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Drugs With Important Actions On Blood Revisi

This document discusses drugs that act on blood cells and coagulation factors. It describes common causes of anemia like iron, vitamin B12, and follic acid deficiencies. It also covers treatments for deficiencies including iron, vitamin B12, folate, erythropoietin, and myeloid growth factors. The document then discusses drugs that affect coagulation, including anticoagulants like heparin and warfarin, antiplatelet drugs like aspirin, and thrombolytics. It provides details on mechanisms of action and uses for managing disorders of blood cells and coagulation.

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Rudi Agustira
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57 views23 pages

Drugs With Important Actions On Blood Revisi

This document discusses drugs that act on blood cells and coagulation factors. It describes common causes of anemia like iron, vitamin B12, and follic acid deficiencies. It also covers treatments for deficiencies including iron, vitamin B12, folate, erythropoietin, and myeloid growth factors. The document then discusses drugs that affect coagulation, including anticoagulants like heparin and warfarin, antiplatelet drugs like aspirin, and thrombolytics. It provides details on mechanisms of action and uses for managing disorders of blood cells and coagulation.

Uploaded by

Rudi Agustira
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Drugs with Important

Actions on Blood
Agents Used in Anemias and
Hematopoietic Growth Factor
 Blood cells  essential for oxygenation of
tissues, coagulation, protection against
infectious agents, and tissue repair
 The most common cause erytrocyte
deficiency or anemia :
- insufficient supply of iron, vitamin B12, or
folic acid
Blood cells deficiencies
 Iron deficiency  microcytic hypochromic
anemia (the most common type)
 Deficiency of vitamin B12 or folic acid 
megaloblastic anemia
 Pernicious anemia  the most common type of
vit B12 deficiency anemia caused by a defect in
the synthesis of intrinsic factor or by surgical
removal of that part of stomach that secretes
intrinsic factor
 Deficiency in the concentration of various blood
cells can be manifestation of a disease or side
effect of radiation
IRON
 An essential metalic component of heme
 Deficiency this agent occurs most often in:

- women (menstrual blood)


- vegetarian or malnourished individual
- children and pregnant women (increased
requirements)
IRON
Clinical use :
Iron deficiency anemia (the only indication)
Should not be given in hemolytic anemia because iron store
are elevated
Toxicity :
Acute iron intoxication
sign & symptoms : necrotizing gastroenteritis, shock,
metabolic acidosis, coma.
Tx : deferoxamine parenterally, which chelats circulating iron
Chronic iron intoxication
occurs most often in individuals who receive frequent
transfusions; hemochromatosis.
treatment of hemochromatosis is usually by phlebotomy
VITAMIN B12
 Vitamin B12 is cofactor required for the
normal maturation of red blood cells
 It is absorbed from the GI tract in the
presence of intrinsic factor
 The 2 available form of vitamin B12;
cyanocobalamin and hydroxocobalamin
VITAMIN B12
Clinical use
Pernicious anemia
Anemia caused by gastric resection
Vitamin B12 def anemia is almost always
caused by inadequate absorption 
therapy using parentally of vitamin B12
Toxicity :
Has no significant toxicity
FOLIC ACID
 Folic acid is required for normal DNA
synthesis
 Deficiency of this agent usually present as
megaloblastic anemia; increases the risk
of neural tube defect in the fetus (during
pregnancy)
 Folic acid is absorbed from GI tract
FOLIC ACID
Clinical use :
Anemia resulting from folic acid deficiency
Folic acid supplement will correct anemia
but not the neurologic deficits of vit B12
deficiency
Toxicity :
Has no recognized toxicity
HEMATOPOIETIC GROWTH
FACTORS
 Erythropoietin
 Myeloid Growth Factors (Filgrastim,
sargramostrim
Erythropoietin
 Produced by the kidney
 Reduction in its synthesis is responsible for the anemia
of renal failure
 Erythropoietin stimulates the production of red cells and
increases their release from the bone marrow
 Clinical use :
- routinely used for the anemia associated with renal
failure
- patient with other forms of anemia (primary or
secondary bone marrow disorder to cancer
chemotherapy or HIV treatment, bone marrow
transplantation
Myeloid Growth Factor
 Filgrastim (granulocyte colony-stimulating factor; G-CSF)
 Sagramostin (granulocyte-macrophage colony-
stimulating factor; GM-CSF)
 Clinical use :
Both are used to accelerate the recovery of neutrophils
after cancer chemotherapy & to treat other forms of
secondary or primary neutropenia (eg; aplastic anemia,
congenital neutropenia)
 Toxicity :
G-CSF  minimal, sometimes causes bone pain
GM-CSF  fever, arthralgia, capillary damage with
edema, allergic reaction
DRUGS USED IN
COAGULATION DISORDERS
 Include : drugs used in clotting and bleeding
disorder
 Anticlotting drugs :
- anticoagulants
- antiplatelet agents
- thrombolytics
 Drugs that facilitate clotting :
- replacement factors
- vitamin K
- antiplasmin drugs
ANTICOAGULANTS
 Anticoagulants reduce the formation of
fibrin clots
 Three major types of anticoagulants :

- heparin
- direct thrombin inhibitors
- coumarin (eg;warfarin)
Heparin
 Heparin is a large polymers, acidic
 Mechanism of action & Pharmacokinetics:
 activates antithrombin III, which proteolyses factors
including thrombin and factors Xa
 given parenterally, has rapid onset
 Clinical use :
- Deep Vein Thrombosis (DVT)
- pulmonary embolism
- acute myocardial infarction(AMI)
- combination with thrombolytics for revascularization
during angiplasty and placement coronary stent
- DOC when an anticoagulant must be used in
pregnancy (because it does not cross the placental
barrier)
Heparin
 Toxicity :
- increased bleeding  result in
hemorrhagic stroke
- Thrombocytopenia
Coumarin
 Pharmacokinetics :
- the coumarin anticoagulants (eg, warfarin) are small, lipid soluble
- given orally administration
- cross the placenta & potentially dangerous to the fetus
 Mechanism of action :
- interfere with the normal posttranlational modification of clotting in the
liver, depends on vitamin K
 Clinical use
- used for chronic anticoagulants in all of the clinical situations, except in
pregnant women
 Toxicity
- bleeding
- bone defects and hemorrhage in the developing fetus
- because their narrow therapeutics window, the interaction with
barbiturates, carbamazepin, phenytoin (Cytochrome P-450 inducing drug)
increase warfarin clearance and reduce the anticoagulant effects.
Cytochrome P-450 inhibitors (cimetidine, amiodarone, selective serotonin
reuptake inh) reduce warfarin clearance & increase anticoagulant effect
ANTIPLATELET DRUGS
 Platelet agregation is important in clots that form in the
arterial circulation
 Platelet agregation is facilitated by thromboxane, ADP,
fibrin, serotonin, & other substances
 Antiplatelet agregation that inhibit platelet agregation
include :
- aspirine and other NSAIDs
- antagonis of ADP receptor (ticlopidine, clopidogrel)
- inhibitors of phosphodiesterase (dipyridamol, cilostazol)
- glycoprotein II/IIIa receptor inhibitor (abciximab,
tirofiban, eptifibated)
ANTIPLATELET DRUGS
Aspirin and other NSAIDs
 MoA : inhibit thromboxane synthesis by blocking the enzyme
cyclooxigenase
 Clinical Use :
- prevent further infarcts in individuals who had 1 or more
myocardial infarcts
- prevent transient ischemic attacks (TIA) and ischemic strokes

Ticlopidine and clopidogrel


 MoA : irreversible inhibition of the ADP receptor (inhibition of ADP-
mediated platelet agregation)
 Clinical use :
- prevent TIA and ischemic strokes, especially in patient who cannot
tolerate aspirin
- prevent thrombosis in patient who have recently received a
coronary stent
ANTIPLATELET DRUGS
Abciximab
 A monoclonal antibody that reversibly
inhibits the binding of fibrin & other ligand
 Inhibitor trombosit: aspirin, dipiridamol,
tiklopidin.
 Antikoagulan: enoksaprin, heparin, warfarin
 Obat trombolitik: alteplase, anistreplase,
streptokinase, urokinase
 Pengobatan perdarahan: asam
aminnoksproat, protamin sulfat, asam
traneksamat, vitamin K
 Pengobatan anemia: sianokobalamin,
erotropoetin, asam folat, besi
 Pengobatan anemia sel sabit: hidroksiurea

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