1 anticoagulant, antiplatelets & hematinics for dentistry

1 anticoagulant, antiplatelets & hematinics for dentistry

• 1.
  Anticoagulants, Antiplateletes &Hematinics
• 2.
  Anticlotting drugs Anticoagulants -↓ blood coagulation • Oral WARFARIN • Parenteral: HEPARINS & HIRUDIN Antiplatelets - ↓ platelete aggregation & thrombus formation • TXA2 Inhibitor: ASPIRIN • ADP Inhibitors: CLOPIDOGREL
• 3.
  WARFARIN Mech of action: •Inhibitsthe synthesis of Vit K •Delayed onset of action (8-12hrs) due to presence of preformed clotting factors in the circulation. •Therapeutic effect is monitored by Prothrombin time & International Normalized Ratio.
• 4.
  Drug interactions: Prothrombin Time(  risk of bleeding) • Hepatic microsomal inhibitors (↓ Metabolism ↑toxicity) Cimetidine, Metronidazole, Ciprofloxacin, Ketoconazole • Displacement from plasma protein ( Sulfonamides ↑toxicity) Prothrombin Time ( therapeutic effects) • Hepatic microsomal Inducers ( ↑ Metabolism & ↓ efficacy) Phenytoin, Carbamazepine, Rifampicin • Cholestyramine (↓ Absorption of Warfarin) WARFARIN
• 5.
  WARFARIN Adverse effects: • Hemorrhage( Needs lab monitoring) • Teratogenicity-Craniofacial deformities, Intracranial hemorrhage • Fat necrosis - skin, breast, fatty tissues. Antidote : Inj. Vit K1 (Phytonadione). Uses : Prophylaxis of • Thromboembolism in Atrial fibrillation • Deep Vein Thrombosis • Thrombosis on Prosthetic heart valves • Extracorporeal circulation Contraindications; Pregnancy & Lactation
• 6.
  Heparins UNFRACTIONATED HEPARIN MOA: • BindsAntithrombin III & potentiates its action 1000 times (Antithrombin III inhibits thrombin (IIa),VIIa, IXa, & Xa) • Rapid onset of action because it acts on preformed clotting factors. • Therapeutic effect is monitored by Activated Partial Thromboplastin Time PK; Given by SC/IV ( IM = Hematomas, to be avoided) • No transplacental passage - safe during pregnancy
• 7.
  Heparins Uses : Prevention& treatment of Deep vein thrombosis, Pulmonary embolism, Acute MI, & Unstable angina. Adverse effects • Haemorrhage (Needs lab monitoring) • Heparin induced Thrombocytopenia (HIT) – > 8 days of therapy • Hypersensitivity • Alopecia • Osteoporosis (> 6 months of therapy) Antidote : Inj Protamine sulphate
• 8.
  Heparins Low Molecular WeightHEPARINS; Enoxaparin, Dalteparin Advantages • ↑ Bioavailability from SC inj, • Long duration of action • Less thrombocytopenia Contraindications of Heparin: • Hypersensitivity to the drug, • Bleeding disorder, • Severe hypertension, • Intracranial hemorrhage, • Ulcerative lesions of GIT,
• 9.
  Direct Thrombin Inhibitors HIRUDINobtained from medicinal leeches (Hirudo medicinalis) • Inhibits Thrombin (IIa) • Administered by IV, • Therapeutic effects monitored by aPTT USES: In patients with thrombosis related to Heparin induced thrombocytopenia Adverse effects: Bleeding & Hypersensitivity
• 10.
  Antiplatelet drugs Inhibit Plateletaggregation thereby ↓ thrombus formation ASPIRIN (Acetyl Salicylic Acid) • At low doses (75-100 mg) inhibits Cyclo-oxygenase by irreversible acetylation  ↓TXA2 synthesis – TXA2 stimulates platelet aggregation USES; • Prophylaxis-Post MI, Cerebral thrombosis, TIA Adverse effects: Bleeding, GI upset,
• 11.
  Antiplatelet drugs CLOPIDOGREL/TICLOPIDINE • InhibitADP mediated platelet aggregation • Synergistic action with Aspirin Uses: Similar to Aspirin & in patients who can not tolerate Aspirin Adv effects (Ticlopidine): • Bleeding, • Severe neutropenia, • Thrombotic thrombocytopenic purpura.
• 12.
  Haematinics • Substances requiredin the formation of blood cells& their deficiency results in anemia. • Vit B12, Folic acid & Iron (Maturation factors for blood cells) Vitamin B12 • Essential for the synthesis of DNA. • Deficiency causes Megaloblastic anemia – Immature red cells in the blood & bone marrow. .
• 13.
  Vitamin B12 Preparations : Parenteral: Cyanocobalamine & Hydroxycobalamin Oral : Methylcobalmin •Prophylaxis & treatment of Megaloblastic anemia (B12 def.) •Pernicious anemia – Given by i.m lifelong. •Prophylaxis during pregnancy & lactation ( ↑ demand)
• 14.
  Folic acid Deficiency: •Dietary deficiency,↑ demand (children, pregnancy & lactation). •Malabsorption • Drug induced. Methotrexate, Cotrimoxazole & Trimethoprim. Manifestations - Megaloblastic anemia, glossitis, diarrhea & weakness Uses: •Treatment of Megaloblastic anemia – given along with vit. B12. •Prophylaxis during pregnancy, lactation, infancy •Prevention of Methotrexate induced toxicity – (Folinic acid or Leucovorin rescue)
• 15.
  Iron Preparations of iron: OralParenteral -Ferrous sulfate Iron dextran i.m/i.v -Ferrous fumerate Iron sorbitol-citric-acid i.m -Ferrous gluconate Sodium ferric gluconate i.v. •Ferrous succinate Adverse effects: Oral route: Epigastric pain, vomiting, metallic taste, constipation (due to astringent effect) staining of teeth & black colored stool Parenteral route: pain & discoloration of skin at the injection site, Arthralgia, lymphadenopathy, Urticarial rash & Anaphylaxis
• 16.
  Iron Indications for parenteraliron therapy: •Intolerance to oral iron. •Failure to absorb oral iron- severe malabsorption,etc •Non-compliance to oral iron •Severe anemia (pregnancy). •Severe deficiency with bleeding. •Along with erythropoietin in patients with renal disease. Antidote : Desferroxamine ( Fe chelating agent)
• 17.
  Erythropoietin • Its secretion↓in patients with renal failure. • Preparation : Recombinant human erythropoietin I.V/S.C. Uses: • Anemia of chronic renal failure • Anemia in AIDS patients treated with Zidovudine • Anemia of Cancer chemotherapy Adverse effects: • Flu like syndrome, Hypertension