+

Hematology
Shan Nanji

Aspirin (ASA)
n

Irreversible COX 1 and COX 2 inhibitor

Great anti-platelet drug (81mg)

Acidic
PC02

HCO3

pH

FIRST

DECREASES

INCREASES

SECOND

DECREASES DECREASES DECREASES

THIRD -gaba INCREASES DECREASES DECREASES

Shan Nanji - NanjiMD@gmail.com

Acid/Aspirin Overdose
n

Just drop the base

Shan Nanji - NanjiMD@gmail.com

ADP Receptor Inhibitors

nClopidogrel
nTiclopidine
nPrasugrel
nTicagrelor

Shan Nanji - NanjiMD@gmail.com

ADP Receptor Inhibitors

MOA:
Inhibit Platelet Aggregation
n Irreversibly Blocking ADP Receptors
n Inhibit Fibrinogen Binding
n Prevents Glycoprotein IIb/IIIa binding to Fibrinogen
n

Clinical Use:
n Acute Coronary Syndrome
n Coronary Stents
n Decrease Chance of Thrombotic Stroke

S/E:
n

Neutropenia
n Associated with Ticlopidine

Shan Nanji - NanjiMD@gmail.com

Warfarin
MOA:
n Interferes With:
n -Carboxylation of Vitamin K Clotting Factors
n Factors

II,VII, IX, X, Protein C and S

n Increase PT (Extrinsic Pathway)
n Long Half-life
n Clinical

Use:
n Anticoagulation Therapy (Chronic or Long Term)

Shan Nanji - NanjiMD@gmail.com

Warfarin
n S/E:
n

Bleeding

Skin and Tissue Necrosis

Contraindicated in Pregnancy
n Crosses Placenta

Shan Nanji - NanjiMD@gmail.com

Warfarin
nWarfarin

Overdose

Give Vitamin K

Fresh Frozen Plasma (Severe Cases that need Rapid Reversal)

Shan Nanji - NanjiMD@gmail.com

Heparin
MOA:
n Promotes Antithrombin Activation
n Works as a Cofactor
n Decrease Thrombin and Factor Xa
n Short Half-life
n

Clinical Use:
n Immediate Anticoagulation in:
n Pulmonary Embolism
n Acute Coronary Syndrome
n MI
n DVT

Shan Nanji - NanjiMD@gmail.com

10

Heparin
nS/E:
n Bleeding
n Heparin

Induced Thrombocytopenia (HIT)

n Osteoporosis

Shan Nanji - NanjiMD@gmail.com

11

Heparin
nHeparin
n Treat

Overdose:

with Protamine Sulfate

n Binds

Shan Nanji - NanjiMD@gmail.com

Heparin

12

Thrombolytics
nalTePlAse

(tPA)
nRetePlAse (rPA)
nTeNeKTePlAse (TNK-tPA)

Alteplase (tPA), Reteplase (rPA), Tenecteplase (TNK-tPA)

n

Thrombolytics

Shan Nanji - NanjiMD@gmail.com

13

Thrombolytics
MOA:
n Aids

in Conversion of Plasminogen to Plasmin

n Thrombin and Fibrin Clot Cleavage
n Increase PT
n Increase PTT
n Clinical

Use:

Early MI
n Early Ischemic Stroke
n Direct Thrombolysis of Severe Pulmonary Embolism
n

Shan Nanji - NanjiMD@gmail.com

14

Thrombolytics
n S/E:

Bleeding
n Contraindicated:
n Active Bleeding
n Recent Surgery
n Intracranial Bleeding in Past
n Severe Hypertension
n

Shan Nanji - NanjiMD@gmail.com

15

Thrombolytics
nThrombolytic
n Treat

Overdose:

with Aminocaproic Acid

n Inhibits

Shan Nanji - NanjiMD@gmail.com

Fibrinolysis

16

Anticoagulation Therapy
nCilostazol,
MOA:

Dipyridamole

n Inhibits

Phosphodiesterase III
n Increase cAMP in Platelets
n Inhibits Platelet Aggregation

n Clinical

Use:

Intermittent Claudication
n Coronary Vasodilation
n Prevent Strokes and TIAs (with Aspirin)
n

Angina Prophylaxis

Shan Nanji - NanjiMD@gmail.com

17

Anticoagulation Therapy
nCilostazol,

Dipyridamole

nS/E:
Nausea
n Headache
n Flushing
n HypOtension
n

Abdominal Pain

Shan Nanji - NanjiMD@gmail.com