Transcript General Pharmacology - Respiratory Therapy Files

General Pharmacology
Neuromuscular Blocking Agents
(NMBAs)
• Cause skeletal muscle weakness or
paralysis for purpose of preventing
movement
Neuromuscular Blocking Agents
(NMBAs)
• Cause skeletal muscle weakness or paralysis for
purpose of preventing movement
Two types
1. Depolarizing agents
2. Non-depolarizing agents
Depolarizing Agents
Bind to acetylcholine receptor sites causing
a post-synaptic membrane depolarization
Prevention of repolarization causes the
post-synaptic ending to become refractory
and unexcitable, resulting in muscle flaccidity



Prevents acetylcholine from binding at
the receptor site
Shorter acting than non-depolarizing
agents
Will cause total muscle paralysis in 60 to
90 seconds that lasts from 10 to 15
minutes
Do not have reversing agents
Generic name
Succinylcholine
Produce paralysis and muscle weakness by
competing with acetylcholine for binding at the
receptor site
Prevention of the binding of acetylcholine
prevents depolarization of the site, thereby
preventing muscle contraction
Action

Action

Non-Depolarizing Agents
Proprietary name
Anectine


Competitive inhibition of acetylcholine at
muscle post-synaptic receptor site
Effects felt in 2 to 10 minutes and last for 30 to
60 minutes
May be reversed by cholinesterase
inhibitors, e.g., Neostigmine
Generic Name
Proprietary Name
Rapacuronium
Raplon
Pancuronium
Pavulon
Cisatracurium
Nimbex
Vecuronium
Norcuron
Rocuronium
Zemuron, Esmeron
Indications
Indications
- Short acting paralytic ideal for
intubation or similar procedures
-
Need for longer term paralysis
Patient-ventilator synchrony
Muscle relaxation during surgery
-
Indications
-
Reduction of intracranial pressure
Immobility in trauma patientsMinimize oxygen consumption
Indications for NMBAs
•
Endotracheal intubation
•
Muscle relaxation during surgery
•
Enhancement of patient-ventilator synchrony
•
Reduction of intracranial pressure in intubated patients
•
Minimizes oxygen consumption
•
Facilitation of procedures or diagnostic studies
•
Maintenance of immobility, e.g., trauma patients (Flail Chest)
Depolarizing Agents
• Bind to acetylcholine receptor sites
causing a post-synaptic membrane
depolarization
Depolarizing Agents
• Prevention of repolarization causes the
post-synaptic ending to become
refractory and unexcitable, resulting in
muscle flaccidity
Non-Depolarizing Agents
• Produce paralysis and muscle
weakness by competing with
acetylcholine for binding at the
receptor site
Non-Depolarizing Agents
• Prevention of the binding of
acetylcholine prevents depolarization
of the site, thereby preventing muscle
contraction
Depolarizing Agents
• Generic name
– Succinylcholine
• Proprietary name
– Anectine
Depolarizing Agents
• Action
– Prevents acetylcholine from binding at the
receptor site
– Shorter acting than non-depolarizing agents
Depolarizing Agents
• Action
– Will cause total muscle paralysis in 60 to 90
seconds that lasts from 10 to 15 minutes
– Do not have reversing agents
Depolarizing Agents
• Indications
– Short acting paralytic ideal for intubation or
similar procedures
Depolarizing Agents
• Side effects and hazards
– May induce sympathomimetic response
• Tachycardia
• Increase in blood pressure
• Vagal response in repeated dosages leading to
bradycardia and hypotension
Depolarizing Agents
• Side effects and hazards
– May induce sympathomimetic response
• Make provoke release of histamines
• Increase in intracranial pressure in patients with
cerebral edema or head trauma
Depolarizing Agents
• Side effects and hazards
– May induce sympathomimetic response
• Malignant hyperthermia – caused by genetic defect of
muscle metabolism
– Hypoventilation
Depolarizing Agents
• Route of administration
– Intravenous administration
• Dosage
– 1.0 to 1.5 mg/kg
Non-Depolarizing Agents
Generic Name
Proprietary Name
Cisatracurium
Nimbex
Pancuronium
Pavulon
Mivacurium
Mivacron
Vecuronium
Norcuron
Non-Depolarizing Agents
• Action
– Competitive inhibition of acetylcholine at muscle
post-synaptic receptor site
– Effects felt in 2 to 10 minutes and last for 30 to
60 minutes
– May be reversed by cholinesterase inhibitors,
e.g., Neostigmine
Non-Depolarizing Agents
• Indications
– Need for longer term paralysis
– Patient-ventilator synchrony
– Muscle relaxation during surgery
Non-Depolarizing Agents
• Indications
– Reduction of intracranial pressure
– Immobility in trauma patients
– Minimize oxygen consumption
Non-Depolarizing Agents
• Side effects and hazards
– Vagolytic effects including tachycardia,
increase in mean blood pressure, and increase
in release of norepinephrine; seen most with
Pancuronium
Non-Depolarizing Agents
• Side effects and hazards
– Release of histamine from mast cells
• Vasodilation leading to flushed appearance
• Reflex tachycardia
• Bronchospasm
– Hypoventilation
Non-Depolarizing Agents
• Route of administration
– Intravenous
Non-Depolarizing Agents
• Dosage
– Tubocurarine
• 0.5 – 0.6 mg/kg infused at 0.08 – 0.12 mg/kg/hr
– Pancuronium
• 0.08 – 0.1 mg/kg infused at 1 µg/kg/min
– Vecuronium
• 0.1 – 0.2 mg/kg infused at 1 µg/kg/min
• https://www.youtube.com/watch?v=UFz
qD53LvMY
Narcotics and Analgesics
• Used for the relief of severe pain
Narcotics and Analgesics
• Opioid analgesics – high potency
– Morphine
• Route of administration
– Oral: (Adults > 50 kg) – 30 mg q3 – q4 hours
– Intravenous: (Adults > 50 kg)
» Single Dose: 4 – 10 mg q3 – q4 hours
» Continuous: 0.8 – 10 mg/hr
– Intramuscular: 4 – 10 mg q3 – q4 hours
Narcotics and Analgesics
• Opioid Analgesics – high potency
– Oxymorphone - (proprietary name – Numorphan)
• Route of administration
– Intravenous: 0.5 mg q3 – 6 hours
– Intramuscular: 1.0 – 1.5 mg q3 – 6 hours
Narcotics and Analgesics
• Opioid analgesics – high potency
– Fentanyl - (proprietary name – Sublimaze, subsys,
Duragesic…)
• Route of administration
– Intravenous: 2 mcg/kg (moderate); 2 – 20 mcg/kg (high)
– Intramuscular: same as IV
– LOLLYPOP
Narcotics and Analgesics
• Opioid analgesics – high potency
– Methadone - (proprietary name – Dolophine)
– Used to overcome Heroine addiction also
• Route of administration
– Oral: 10 mg
– Intravenous: 5 mg
• Methadone is mainly used in the treatment of
opioid dependence. It has cross-tolerance
with other opioids including heroin and
morphine, offering very similar effects and a
longer duration of effect. Oral doses of
methadone can stabilise patients by
mitigating opioid withdrawal syndrome.
Higher doses of methadone can block the
euphoric effects of heroin, morphine, and
similar drugs. As a result, properly dosed
methadone patients can reduce or stop
altogether their use of these substances.
Narcotics and Analgesics
• Opioid Analgesics – high potency
– Hydromorphone - (proprietary name – Dilaudid)
• Route of administration
– Oral: 4 – 8 mg q3 – 4 hours
– Intravenous
» Single dose – 1.5 mg q3 – 4 hours
» Continuous – 0.2 – 30 mg/hr
– Intramuscular: 1.5 mg q3 – 4 hours
Narcotics and Analgesics
• Opioid analgesics – intermediate potency
– Meperidine - (proprietary name – Demerol)
• Route of administration
– Oral: 50 – 150 mg q3 – 4 hours
– Intravenous
» Single dose: 50 – 150 mg q3 – 4 hours
» Continuous: 15 – 35 mg/hr
– Intramuscular: 50 – 150 mg q3 – 4 hours
Narcotics and Analgesics
• Opioid analgesics – intermediate potency
– Oxycodone - (proprietary names – Percolone,
Oxycontin; with acetaminophen – Percocet
• Route of administration
– Oral: 5 – 10 mg q3 – 4 hours
– Oral: time release capsule – q12 hours
Narcotics and Analgesics
• Opioid analgesics – low potency
– Codeine - (proprietary name – Paveral)
• Route of administration
– Oral
» Analgesic: 15 – 60 mg q3 – 6 hours
» Antitussive: 10 – 20 mg q4 – 6 hours
– Intravenous: 15 – 60 mg q4 – 6 hours
– Intramuscular: 15 – 60 mg q4 – 6 hours
Other Narcotics
• Subutex (Meperidine)
• Ultram ODT (Tramadol)
• Butrans (budprenorphine)
Narcotics and Analgesics
• Opioid analgesics
– Action – not completely understood, but affect
neurotransmission at specific sites in the CNS,
affect autonomic nervous system transmission
Narcotics and Analgesics
• Opioid analgesics
– Indications
• Relief of pain
• Fentanyl used as analgesic supplement to general
anesthesia
• Methadone used as substitute for heroin, etc
Narcotics and Analgesics
• Opioid analgesics
– Side effects and hazards
• Hypotension
• Transient hyperglycemia
• Depression of respiratory system
• Cough reflex decreased
• Nausea and vomiting
Narcotics and Analgesics
• Opioid analgesics
– Contraindications
• Hypersensitivity/allergy to agent
• Head trauma
Narcotics and Analgesics
• Opioid analgesics
– Route of administration
• Oral (PO)
• Intravenous (IV)
• Intramuscular (IM)
• Subcutaneous (SubQ)
Narcotic Antagonists
• Action
– Competitive replacement of narcotic from
receptor site
• Indication
– Reversal of the effects of a narcotic
Narcotic Antagonists
• Partial antagonists
– Side effects
• Cause narcotic-like effects in absence of a narcotic
• Increased respiratory depression in non-narcotic
overdose
Narcotic Antagonists
• Pure antagonists
– Does not increase respiratory depression if
administered in a non-narcotic overdose
Narcotic Antagonists
• Pure antagonists
– Naloxone - (proprietary name – Narcan)
– Naltrexone and Nalmefene
• Route of administration
– Initial dose: 0.4 to 2 mg IV
– May be repeated at 2 to 3 minute intervals
– May be given IM or subcutaneously if IV unavailable
Sedatives and Hypnotics
• Causes longer generalized depression of
the central nervous system
• http://www.youtube.com/watch?v=68Nag
Ut9DzY
Sedatives and Hypnotics
• Anti-anxiety agents
– Lorazepam - (proprietary name – Ativan)
http://www.youtube.com/watch?v=oG-LHYO8ggg
• Route of administration
– Oral: 2 to 6 mg/d.
– Intramuscular: 0.05 mg/kg
– Intravenous
» Intermittent dose: 0.02 to 0.06 mg/kg q2 to q6 hours
» Infusion rate: 0.01 to 0.10 mg/kg/h
Sedatives and Hypnotics
• Anti-anxiety agents
– Midazolam - (proprietary name – Versed)
• Route of administration
– Intramuscular: 0.07 to 0.08 mg/kg
– Intravenous (for conscious sedation)
» Intermittent dose: 0.02 to 0.08 mg/kg q30 minutes to
q2 hours
» Infusion rate: 0.04 to 0.2 mg/kg/hr
Sedatives and Hypnotics
• Anti-anxiety agents
– Haloperidol - (proprietary name – Haldol)
• Oral: 0.5 to 2 mg BID
• Intramuscular: 2 to 5 mg q4 to q8 hours as needed
• Intravenous
– Intermittent dose: 0.03 to 0.15 mg/kg q30 minutes to q6
hours
– Infusion rate: 0.04 to 0.15 mg/kg/hr
– Haloperidol is a dopamine inverse agonist of the
typical antipsychotic/Schizophrenic/Delerium
Sedatives and Hypnotics
• Anti-anxiety agents
– Propofol - (proprietary name – Diprivan)
• Induction – 40 mg q10 seconds until induction achieved
• Maintenance – 5 to 80 µg/kg/min
• http://www.youtube.com/watch?v=i1GdGMOJw4c
Sedatives and Hypnotics
• Barbiturates
– Thiopental - (proprietary name – Pentothal)
• Route of administration
– Intravenous: 3 to 7 mg/kg
– Used in some states for lethal injection
Sedatives and Hypnotics
• Barbiturates
– Secobarbital - (proprietary name – Seconal)
• Route of administration
– Pre-operative sedation: 200 to 300 mg 1 to 2 hours Before
surgery
– At night: 100 mg PO at hs
– Used as a sleep aid for insomnia
Sedatives and Hypnotics
• Barbiturates
– Phenobarbital
– used to treat or prevent seizures. Phenobarbital is also used
short-term as a sedative to help you relax.
• Route of administration
– Oral
» Sedation – 30 to 120 mg/d in two to three divided doses
» Hypnotic – 100 to 200 mg
barbiturate and the most widely used anticonvulsant
worldwide, and the oldest still commonly used
Sedatives and Hypnotics
• Barbiturates
– Phenobarbital
• Route of administration
– Intramuscular
» Sedation – 30 to 120 mg 60 to 90 minutes before
surgery
» Hypnotic – 100 to 320 mg
Sedatives and Hypnotics
• Barbiturates
– Phenobarbital
• Route of administration
– Intravenous
» Same as intramuscular
Sedatives and Hypnotics
• Etomidate:
• used for: Inducing general anesthesia
and with other medications to provide
anesthesia during short surgeries
• rapid onset of action, usually within one
minute: IDEAL for intubation
Sedatives and Hypnotics
• Precedex: indicated for sedation of
initially intubated and mechanically
ventilated patients. administered by
continuous infusion not to exceed 24
hours. It is not necessary to discontinue
Precedex prior to extubation.
Sedatives and Hypnotics
• Hypnotics
– Methaqualone - (proprietary name – Quaalude)are
a synthetic, barbiturate-like, central nervous system
depressant. Methaqualone is an anxiolytic and a sedativehypnotic drug. Quaaludes were introduced as a safe
barbiturate substitute, but they later showed that the
possibility of addiction and withdrawal symptoms were
similar to those of barbiturates. More common as a street drug
Sedatives and Hypnotics
• Hypnotics
– Flurazepam - benzodiazepine similar to Valium.
Flurazepam affects chemicals in the brain that
may be unbalanced in people with
sleep problems (insomnia).
Sedatives and Hypnotics
• Hypnotics
– Diazepam - (proprietary name – Valium)
• Route of administration
– Oral: 2 to 10 mg bid to qid
– Intramuscular: 2 to 20 mg repeated in three to four hours
– Intravenous: 0.03 to 0.01 mg/kg q30 minutes to q6 hours
Sedatives and Hypnotics
• Action
– Depression of ascending reticular activating
system resulting in loss of consciousness
Sedatives and Hypnotics
• Indications
– Sleep induction
– Relief of anxiety
– Relief of depression
Sedatives and Hypnotics
• Indications
– Anticonvulsant
– Voluntary muscle relaxation
Sedatives and Hypnotics
• Side effects
– Drowsiness
– Impaired performance and judgment
– Potential for abuse
– Hangover effect
Sedatives and Hypnotics
• Contraindications
– Hypothyroidism
– Hypoadrenalism
Sedatives and Hypnotics
• Routes of administration
– Oral (PO)
– Intravenous (IV)
– Intramuscular (IM)
– Subcutaneous (SubQ)
Diuretic Agents
•
Osmotic diuretics are solutes that oppose the passive movement
of water during sodium transport. The rapid loss of sodium and
water occurs by inhibiting their reabsorption in the proximal
tubule. These low-molecular-weight substances create an
opposing osmotic force and contribute to a decreased fluid
reabsorption and increased urine volume. Osmotic diuretics also
cause sodium excretion to increase because of significant back
diffusion. Because water reabsorption is inhibited and sodium
transport is occurring, a sodium concentration gradient develops.
As a result of the high concentration gradient back diffusion
occurs.
•
Alteration of the re-absorption of water within the nephron system
• http://www.youtube.com/watch?v=6Wc4
f2KnbYo
• http://www.youtube.com/watch?v=JJAM
YHAwCMs&feature=related
Classification of Diuretics
• Osmotic diuretics
– Interfere with the water re-absorption in the
descending loop of Henle and in the proximal
tubule
– Used to treat or prevent acute renal failure
Classification of Diuretics
• Osmotic diuretics
– Mannitol
• Route of administration - IV
– Reduction of intracranial pressure – 1.5 to 2 g/kg as a 15%
to 25% solution over 30 to 60 minutes
Mannitol
• Mannitol is used to reduce acutely raised intracranial
pressure until more definitive treatment can be
applied, e.g., after head trauma. It is also used to
treat patients with oliguric renal failure. It is
administered intravenously, and is filtered by the
glomeruli of the kidney, but is incapable of being
resorbed from the renal tubule, resulting in decreased
water and Na+ reabsorption via its osmotic effect.
Consequently, mannitol increases water and Na+
excretion, thereby decreasing extracellular fluid
volume.
• Mannitol can also be used as a facilitating agent for
the transportation of pharmaceuticals directly into the
brain.
Classification of Diuretics
• Carbonic anhydrase inhibitors
– Prevent re-absorption of sodium and bicarbonate
ions in the proximal tubule
– Weak agents used to lower intraocular pressure in
glaucoma
Carbonic anhydrase inhibitors
• suppress the activity of carbonic
anhydrase. Their clinical use has been
established as antiglaucoma agents,
diuretics, antiepileptics, in the
management of mountain sickness,
gastric and duodenal ulcers,
neurological disorders, or osteoporosis
Classification of Diuretics
• Carbonic anhydrase inhibitors
– Acetazolamide (proprietary name – Diamox)
• Route of administration - orally
– Diuresis in CHF – 250 to 375 mg (5 mg/kg) qd in the
morning
– May be used for severe metabolic alkalosis
Classification of Diuretics
• Carbonic anhydrase inhibitors
– Methazolamide - (proprietary name – Neptazane)
• Route of administration - orally
– Reduction of intraocular pressure – 50 to 100 mg bid
Classification of Diuretics
• Loop diuretics
– Inhibit absorption of chloride ions in the
ascending loop of Henle
– Used to treat hypertension, acute CHF, chronic
renal failure, ascites
Classification of Diuretics
• Loop diuretics
– Furosemide - (proprietary name – Lasix)
• Route of administration - orally or IV
– Acute pulmonary edema – 40 mg IV over 1 to 2
minutes
Lasix
• Furosemide, a 'water pill,' is used to
reduce the swelling and fluid retention
caused by various medical problems,
including heart or liver disease. It is also
used to treat high blood pressure. It
causes the kidneys to get rid of
unneeded water and salt from the body
into the urine.
Lasix
• The tendency, as for all loop diuretics,
to cause low potassium levels
(hypokalemia) has given rise to
combination products, either with
potassium itself (e.g. Lasix-K) or with
the potassium sparing diuretic of
amiloride
Classification of Diuretics
• Loop diuretics
– Furosemide
• Administered orally
– Chronic edema – 20 to 80 mg/d PO initially; may be
given q6 to q8 hrs
– Hypertension – 40 mg PO bid
Classification of Diuretics
• Loop diuretics
– Ethacrynic acid - (proprietary name – Edecrin)
• Administered orally or IV
– Edema – initial dose of 50 to 100 mg/d PO; 0.5 to 1.0
mg/kg IV administered slowly over several minutes
Classification of Diuretics
• Thiazide diuretics
– Block sodium and chloride ion re-absorption
in the distal tubule
– Used to treat hypertension and CHF
Classification of Diuretics
• Thiazide diuretics
– Chlorothiazide - (proprietary name – Diuril)
• Administered orally or IV
– Edema – 0.5 to 2.0 g PO or IV qd to bid
– Hypertension – 0.5 to 2 g/d PO; IV not recommended
Classification of Diuretics
• Thiazide diuretics
– Chlorthalidone - (proprietary name – Thalitone)
• Administered orally
– Edema – 50 to 100 mg/d PO
– Hypertension – 25 – 100 mg/d based on patient
response
Classification of Diuretics
• Thiazide diuretics
– Hydrochlorothiazide - (proprietary name –
HydroDiuril)
• Administered orally
– Edema – 25 – 200 mg qd PO
– Hypertension – 12.5 – 50 mg PO initially; 25 – 100 mg
qd maintenance
Classification of Diuretics
• Thiazide diuretics
– Methyclothiazide - (proprietary name –
Aquatensen)
• Administered orally
– Edema – 2.5 – 10 mg qd PO
– Hypertension – 2.5 – 5 mg qd PO
Classification of Diuretics
• Potassium sparing diuretics
– Block sodium re-absorption in the distal tubule
and collecting duct
– Used to treat chronic liver disease and in CHF
to counteract the hypokalemic effects of other
diuretics
Classification of Diuretics
• Potassium sparing diuretics
– Spironolactone - (proprietary name – Aldactone)
• Administered orally
– Edema – 100 – 200 mg/d PO
– Essential hypertension – 50 – 100 mg/d PO
Classification of Diuretics
• Potassium sparing diuretics
– Triamterene - (proprietary name – Dyrenium)
• Administered orally
– Diuresis – 100 mg bid PO
Classification of Diuretics
• Indications
– Used for diuresis in patients with excessive
fluid such as with congestive heart failure,
hypertension, and acute and chronic renal
failure
Classification of Diuretics
• Side effects
– Hypokalemia
– Acid-base alterations
– Hyperglycemia
Steroids
• A class of hormonal agents produced
naturally by the body to regulate various
metabolic functions; artificially produced
versions are used to mimic the normal
agents
Steroids
• Actions
– In the context of the ICU, prevention or
suppression of inflammatory responses caused
by hypersensitivity
– Decrease capillary permeability in edema
Steroids
• Indications
– Presence of allergic or non-allergic inflammatory
response
• Asthma
• Chronic obstructive pulmonary disease
Steroids
• Indications
– Suppression of immune response in organ
transplant patients
Steroids
• Side effects from systemic administration
– Cushing’s disease
• Moon face
• Hirsutism
• Muscle wasting
• Hypokalemia
Steroids
• Side effects from systemic administration
– Hypertension
– Atrophy of the adrenal glands
– Obesity
– Suppression of growth
Steroids
• Side effects from systemic administration
– Thinning of skin
– Osteoporosis
– Immunosuppression
– Masks infection
Steroids
• Hydrocortisone
– (proprietary names – Cortaid, Aquacort)
– Routes of administration – oral, topical,
intramuscular, intravenous
• Intramuscular & intravenous: 100 to 500 mg initially,
then q 2 to q10 hours
Steroids
• Cortisone
– (proprietary name –
– Cortone)
– Routes of administration
• Oral: 25 to 300 mg/d
• Intramuscular: 20 to 330 mg/d
Steroids
• Prednisone
– Route of administration
• Oral: initial dose variable depending upon severity of
symptoms; maintenance dose of 5 to 60 mg/d PO
Solu-Medrol
• Potent IV steroid for COPD/Asthma
exacerbations
• 40, 125, 500 mg doses
Anti-Thrombotic Agents
• Anti-coagulant agents
– Action
• Potentiates the inhibitory effect of anti-thrombin on
Factor Xa and thrombin
• Prevents the conversion of fibrinogen to fibrin
• http://www.youtube.com/watch?v=ac_om5HCjvg&featur
e=related
Anti-Thrombotic Agents
• Anti-coagulant agents
– Indications
• Prophylaxis and treatment of thrombo-embolic
disorders
• (Pulmonary emboli, stroke, MI…)
Anti-Thrombotic Agents
• Anti-coagulant agents
– Side effects
• Excessive bleeding
• Hypersensitivity
• http://www.youtube.com/watch?v=Lt0BjNwF6IU
Anti-Thrombotic Agents
• Anti-coagulant agents
– Heparin
• Route of administration
– Intravenous
» Bolus – 10,000 units
» Continuous infusion – 20,000 to 40,000 units
infused over 24 hours
Anti-Thrombotic Agents
• Anti-platelet agents
– Action
• Inhibits platelet aggregation
– Indications
• Reduction of risk of myocardial infarction, stroke, and
peripheral vascular disease
• Artrial fibrillation
• The most important antiplatelet drugs
are:
• Cyclooxygenase inhibitors
– Aspirin
• Adenosine diphosphate (ADP) receptor
inhibitors
– Clopidogrel (Plavix)
– Prasugrel (Effient)
– Ticagrelor (Brilinta)
– Ticlopidine (Ticlid)
Anti-Thrombotic Agents
• Anti-platelet agents
– Side effects
• Increased risk of bleeding
• Safety not established in pregnancy
Anti-Thrombotic Agents
• Anti-platelet agents
– Clopidogrel - (proprietary name – Plavix)
• Route of administration
– Oral
» Daily – 75 mg PO
» Acute coronary syndrome – 300 mg initially, then 75
mg once daily
Anti-Thrombotic Agents
• Anti-platelet agents
– Acetylsalicylic Acid - (proprietary name – Aspirin)
• Route of administration
– Oral: for prevention of myocardial infarction – 300 to 325
mg/d; dosage as low as 80 mg/d may be effective
Anti-Thrombotic Agents
• Thrombolytic agents
– Action
• Converts plasminogen to plasmin, which is then able to
degrade fibrin in clots
Anti-Thrombotic Agents
• Thrombolytic agents
– Indications
• Acute myocardial infarction
• Massive pulmonary embolism
• Deep vein thrombosis
• Acute ischemic stroke
Anti-Thrombotic Agents
• Thrombolytic agents
– Side effects
• Intracranial hemorrhage
• Bleeding
Anti-Thrombotic Agents
• Thrombolytic agents
– Streptokinase - (proprietary name – Streptase)
• Route of administration – intravenous
– Myocardial infarction – 1.5 million units IV
– Deep vein thrombosis, pulmonary emboli – 250,000 units
loading dose, then 100,000 units/hr for 24 hours