Diagnostic: PTT is a blood test that looks at
CARDIOVASCULAR how long it takes for blood to clot. Partial
PHARMACOLOGY Thromboplastin Time
Antidote: Protamine Sulfate
NOTES/REVIEWER
Route: SubQ as prophylaxis, IV bolus, IV fluid
INTRINSIC PATHWAYS – closest to the injury Orally = easily destroyed by Heparinase (liver
EXTRINSIC PATHWAY – closest to the wound enzyme), Poorly absorbed orally in GI mucosa
COMMON PATHWAY – merge of I.P & I.E with ________________________________________
the help of calcium, will eventually change as WARFARIN – per orem version of heparin,
stabilized clot before d/c of heparin
STABILIZED CLOT – refers to the final stage LOW MOLECULAR WEIGHT HEPARIN -
of the coagulation process, where the initial Prevent Venous thromboembolism -
platelet plug is reinforced and strengthened Administered Subcutaneous
________________________________________ 7-14 days treatment duration then shift to
ANTI-COAGULANTS – Inhibit clot formation. other heparin per orem
Does not dissolve clots but prevent it. Used in → Reminder: Instruct the patient not to
P.E., Coronary thrombosis and DVT (Deep massage the site of injection (ecchymosis)
Vein Thrombosis)
→ Contraindicated in patients with Strokes,
Patients tendency to clot decrease but an Peptic ulcers and Blood anomalies
increase tendency to bleed
Examples: Enoxaparin Sodium (Lovenox,
THROMBOLYTICS – removes clot Clexane) 40mg/PFS (Pre-filled Syringe)
THROMBI – clot formed in its original site Fondaparinux (Arixtra)
(heart)
EMBOLI – clot formed in another site but has ORAL ANTI-COAGULANT
eventually tracelled to other part of the body 1. Warfarin (Coumadin)
(DVT – Deep Vein Thrombosis, Pulmonary
Embolism) legs to lungs or other part of body Diagnostic monitored: PT (Prothrombin
Time), INR (International Normalised Ration)
THROMBOTIC STROKE – clot originated from (Ok 1.5-2 times the normal)
brain
Inhibit hepatic synthesis of Vitamin K
EMBOLIC STROKE – from the heart
eventually went to the brain Affects Clotting Factor II, VII, IX
HEMORHAGIC STROKE – when brain beed, Delaying prothrombin synthesis in the liver.
aneurysm
2. Dabigatran (Pradaxa)
________________________________________
Stroke prevention and Atrial Fibrillation
HEPARIN – stops coagulation system,
thrombin will not be converted into fibrinogen Food Interaction of Anti-coagulant: Garlic,
to fibrin and will not result to stabilized clot Ginger, Green and Chamomile tea (increase
bleeding)
, ________________________________________ Increase blood flow thereby:
ANTI-PLATELETS 1.) increase oxygen supply.
Role of platelets into coagulation adheres to 2.) decrease oxygen demand by the
the surface of wound myocardium.
Prevent arterial thrombosis Suppress platelet
thrombosis
Effect: Sublingual – onset is 1-3 minutes.
S.Effect: Bleeding and Stomach upset
Transdermal – onset is 30-60min.
Intravenous – onset is 1-3 minutes.
1. ASPIRIN - Oldest non-narcotic analgesic
Examples:
drug still in use. (80 mg/tablet)
1.) Isosorbide Mononitrate (Imdur) 30 mg
4 Effects = Analgesic, Anti-inflammatory,
and 60mg tablets.
Antipyretic, decrease platelet aggregation
(main purpose) so that the patient won’t clot 2.) Nitroglycerin (Deponit 5mg or 10mg
faster patch, Transderm Nitro 5mg Patch).
Pain, fever, inflammation 3.) Isosorbide Dinitrate (Isoket) 10mg / 10ml
ampule, and Isordil 5mg tablets given
2. CLOPIDOGREL (Plavix) 75mg/tablet
sublingually. (IV prep)
Inhibits platelet aggregation by blocking
4.) Glyceryl tinitrate (Nitronal Aqueous) 10mg
activation of glycoprotein IIb / IIIa pathway ->
/10 ml ampule (IV prep)
purpose: it regulates adhesion of plateletes
If you are not yet in hospital sublingual
Discontinued: 7 days pre-surgery its purpose
(initial) --- hospi IV (control)---when already
is to avoid bleeding
had effect oral or patch (controled)
3. TIROFIBAN (Aggrastat)
Taking Nitroglycerin sublingual reminders:
Indication: ACS (Acute Coronary Syndrome)
1.) No more than 3 tablets should taken in a
and patients undergoing PTCA (Percutaneous
10 minute period (one tablet every 5 minutes
transluminal coronary angioplasty)
0-5-10)
Glycoprotein (GP) IIb / IIIa antagonist
2.) Offer sips of water before giving
Usual Dilution: 12.5 mg in D5W 200ml sublingual nitrates – dryness of mouth may
inhibit drug absorption.
3.) Store in original glass container in a cool
NITRATES – open up - act directly on the
place, date bottle when opening and discard
smooth muscle of blood vessels, causing
after 3 months.
relaxation and dilatation.
4.) Side-effect: Headache (Hypotension and
Used to treat angina pectoris = chest pain
Dizziness could also occur).
5.) When carrying it place it in a bag not in the
pocket (body temperature).
__________________________
CARDIOVASCULAR how long it takes for blood to clot. Partial
PHARMACOLOGY Thromboplastin Time
Antidote: Protamine Sulfate
NOTES/REVIEWER
Route: SubQ as prophylaxis, IV bolus, IV fluid
INTRINSIC PATHWAYS – closest to the injury Orally = easily destroyed by Heparinase (liver
EXTRINSIC PATHWAY – closest to the wound enzyme), Poorly absorbed orally in GI mucosa
COMMON PATHWAY – merge of I.P & I.E with ________________________________________
the help of calcium, will eventually change as WARFARIN – per orem version of heparin,
stabilized clot before d/c of heparin
STABILIZED CLOT – refers to the final stage LOW MOLECULAR WEIGHT HEPARIN -
of the coagulation process, where the initial Prevent Venous thromboembolism -
platelet plug is reinforced and strengthened Administered Subcutaneous
________________________________________ 7-14 days treatment duration then shift to
ANTI-COAGULANTS – Inhibit clot formation. other heparin per orem
Does not dissolve clots but prevent it. Used in → Reminder: Instruct the patient not to
P.E., Coronary thrombosis and DVT (Deep massage the site of injection (ecchymosis)
Vein Thrombosis)
→ Contraindicated in patients with Strokes,
Patients tendency to clot decrease but an Peptic ulcers and Blood anomalies
increase tendency to bleed
Examples: Enoxaparin Sodium (Lovenox,
THROMBOLYTICS – removes clot Clexane) 40mg/PFS (Pre-filled Syringe)
THROMBI – clot formed in its original site Fondaparinux (Arixtra)
(heart)
EMBOLI – clot formed in another site but has ORAL ANTI-COAGULANT
eventually tracelled to other part of the body 1. Warfarin (Coumadin)
(DVT – Deep Vein Thrombosis, Pulmonary
Embolism) legs to lungs or other part of body Diagnostic monitored: PT (Prothrombin
Time), INR (International Normalised Ration)
THROMBOTIC STROKE – clot originated from (Ok 1.5-2 times the normal)
brain
Inhibit hepatic synthesis of Vitamin K
EMBOLIC STROKE – from the heart
eventually went to the brain Affects Clotting Factor II, VII, IX
HEMORHAGIC STROKE – when brain beed, Delaying prothrombin synthesis in the liver.
aneurysm
2. Dabigatran (Pradaxa)
________________________________________
Stroke prevention and Atrial Fibrillation
HEPARIN – stops coagulation system,
thrombin will not be converted into fibrinogen Food Interaction of Anti-coagulant: Garlic,
to fibrin and will not result to stabilized clot Ginger, Green and Chamomile tea (increase
bleeding)
, ________________________________________ Increase blood flow thereby:
ANTI-PLATELETS 1.) increase oxygen supply.
Role of platelets into coagulation adheres to 2.) decrease oxygen demand by the
the surface of wound myocardium.
Prevent arterial thrombosis Suppress platelet
thrombosis
Effect: Sublingual – onset is 1-3 minutes.
S.Effect: Bleeding and Stomach upset
Transdermal – onset is 30-60min.
Intravenous – onset is 1-3 minutes.
1. ASPIRIN - Oldest non-narcotic analgesic
Examples:
drug still in use. (80 mg/tablet)
1.) Isosorbide Mononitrate (Imdur) 30 mg
4 Effects = Analgesic, Anti-inflammatory,
and 60mg tablets.
Antipyretic, decrease platelet aggregation
(main purpose) so that the patient won’t clot 2.) Nitroglycerin (Deponit 5mg or 10mg
faster patch, Transderm Nitro 5mg Patch).
Pain, fever, inflammation 3.) Isosorbide Dinitrate (Isoket) 10mg / 10ml
ampule, and Isordil 5mg tablets given
2. CLOPIDOGREL (Plavix) 75mg/tablet
sublingually. (IV prep)
Inhibits platelet aggregation by blocking
4.) Glyceryl tinitrate (Nitronal Aqueous) 10mg
activation of glycoprotein IIb / IIIa pathway ->
/10 ml ampule (IV prep)
purpose: it regulates adhesion of plateletes
If you are not yet in hospital sublingual
Discontinued: 7 days pre-surgery its purpose
(initial) --- hospi IV (control)---when already
is to avoid bleeding
had effect oral or patch (controled)
3. TIROFIBAN (Aggrastat)
Taking Nitroglycerin sublingual reminders:
Indication: ACS (Acute Coronary Syndrome)
1.) No more than 3 tablets should taken in a
and patients undergoing PTCA (Percutaneous
10 minute period (one tablet every 5 minutes
transluminal coronary angioplasty)
0-5-10)
Glycoprotein (GP) IIb / IIIa antagonist
2.) Offer sips of water before giving
Usual Dilution: 12.5 mg in D5W 200ml sublingual nitrates – dryness of mouth may
inhibit drug absorption.
3.) Store in original glass container in a cool
NITRATES – open up - act directly on the
place, date bottle when opening and discard
smooth muscle of blood vessels, causing
after 3 months.
relaxation and dilatation.
4.) Side-effect: Headache (Hypotension and
Used to treat angina pectoris = chest pain
Dizziness could also occur).
5.) When carrying it place it in a bag not in the
pocket (body temperature).
__________________________
