Transcript EO 003.01 - Part 18 - Blood and Blood Forming Products

Blood and Blood Forming Agents
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EO 003.01 Part 18
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Lesson Overview
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• A Review of Components of the blood.
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• 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
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• 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.
‫• متشکل از پالزما (مايع) و‬
‫حجرات مختلف‬
‫• مواد مغذى و فضله را انتقال‬
‫ميدهد‬
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What I need to know as a pharmacy technician
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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
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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
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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)
(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
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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
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This class of drug includes both
aspirin and clopidogrel.
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Mechanism of Action
Anti-platelets prevent the adhesion of
platelets to one another, preventing clot
formation.
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Anti-platelet Agents
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Indications (Uses)
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• 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.
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Stent
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Anti-platelets
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Side Effects
•Heartburn
•Upset Stomach
•Easy bruising
•Abnormal bleeding (i.e. bleeding of
the gums, blood in the stool or black
tarry stools).
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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
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This class of drugs includes heparins and
warfarin.
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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
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Indications (Uses) - Continued
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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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Side Effects
Anticoagulants
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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
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Important Points
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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
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Fibrinolytic: Streptokinase
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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
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Tranexamic Acid
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Mechanism of Action
Prevents the bodies natural process of
breaking down blood clots from occuring.
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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
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Side Effects
• Headache
• Muscle pain
• Nose stuffiness
• Upset Stomach
• Diarrhea
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Vitamin K
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Mechanism of Action
Promotes production of clotting
factors.
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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
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Iron Supplements
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Mechanism of Action
Minerals are chemical elements
required by living organisms other than
(carbon, oxygen, hydrogen and
nitrogen).
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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.
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Vitamin B12 and Folic Acid
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Vitamins are vital nutrients that our
body obtains from food (our body
cannot produce these compounds on
its own).
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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
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Side Effects
Minimal side effects to include nausea
and upset stomach
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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
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Erythropoietin
Occurs naturally in our body and
regulates the production of red blood
cells.
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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
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Erythropoietin
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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
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Plasma
In blood, the serum is the component
that is neither a blood cell nor a
clotting factor.
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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
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Small volume solutions
(50 – 100ml) are typically used for
delivering medications.
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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
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Fluid Replacement Solutions
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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
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Pre-made solutions are available
commercially.
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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
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Mechanism of Action
Decreases acidity.
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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
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An enzyme that aids in the digestion of
proteins.
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Questions?
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In-class Assignment
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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 antiplatelets?
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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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3.Match the following drugs with their correct class?
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A)Warfarin
B)Asprin
C)Heparin
D)Streptokinase
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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?
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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?
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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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