dari

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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

For each of these medications/classes students must obtain an understanding of:

(1) Mechanism of Action

(2) Indications (Uses)

(3) Efficacy

(4) Side Effects

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A01 Antithrombotic Agents(Insert Dari)

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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)Stroke – interruption of blood supply to the brain

(2)Heart Attack – interruption of blood supply to the heart

(3)Venous Thromboembolism – blood clot in the vein of a limb

(4)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

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Patient with a DVT of the left leg. Notice the swelling and condition of the skin.

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Anti-platelet Agents(Insert Dari)

This class of drug includes both aspirin and clopidogrel.

Mechanism of Action

Anti-platelets prevent the adhesion of platelets to one another, preventing clot formation.

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Indications (Uses)

• 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 anti-inflammatory and can be prescribed to a patient for that reason aswell.

Anti-platelet Agents(Insert Dari)

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Stent(Insert Dari)

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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).

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.

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Anticoagulants(Insert Dari)

This class of drugs includes heparins and warfarin.

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.

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Anticoagulants(Insert Dari)

Indications (Uses) - Continued

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.

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Anticoagulants(Insert Dari)

Side Effects

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

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Anticoagulants(Insert Dari)

Important Points

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.

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Fibrinolytic(Insert Dari)

Fibrinolytic: Streptokinase

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.

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B02 Anti-hemorrhagics(Insert Dari)

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Tranexamic Acid (Insert Dari)

Mechanism of Action

Prevents the bodies natural process of breaking down blood clots from occuring.

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.

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Tranexamic Acid (Insert Dari)

Side Effects

• Headache

• Muscle pain

• Nose stuffiness

• Upset Stomach

• Diarrhea

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Vitamin K (Insert Dari)

Mechanism of Action

Promotes production of clotting factors.

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

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Antianemics(Insert Dari)

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Iron Supplements (Insert Dari)

Mechanism of Action

Minerals are chemical elements required by living organisms other than (carbon, oxygen, hydrogen and nitrogen).

Indications (Use)

Used to treat iron-deficient anemia.

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Side Effects

Constipation and nausea.

Important Points

Good to tell patients to take with food if they have stomach upset.

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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).

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.

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Vitamin B12 and Folic Acid(Insert Dari)

Side Effects

Minimal side effects to include nausea and upset stomach

Important Points

• Vitamin B12 can be administered as an injection or as an oral tablet.

• Folic acid is administered as an oral tablet.

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Other Antianemic Preparations(Insert Dari)

Erythropoietin

Occurs naturally in our body and regulates the production of red blood cells.

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.

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Other Antianemic Preparations(Insert Dari)

Erythropoietin

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.

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B05 Blood Substitutes and Perfusion Solutions

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These products are generally managed by the laboratory or blood bank services. Pharmacy is not responsible for providing these products.

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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.

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.

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IV Solutions(Insert Dari)

Small volume solutions (50 – 100ml) are typically used for delivering medications.

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.

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IV Solution Bags(Insert Dari)

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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

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Other Solutions(Insert Dari)

Pre-made solutions are available commercially.

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.

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Sodium Bicarbonate(Insert Dari)

Mechanism of Action

Decreases acidity.

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.

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Chymotrypsin (Insert Dari)

An enzyme that aids in the digestion of proteins.

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Questions? (Insert Dari)

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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.

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1. Which of the following is NOT a result of inappropriate clot formation?

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A) Stroke

B) Heart Attack

C) Constipation

D) Swelling of a limb

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1. Answer: Which of the following is NOT a result of inappropriate clot formation?

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A) Stroke

B) Heart Attack

C) Constipation

D) Swelling of a limb

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2. Which of the following correctly describes the mechanism of action for anti-platelets?

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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.

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2. Answer: 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.

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3.Match the following drugs with their correct class? (Insert Dari)

A) Warfarin

B) Asprin

C) Heparin

D) Streptokinase

Drug classes can be used more than once

1) Antifibrinolytic

2) Anti-coagulant

3) Anti-platelet

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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

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4. Which of the following can be used to reverse the effects of warfarin?

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A) Vitamin D

B) Tranexamic Acid

C) Vitamin K

D) Sodium Bicarb

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4. Answer: Which of the following can be used to reverse the effects of warfarin?

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A) Vitamin D

B) Tranexamic Acid

C) Vitamin K

D) Sodium Bicarb

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5. Which of the following best describes the common side effect(s) of iron?

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A) Diarrhea

B) Constipation and nausea

C) Increased heart rate

D) Drowsiness

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5. Answer: Which of the following best describes the common side effect(s) of iron?

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A) Diarrhea

B) Constipation and nausea

C) Increased heart rate

D) Drowsiness

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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

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6. Answer: Which of the following is NOT an antianemic preparation?

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A) Iron (ferrous)

B) Folic Acid (folate)

C) Vitamin K

D) Vitamin B12

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7. True or False: The pharmacy department is responsible for supplying blood products to the

hospital.

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7. True or False: The pharmacy department is responsible for supplying blood products to the

hospital.

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Answer: False, the laboratory or blood bank services are responsible for providing blood

prodcuts to the hospital.

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8. Large volume IV solutions are used to do the following except for?

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A) Rehydrate

B) Deliver nutrients

C) Replace electrolytes

D) Deliver medications

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8. Answer: Large volume IV solutions are used to do the following except for?

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A) Rehydrate

B) Deliver nutrients

C) Replace electrolytes

D) Deliver medications (generally smaller IV bags are used)

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