Pharmacology of the blood and blood clot Flashcards
(142 cards)
1
Q
what’s the mechanism of aspirin
A
irreversible inhibitor of cyclooxygenase enzyme → ⭣TXA2 → antithrombotic
- blocks production of TXA2 by acetylation of a serine residue
- permanent for the platelets life (7-10 days)
2
Q
what’s the “proper name” of aspirin
A
acetylsalicylic acid
3
Q
what’s the use of aspirin
A
cardiovascular or cerebrovascular disease, Kawasaki disease
- acute coronary syndrome, ischemic stroke
- other indications → relief of moderate pain, headaches, inflammatory diseases and fever (including rheumatic fever), pregnant women with preeclampsia (low doses in the 2nd trimester)
4
Q
adverse effects of aspirin
A
bleeding, gastric ulcer disease (⭣PGs), tinnitus, kidney injury (chronic aspirin use), allergic reactions (or DRESS syndrome), aspirin exacerbated respiratory disease
5
Q
effect of aspirin in the kidneys
A
- low doses → uric acid retention
- high doses → uric acid excretion
6
Q
what’s Reye syndrome
A
hepatic encephalopathy in children with viral illness when given aspirin
7
Q
what are the contraindications of aspirin
A
- syndrome of asthma, rhinitis and nasal polyps
- children or adolescents w/ viral infections → reye’s syndrome
- increased alcohol consumption increases risk of bleeding
- hemophilia, liver disease, vitamin k deficiency → they’re all bleeding disorders
8
Q
what medications are P2Y12 (ADP) receptor antagonist
A
clopidogrel, prasugrel, ticagrelor, ticlopidine
9
Q
what’s the MOA of clopidrogel
A
P2Y12 receptor antagonist → changes shape of platelets →⭣ IIb/IIIa → no aggregation
- irreversible action
- it’s a prodrug → needs metabolic activation in the liver
- oral administration
10
Q
what’s the use of P2Y12 receptor antagonist (like clopidogrel, prasugrel, etc.)
A
MAIN USE: cardiovascular disease (PCI), alternative to aspirin
- PCI = percutaneous coronary intervention → angioplasty and stenting
- can be used as a dual antiplatelet therapy (DAPT) w/aspirin in:
—-ST-elevation myocardial infarction (STEMI)
—-unstable angina/NSTEMI with recurrent isquemia
—-usually recommended for 1year after MI → then aspirin alone
11
Q
adverse effects of P2Y12 receptor antagonists
A
bleeding, allergic reactions, neutropenia (ticlopidine → this one is irreversible)
thrombotic thrombocytopenic purpura → deficiency of ADAMTS13 → ⭡vWF multimerization
12
Q
what are contraindications for P2Y12 receptor antagonist
A
- CYP2C19 inhibition by PPIs → less effect of clopridrogel
- cimetidine, amiodarone, omeprazole, etc.
- CYP2C19 inducers and opiods
- more risk of bleeding with: anticoagulants, NSAIDs and antidepressants
- nor effective in individuals with genetic polymorphisms of CYP enzimes
13
Q
what meds are glycoprotein IIb/IIIa inhibitors
A
abciximab, eptifibatide, tirofiban
14
Q
what’s abciximab
A
fragment of monoclonal antibody (Fab region vs GPIIb/IIIaR)
15
Q
which med is stronger abciximab or tirofiban
A
abciximab
16
Q
additional uses of tirofiban
A
- additionally from PCI can be used for acute coronary syndrome
- less risk of bleeding
17
Q
mechanisms of abciximab
A
- glycoprotein IIb/IIIa inhibitors → inhibit binding of fibrinogen → inhibition of platelet agregation and thrombus formation
18
Q
are glycoprotein IIb/IIIa inhibitors given orally?
A
NO
given by IV → used in the hospital
19
Q
use of abciximab
A
high risk cardiovascular disease planning for PCI (Percutaneous Coronary Intervention → angioplasty)
used in prevention of thrombotic complications in high-risk patients with unstable angina(NSTEMI) going for PCI
20
Q
adverse effects of glycoprotein IIb/IIIa inhibitors
A
thrombocytopenia, bleeding
**contraindication = px w/ platelets <100,000/mm3
21
Q
what does Heparin due
A
mechanism = potentiates antithrombin → ⭣Xa activity, ⭣IIa (thrombin) activity
22
Q
is heparin fast?
A
yes, it gives immediate anticoagulation
23
Q
what do you have to monitor when giving heparin
A
aPTT (looking at the intrinsic pathway)
24
Q
what types of heparin are there
A
unfractionated heparin
low molecular weight heparin
synthetic heparin
25
uses of heparin
anticoagulation, DVT (deep vein thrombosis) prophylaxis
DOES NOT CROSS PLACENTA
26
how does unfractionated heparin work
short half life, easily reversible
- binds to antithrombin III (ATIII), also to thrombin
27
how does low molecular weight heparin work
⭡bioavailability, longer half-life, renal clearance
- binds to antithrombin III (ATIII), also NOT to thrombin
- administration = always subQ!
28
can you give low molecular weight heparin to everyone?
don’t use if there is renal compromise (⭣creatinine clearance ) → there can be accumulation of LMWH → bleeding risk
29
what types of heparin are LMWH
enoxaparin = heparin E; nadroparin
30
which heparin has an oral administration
synthetic heparin (fondaparinux)
31
name a synthetic heparin
fondaparinux
32
how does fondaparinux work
- only inhibits Xa (indirectly)
- selective → only binds to antithrombin III
- administration = oral
33
if you need to reverse the effect of heparin, which medication can you give your px
protamine sulfate
34
complications of heparin
heparin-induced thrombocytopenia
nephrotic syndrome
35
how does heparin-induced thrombocytopenia work
heparin-induced (consumptive) thrombocytopenia = platelet factor IV/heparin IgG antibodies → platelet activation
takes 5-10 days to happen → presents as DVT with ⭣in platelet count
36
what's the tx for heparin induced thrombocytopenia
direct thrombin inhibitors
37
why does heparin give nephrotic syndrome
all ATIII goes in urine = hypercoagulability state
38
which medications are direct thrombin inhibitors and what are their administrations
bivalirudin, argatroban, dabigatran
- bivalirudin, argatroban → IV
- dabigatran → oral
39
where do direct thrombin inhibitors come from
they are derivatives of hirudin, a modified component of leech saliva
40
what do you have to monitor when giving dabigatran
thrombin time (TT) → less effect on PT and aPTT
41
what type of meds are argatroban and dabigatran
direct thrombin inhibitors
42
when do you give direct thrombin inhibitors
- consider in heparin induced thrombocytopenia and antithrombin III deficiency
- can be used with aspirin (or clopidogrel) to prevent clot in px going to coronary artery surgery
43
which direct thrombin inhibitor has a reversal, and which drug is it
dabigatran reversal = idarucizumab → reverse thrombine inhibition → prevents bleeding
44
when trying to reverse the effects of dabigatran you give idarucizumab alone?
no, you usually combine it with dialysis
45
side effects of direct thrombin inhibitors
dyspepsia and gastritis
risk of bleeding when taken in excess
46
what are contraindications of direct thrombin inhibitors
- hypersensitivity in bivalirudin
- should not be discontinued suddenly → risk of thrombosis and stroke
- don’t use with PPIs
47
mode of administration of warfarin
oral
48
how does warfarin work
mechanism = inhibition of vitamin K epoxide reductase → ⭣gamma-carboxylation on II, VII, IX, X, protein C and S
49
whats the use of warfarin
anticoagulation
50
which medication has a longer half life, warfarin or heparin
warfarin
51
indications for giving warfarin
valvular atrial fibrillation and non-valvular atrial fibrillation
52
what do you have to monitor when giving warfarin
PT/INR = extrinsic pathway
- factor VII has the shorter life span → so it’s easier to check how the tx is working
- ⭡ PT → lower dose
- ⭣PT → elevate dose
53
whats bridging anticoagulation
a strategy used when a patient on warfarin needs to temporarily stop their medication before a procedure or surgery. It involves using a different, short-acting blood thinner, like low-molecular-weight heparin (LMWH), to minimize the time the patient is not adequately anticoagulated and thus reduce the risk of blood clots
54
why is there a transient hypercoagulability state with warfarin
this happens because protein C has a shorter life span, it acts as an inhibitor of homeostasis → if ⭣protein C + other coagulation factors staying up → hypercoagulability state
- bridging anticoagulation may be required → usually w/ heparin
55
what methods of reversal exist for warfarin
- vitamin K (phytomenadione) → slower
- prothrombin complex concentrates (PCC)→ faster = preferred if active bleeding
- if ⭡⭡ PT/IRN
- fresh frozen plasma (FFP) works similarly
56
complications with/of warfarin
- uncontrollable bleeding → more common in the GI
- skin necrosis → most common in px with protein C deficiency (higher risk of hypercoagulability)
- use “heparin bridge” = use LMWH to maintain anticoagulation while a patient temporarily stops taking warfarin → do it for at least 5 days AND until INR is ≥2.0 for 2 consecutive days
- transient hypercoagulability states
- TERATOGENICITY
57
people with what gene have altered effects when given vitamin K antagonist ? AND how do you adjust their dose
px with VKORC1 gene → altered effect on vitamin K antagonists → give lower doses
58
contraindications for giving warfarin
- pregnancy → risk of fetal hemorrhaging, abortion, bone deformities, and neurological abnormalities
- drug interactions
59
what's Acenocumarol and how does it work
- oral medication → acts like an anticoagulant similarly to warfarin
- mechanism = vitamin K antagonist = inhibition of gamma carboxylation of proteins made by vitamin K (II, VII, IX, X and protein C)
60
what's the use, side effects and contraindications of Acenocumarol
- use → thromboembolic conditions
- side effects → bleeding
- contraindications → pregnancy, certain surgeries, peptic ulcers, protein C and S deficit, hepatic failure
61
which meds directly inhibit Xa
apixaban, rivaroxaban, edoxaban
-XABAN
62
what's the MOA of apixaban
inhibit free and clot-associated factor Xa → reduced thrombin generation → less platelet aggregation and fibrin formation suppression
63
do you have to monitor anything when giving apixaban or rivaroxaban
- monitoring → unreliable, not required
- BUT you can check PTT and aPTT since it has no effect on thrombin time
64
side effect of direct inhibitors of Xa
uncontrollable bleeding
65
can you reverse the effect of apixaban
reversal = andexanet alfa → recombinant form of factor Xa
66
contraindications for apixaban
- drug interactions (CYP450) → if these drugs accumulate on blood there can be bleeding
** cimetidine, metronidazole, TMP/SMX, amiodarone
67
which types of fibrinolytics/thrombolytics are there
fibrin specific agents
non fibrin specific agents
68
what meds are fibrin specific agents (fibrinolytics)
alteplase and tenecteplase (tPA)
69
differences between alteplase and tenecteplase (tPA)
- alteplase → IV
- tenecteplase → longer half-life, relatively resistant to inhibition by PAI-1
70
what's streptokinase
a fibrinolytic, specifically a non fibrin specific agent
71
what does it mean that streptokinase is a non-fibrin specific agent AND where does it come from
- non-fibrin specific agent → degradation of fibrin and fibrinogen
- it’s an enzyme produced by group A streptococci
** it’s and urokinase → serine protease in plasma, urine and different types of tissue
**not that used
72
whats the MOA of thrombolytics
- converts plasminogen into plasmin →⭡plasmin → fibrin thrombus breakdown
73
what marker can you see being increased when giving alteplase
you can see an ⭡D-dimer
74
what should you monitor when giving thrombolytics
⭡PT, ⭡PTT, normal platelet count
75
what are the indications and side effects of alteplase
- indications → acute ischemic stroke, life threatening pulmonary embolism, STEMI (ST elevation myocardial infraction)
- side effects =⭡risk of bleeding
76
what are the contraindications for tenecteplase (tPA)
- active bleeding
- prior intracranial hemorrhage
- recent surgery
- severe hypertension
- know bleeding diathesis
77
how can you reverse the effects of alteplase
- reversal = antifibrinolytics → tranexamic acid and aminocaproic acid
- can also be combined with fresh frozen plasma (FFP)
- if necessary do a platelet transfusion
78
a type of antifibrinolytics are inhibitors of plasminogen, which medications fall into this category
tranexamic acid and aminocaproic acid
79
whats tranexamic acid and how does it work
- IV (but theres an oral tx for heavy menstrual bleeding)
- synthetic lysine analog
- mechanism = direct inhibitor of plasminogen
80
what can you use tranexamic acid for
trauma resuscitation, massive hemorrhaging
**postpartum hemorrhage → added after oxytocin to help the mesh to form in postpartum hemorrhage
81
what's aminocaproic acid and how does it work
- IV or oral administration
- lysine derivative
- mechanism = inhibitor of plasminogen activators and plasmin
82
what's the problem with taking inhibitors of plasminogen
thrombi that form during the tx are not degraded
px can also develop renal problems
83
what are the side effects of inhibitors of plasminogen
myopathy and muscle necrosis
84
what's aprotinin
a discontinued antifibrinolytic
85
why was aprotinin discontinued
increased risk of death, kidney failure and cardiovascular complications
86
whats the MOA and main uses of aprotinin
- mechanism = serine protease inhibitor → inhibits: plasmin, trypsin, kallikrein and others
- mainly used to = reduce bleeding in mayor surgeries (mainly cardiac surgery, major orthopedic surgery and liver transplant)
87
what procoagulants are there
fibrinogen = factor 1
prothrombin complex concentrate (PCC)
vitamin K (phytomenadione)
factor VII
88
what's fibrinogen (factor I), and what are it's presentations
prepared from pooled human plasma from suitable donors
it’s activated by thrombin (factor IIa)to fibrin
it comes in two forms:
- cryoprecipitate = blood product rich in fibrinogen → also has factor VIII, vWF and factor XIII
- fibrinogen concentrate = purified, lyophilized fibrinogen from pooled plasma
89
which form of fibrinogen is preferred
fibrinogen concentrate is preferred!! because it’s more controlled and safer (less infection risk)
90
when is fibrinogen indicated
- massive hemorrhage
- DIC
- congenital fibrinogen deficiency → very rare
- postpartum hemorrhage
- liver failure → since the liver won’t be able to make fibrinogen
91
what's the goal of giving fibrinogen and what're it's side effects
- goal = raise plasma fibrinogen levels to > 150-200 mg/dL
- side effects:
- thrombosis if overdose
- hypersensitivity → more common in the cryoprecipitate
- infections
92
what's the prothrombin complex concentrate
it’s a plasma-derived medication that contains several clotting factors: II, VII, IX, X (vitamin k dependents)
- factor II → main source of thrombin
- factor VII → activated the extrinsic clotting pathway
- factor IX → part of the intrinsic pathway (important in hemophilia B)
- factor X → activated thrombin generation
** can also have protein C and S
93
when is prothrombin complex concentrate (PCC) indicated
- emergency reversal of warfarin (vitamin k antagonist)
- life-threatening bleeding in anticoagulated patients
- rapid INR correction before urgent surgey
- tx of hemophilia B
** considered better than fresh frozen plasma → because there’s less risk of overload and has a rapid effect
94
what are the major risks of giving prothrombin complex concentrate
thrombosis and hypersensitivity
95
what's vitamin K (phytomenadione)
- natural sources → leafy green vegetables (vitamin K1)
- storage in liver
- warfarin antagonist
96
what's the function of vitamin K
cofactor for y-carboxylation of glutamate residues on vitamin-K-dependent proteins involved in:
- coagulation → maturation of factors II (prothrombin), VII, IX, X, protein C and protein S
- bone formation → osteocalcin (bone GIa protein), matrix GIa protein
97
what happens in a vitamin K toxicity
hemolytic anemia, hyperbilirubinemia, jaundice, and kernicterus infants
98
what are the therapeutic uses for vitamin K
- postnatal vitamin K injection to prevent VKDB (Vitamin K deficiency bleeding)
- coagulopathy → disorders of the extrinsic pathway of coagulation
99
what's NovoSeven
**Factor VII (NovoSeven) → INSTRINSIC PATHWAY**
- recombinant activated factor VII (rFVIIa) is a pro-coagulant drug that helps trigger clot formation very fast, even when other parts of the clotting system are damaged
- administration = IV injection
100
what's the MOA of factor VII
activates factor X directly (even without tissue factor)
→ this creates a thrombin burst → fibrin clot formation → stops bleeding
101
when is NovoSeven indicated
- hemophilia A or B with inhibitors (antibodies that block factor VIII or IX)
- Glanzmann thrombasthenia → deficiency of GP IIb/IIIa protein = no platelet aggregation
- severe bleeding from trauma, surgery, or obstetric emergencies
102
side effects of NovoSeven
- thrombosis (DVT, pulmonary embolism, stroke, MI)
- it’s expensive !
- needs a careful monitoring
103
what's folic acid and how can it be administered and absorbed
- synthetic form of Vitamin B9/folate
- ADME → oral, IM and subQ
- absorption in the jejunum
104
what's the mechanism of folic acid
- folic acid is not the active form, it is the precursor of tetrahydrofolic acid (active form) → THF is a cofactor for 1-carbon transfer reactions for synthesis of purines and thymidylates of nucleic acids
- the transformation into dihydrofolate and THF happens in the liver → this process is mediated by an enzyme called dihydrofolate reductase (DHFR)
105
when is folic acid indicated
anemias → megaloblastic anemia due to folic acid deficiency in tropical or non-tropical sprue, nutritional anemias, and in pregnancy, infancy and childhood
adequate intake of folate
prevention of neural tube defects → prophylaxis before and during pregnancy
- reduces the risk for spina bifida, anencephaly and encephalocele
cardiovascular risk reduction
px with parental nutrition as part of their regimen
px with diseases that have high cell turnover (ex. hemolytic anemia)
high levels of homocysteine
106
is acid folic toxic
no, it has no side effects
107
what are the contraindications of folic acid
- known intolerance
- not indicated to pernicious anemia and other megaloblastic anemias due to vitamin B12 deficiency
- interactions with drugs that inhibit dehydrofolate reductase
- like: methotrexate and trimethoprim
108
natural sources of folate
liver, kidneys, yeast, leafy green vegetables, other vegetables, citrus fruits and juice, and legumes
109
whats Hidroxocobalamin?
- it’s a (synthetic) precursor of vitamin B12
- it’s an alternative to cyanocobalanin IM with better retention, it’s administer on alternate days for 1-2 weeks, then every 2-3 months
110
treatment of choice for vitamin B12 deficiency
cyanocobalamin administered by IM or subcutaneous injection, never IV
111
how is hidroxocobalamin administered and absorbed
- ADME → injection
- absorbs in the ILEUM
112
what's the mechanism and indication for hydroxocobalamin
mechanism → binds to transcobalamin
indications
- first line antidote for cyanide poisoning → binds to cyanide and forms vitamin B12, then it’s excreted in urine
- vitamin B12 deficiency
113
what are the side effects of hidroxocobalamin
red discoloration (skin, urine, plasma)
**can affect labs that rely on spectrophotometry
114
what IV medications are available for iron deficiencies
iron dextran
ferrous saccharate
115
what's iron dextran and how is it administered
- ferric hydroxide or ferric oxyhydroxide in a complex with partially hydrolyzed low molecular weight dextran
- ADME → parenteral = IV or IM
116
what's the mechanism of iron dextran
- macrophages remove iron dextran from the bloodstream into the reticuloendothelial system (RES) → the RES separated the components of iron dextran → iron binds to transferrin → the iron-transferrin complex binds to the TFR1 on erythroid progenitor cells in the BM → iron disassociates from transferrin → the erythroid progenitor cells use iron to produce heme
** it corrects erythropoietic abnormalities due to iron deficiency, but it doesn’t stimulate erythropoiesis nor correct hemoglobin disturbances
117
what are the indications for iron dextran
iron deficiency not amenable to oral iron therapy
- patients w/ chronic kidney disease (CKD) on hemodialysis
- intestinal malabsorption
- oral iron intolerance
routine supplementation to total parenteral nutrition
patients who are receiving erythropoietin
118
side effects of iron dextran
- sensitivity reactions
- myalgias, arthralgias and headaches 1-2 days after
- thrombophlebitis
- exacerbation of cardiovascular complications
- carcinogenesis
- possible fever and exacerbation or reactivation of joint pain and swelling in px w/ rheumatoid arthritis
- fever, malaise, lymphadenopathy, arthralgias, and urticaria → can develop days or weeks following injection
119
contraindications for iron dextran
- anemias not associated with iron deficiency
- hypersensitivity → sudden onset of respiratory difficulty (wheezing, bronchospasm, rigor, dyspnea, cyanosis), tachycardia, hypotension, respiratory arrest, and/or cardiovascular collapse
- patients with rheumatoid arthritis or other connective tissue diseases and during the acute phase of an inflammatory illness
120
what's ferrous saccharate and how does it work
parenteral iron → IV administration
mechanism = basically the same as iron dextran, BUT since it has a lower molecular weight it’s:
- rapidly cleared from plasma
- quickly taken up by macrophages in RES
- iron is released faster → more available for erythropoiesis
- lower likelihood of iron overload
- overall → better tolerated and less adverse effects
121
indications for ferrous saccharate
iron deficiency non amenable to oral iron therapy
- PREFERRED for px w/ chronic kidney disease (CKD) on hemodialysis
- intestinal malabsorption
- oral iron intolerance
routine supplemento to total parenteral nutrition
px who are receiving erythropoietin
122
what oral medications exists for the tx of iron deficiencies
ferrous fumarate
ferrous sulfate
123
how is ferrous fumarate administered and absorbed
oral administration → absorbs in the DUODENUM
124
what's the mechanism of ferrous fumarate
- Fe²⁺ is released from fumarate in the duodenum and proximal jejunum → absorbed via the divalent metal transporter 1 (DMT1) on enterocytes → some Fe²⁺ is stored as ferritin in the enterocytes the rest is exported by ferroportin into the bloodstream → oxidized to Fe³⁺ by hephaestin and binds to transferrin
- transferrin delivers iron to erythroid precursors → iron is incorporated into heme, then hemoglobin
125
what's the indication of ferrous fumarate
tx and prevention of iron deficiency anemia
126
side effects and contraindications for ferrous fumarate
side effects:
- constipation, diarrhea, dark stools
- nausea, epigastric pain
- iron toxicity → can be deadly
contraindications:
- primary hemochromatosis → condition where your body absorbs and stores too much iron from the food you eat, leading to iron overload
- peptic ulcer, regional enteritis or ulcerative colitis
- children <12, pregnant and nursing should consult beforehand
127
what drug interactions does ferrous fumarate have
- antacids → decrease absorption (needs acid environment)
- calcium supplements, chloramphenicol, H2 receptor antagonist, tetracyclins
- vitamin C → increased absorption of iron from the GI tract
128
how is ferrous sulfate administered and when is it indicated
- oral administration
- mechanism = same as ferrous fumarate
- indications: all px with iron deficiency anemia
129
what's the treatment of choice for iron deficiency anemia
ferrous sulfate
* take once daily on an empty stomach
130
side effects and contraindications for ferrous sulfate
side effects:
- heartburn
- GI discomfort, constipation, black stool
- esophagitis
- iron toxicity
contraindications → foods and antacids → they reduce intake
- tx should be given at least 3-6 months
131
what can you give a px that received too much ferrous sulfate
if the iron capacity is higher than what it can take give deferoxamine (it’s an iron chelator)
132
what's erythropoietin and how is it administered
- growth factor → epoetin alfa (*darbepoetin*), epoetin beta, epoetin omega, and epoetin zeta
- ADME → IV and subQ → usually once a week dosing
133
what are the indications for erythropoietin
- anemias associated with surgery, AIDS, cancer chemotherapy, prematurity, and certain chronic inflammatory conditions
- epoetin alfa
- anemia of chronic renal failure
- darbepoetin alfa subQ
- recombinant erythropoietin therapy w/adequate iron intake
134
what med can be abused to increase ATHLETIC PERFORMANCE
erythropoietin
135
side effects of erythropoietin
- aggravation of hypertension because of rapid increase of hematocrit
- increased risk of thrombosis → px may require anticoagulants
- hypertensive encephalopathy and seizures → in px with CKD
- headache, tachycardia, edema, shortness of breath, nausea, vomiting, diarrhea, injection site stinging, and flu-like symptoms (arthralgias and myalgias)
- functional iron deficiency → need therapy with iron supplements if ferritin is < 100 micrograms/L
136
contraindications for giving erythropoietin
pxs with uncontrolled hypertension
137
what's methenole and how does it work
- comercial name = primobolan
- ADME → oral or injectable
- mechanism = it’s an anabolic androgenic steroid (AAs) → it’s a derivative of testosterone
** it promotes muscle growth and androgenic effects
138
indications for methenolone
- rarely used!!
- muscle wasting
- severe weight loss
- osteoporosis
- some anemias
139
side effects of methenolone
- liver toxicity → specially if oral administration
- suppression of natural testosterone → acne, hair loss
- mood changes
- cardiovascular risk → increased LDL, decreased HD
140
what's pentoxifylline and how does it work
- its a purine derivative that causes hemodilution
- ADME → oral and IV
- mechanism = ↓ blood viscosity → ↓ fibrinogen and ↓ platelet aggregation
- erythrocyte flexibility → capillary blood flow and oxygenation
141
when is pentoxifylline indicated
- cerebrovascular and peripheral vascular vascular insufficiency
- intermittent claudication → leg pain that occurs during activity, such as walking, and is relieved by rest
142
what are the side effects and contraindications of Pentoxifylline
- side effects:
- teratogenic
- drowsiness, nausea, vomiting
- contraindications:
- cerebral hemorrhaging
- breastfeeding
- interaction with theophylline (asthma tx used to prevent and treat wheezing, shortness of breath, and chest tightness)
