drug therapy of the muscular system
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I. DRUG THERAPY OF THE MUSCULAR SYSTEM:
A. CENTRALLY ACTING SKELETAL MUSCLE RELAXANT:
Actions: exact mechanism of action is still unknown, except that they act by CNSdepression. All of these muscle relaxants produce some degree of sedation &
most physicians believe that the benefits from these agents come from the
sedative effect rather from the actual muscle relaxing effect
Uses: for relief from muscle spasm (spinal cord injuries, rheumatic d/o)
Side Effects: sedation, weakness, GIT upset
Adverse effects: liver damage, blood dyscracias
Drug interactions: Alcohol, narcotics, barbiturates, anticonvulsants, sedative
hypnotics, tranquilizers and anti depressants can ENHANCE its depressive effect
Agents: carisoprodol, chlorzoxazone, metaxalone, methocarbamol, tizanidine
B. DIRECT ACTING SKELETAL MUSCLE RELAXANT; DANTROLENE
Actions: this agent acts directly on skeletal muscles producing generalized mild
weakness of skeletal muscles & decreases the force of reflex muscle contraction,hyperrelfexia, clonus, muscle stiffness, involuntary muscle movements &
spasticity
Uses: Cerebral palsy, multiple sclerosis, stroke syndrome, Malignant
hyperthermia
Side effects: weakness, diarrhea, drowsiness, dizziness
Adverse effects: photosensitivity. Liver damage
Drug interactions: CNS DPRESSANT: alcohol, analgesics, tranquilizers,potentiates the sedative effect of dantrolene
C. NEUROMUSCULAR BLOCKING AGENTS:
Actions: Acts by interrupting transmission of impulses from motor nerves of
muscles at the NMJ. Neuromuscular blocking agents have no effect onconsciousness, memory or pain threshold
Uses: used during induction of anesthesia, intubation and electroshock therapy
Side effects: salivation, discomfort
Adverse effects: signs of respiratory distress, diminished cough reflex, & inability
to swallow
Drug interactions: Drugs that enhance Therapeutic & toxic effect: anesthetics, theaminoglycosides, beta blockers, quinidine, diuretics.
Agents: atracurium, cisatracurium, doxacurium, mivacurium, succinylcholine,
tubocurarine Cl.
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II. DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM
A. DRUGS USED TO TREAT HYPERLIPIDEMIAS:
1. BILE ACID-BINDING RESIN: Actions: cholestyramine & colestipol are resins that bind bile acids in the
intestines. After oral administration, the resin forms a non-absorbable complex
with bile acids, preventing enterohepatic recirculation of the bile acid. Because ofthe removal of the bile acid, liver cells compensate by increasing metabolism of
cholesterol to p[roduce more bile acids , resulting in the net reduction in total
cholesterol levels
Uses: used in conjunction with dietary therapy to decrease elevated cholesterol
concentration, in type II hyperlipidemia. Also for treating pruritus in biliary stasis,
diarrhea
Side effects: constipation, bloating, fullness, nausea
Adverse effects: Flatulence Drug interactions: digitoxin, warfarin, thyroxine, diuretics, Phenobarbital,
NSAIDS, tetracyclines & beta blockers: reduces absorption. Bile acid binding
agents reduces absorption of fat soluble vitamins
2. NIACIN:
Actions: this is also called nicotinic acid. A water soluble vitamin B. the exact
mechanism of action is unknown, but it appears to inhibit the formation of VLDL
which in turn lowers the LDL levels
Uses: used in conjunction with dietary therapy to reduce cholesterolin type II, III,
IV, & V hyperlipidemias
Side effects: flushing, pruritus, headache, nausea, abdominal discomfort,dizziness, fatigue
Adverse effect: myopathy, anorexia
Drug interactions: Lovastatin if combined w/ niacin enhances the myopathic
effect
3. HMGCoA REDUCTASE INHIBITORS;
Actions: also called statins. They competitively inhibit the enzyme responsible
for converting HMG-CoA to mevalonatein the biosynthetic pathway to
cholesterol in the liver. The reduction in liver cholesterol increases the removal of
LDL from the circulating blood. These agents are more effective if administeredat night because peak of production of cholesterol during this period.
Uses: For hypelipidemia/cholesterolemia
Side effects: head ache, nausea, abdominal discomfort.
Adverse effects: Myopathy, liver dysfunction
Drug interactions: Cyclosporine, itra/keto/fluco nazoles, niacin, verapamil,
eryhthromycin increases the incidence of myopathy. Ranitidine, omeprazole &cimetidine, increases statin levels
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Agents: atorvastatin, fluvastatin, simvastatin, lovastatin
4. FIBRIC ACID:
Actions: exact action is unknown
Uses: for hypertriglyceridemia. Fibric acids are not recommended in combination
with statins due to the risk of rhabdomyolysis Side effects: nausea, diarrhea, abdominal discomfort, fatigue
Adverse effects: myopathy, jaundice
Drug interactions: enhanced Warfarin effect, enhanced insulin effect. Probenecidincreases its toxic effect
B. DRUGS USED TO TREAT HYPERTENSION
1. DIURETICS:
Actions: causes volume depletion, sodium excretion, & vasodilatation of
peripheral arterioles. It has 4 classes: (a.) carbonic anhydrase inhibitors, (b.)Thiazide & thiazide like agents, (c.) loop diuretics, (d.) potassium sparingdiuretics. These are the most commonly prescribed antihypertensive agents
because it is proven to lower cardiovascular morbidity & mortality associated
with hypertension
Uses: antihypertensive.
2. BETA BLOCKERS:
SEE MIDTERM NOTES
3. ANGIOTENSIN CONVERTING ENZYMES INHIBITORS (ACEI)
Actions: these act by inhibiting angiotensin I converting enzyme (dipeptidyldipeptidase), the substance responsible for conversion of angiotensin I to
angiotensin II
Use: antihypertensive
Side effects: nausea, dizziness, diarrhea
Adverse effects: Orthostatic hypotension, facial edema, neutropenialiver damage,
hyperkalemia, chronic cough, teratogenesis
Drug interactions: lithium, digoxin, capsaicin reduces therapeutic effects
Agents: captopril, enalapril, quinipril, ramipril
4. ANGIOTENSIN II RECEPTOR ANTAGONISTS: (AT1receptor antagonist) Actions: binds to angiotensin II receptor sites, blocking the very potent
vasoconstrictor.
Uses: antihypertension
Side effects: head ache, dyspepsia, diarrhea
Adverse effects: orthostatic hypotension, may be a teratogenic agent,hyperkalemia
Drug interactions: Enhanced effect with: diuretics, alcohol, beta blockers
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Agents: candesartan, irbesartan, losartan, valsartan
5. CALCIUM ION ANTAGONIST:
Actions: inhibits the movement of calcium ions across a cell membrane, this
results in fewer arrhythmias a slower rate of cardiac contraction & relaxation ofsmooth muscles of blood vessels, resulting in vasodilatation & reduced BP
Uses: antihypertensive
Side effects: syncope, hypotension
Adverse effect: edema
Drug interactions: enhanced effect with- alcohol, phenothiazines, beta blockers,
histamine antagonists
Agents: amlodipine, nifedipine, nicardipine, verapamil
6. ALPHA 1 BLOCKING AGENTS:
Actions: blocks post-sympathetic alpha1 adrenergic receptors to produce
arteriolar & venous dilatation, reducing peripheral vascular resistance w/oreducing cardiac output or inducing a reflex tachycardia. These agents do not
increase catecholamines therefore there is no increase in heart rate or myocardialoxygen consumption. Because of the presence of alpha 1 receptors in the prostate
gland & bladder, TERAZOSIN & DOXAZIN are also able to reduce urinary
outflow resistance in men with BPH.
Uses: hypertension, BPH
Side effects: headache drowsiness, tachycardia, fainting
Adverse affects: lethargy
Drug interactions: Enhanced effect with- diuretics, tranquilizers alcohol,
barbiturates, antihistamines
Agents: Doxazin, terazosin
7. CENTRALLY ACTING ALPHA 2 ANTAGONISTS
Actions: stimulates the alpha adrenergic receptors in the brain stem , resulting in areduced sympathetic outflow from the CNS with a decreased HR, & PVR,
resulting in BP drop
Uses: Antohypertensive
Side effects: drowsiness, mouth dryness, dizziness
Adverse effects: DEPRESSION
Drug interaction: enhanced effect with- digitalis, guanethidine, barbiturates,
tranquilizers, beta blockers Agents: Clonidine, methyldopa
8. PERIPHERALLY ACTING ADRENERGIC ANTAGONISTS:
Actions: causes release & subsequent depletion of NE from adrenergic nerve
endings. This causes a relaxation of vascular smooth muscle which decreases TPR
& venous return. A hypotensive effect results that is greater in the standing than
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in the supine position. Heart rate is decreased & fluid retention occurs. Sedation
occurs due to depletion of NE in the brain
Uses: Hypertension
Side effects: sedation
Adverse effects: orthostatic hypotension, edema
Drug interactions: Enhanced effect with- barbiturates, diuretics, tranquilizers,antihistamines, alcohol
Agents: guanethedine, reserpine, guanadrel
9. DIRECT VASODILATORS
Actions: causes direct arteriolar smooth muscle relaxation resulting in a decreased
PVR. The reduction in peripheral resistance causes a reflex increase in HR, CO,
& renin release with sodium & water retention.
Uses: for stage 2 & 3 hypertension, baldness
Side effects: nausea, dizziness, tachycardia, fever, chills
Adverse effects: myalgia, arthralgia, orthostatic hypotension
Drug interactions: enhanced effect with- diuretics, alcohol, beta blockers
Agents: minoxidil, hydralazine, nitroprusside sodium
C. DRUGS USED FOR THE TREATMENT OF HEART FAILURE:
1. DIGITALIS GLYCOSIDES: DIGOXIN
Actions: derived from the foxglove plant, this agent increases the force ofcontraction & slows down the heart rate, reducing the conduction velocity &
prolonging the refractory period at the AV node. The excat mechanism of action
is unknown.
Uses: heart failure
Side effects: bradycardia, tachycardia, n/v
Adverse effects: HypoK, HypoMg, HypoCa
Drug interactions: Enhanced effect with- nifedipine, verapamil, antibiotics,
betablockers
Agents: digitoxin, digoxin
2. PHOSPHODIESTERASE INHIBITORS:
Actions: increases the force & velocity of myocardial contractions by inhibitingCAMP phosphodiesterase activity & increases cellular level of CAMP in heart
muscles. It is also a vascular smooth muscle relaxantthat causes vasodilatation,
reducing preload & after load
Uses: for short term treatment of heart failure
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Side effects: N/V, abdominal discomfort
Adverse effects: arrhythmias, hypotension, thrombocytopenia, liver damage
Drug interactions: digitalis & furosemide.
Agents: amrinone, milrinone
3. ANGIOTENSIN CONVERTING ENZYME INHIBITORS
Actions: Reduces afterload & help reduce circulating blood volume by inhibitingthe secretion of aldosterone
Uses: reduces BP & increases renal blood flow
D. DRUGS USED TO TREAT ARRHYTHMIAS
1. ADENOSINE:
Actions: it has a variety of roles including energy transfer, promotion ofprostaglandin release, inhibition of platelet aggregation, antiadrenergic effectscoronary artery dilatation & suppression of heart rate
Uses: strong depressant of SA & AV node. Used in paroxysmal supraventricular
tachycardia
Side effects: flushing, dyspnea, chest pressure, nausea, head ache
Adverse effects: Are short lived because the half life of adenosine is only 10
seconds
Drug interactions: Enhanced effect with- dipyridamole & carbamazipines
2. AMIODARONE:
Actions: action is unknown. This is a class III agent that acts by prolonging theaction potential of atrial and ventricular tissues and by increasing the refractory
period w/o altering the RMP, thus delaying repolarization
Uses: SVT, atrial fibrillation & flutter, bradycardia-tachycardia syndrome, &hypertrophic cardiomyopathies
Side effects: chest pain, fatigue, syncope, palpitations, edema
Adverse effects: narrowing of pulse pressure, dyspnea, ataxia, confusion, bluuredvision, yellow brown pigments in the cornea, photosensitivity & liver damage
3. BETA ADRENERGIC BLOCKING AGENTS:
Actions: Class II agents. They block the cardiac response to sympathetic nervestimulation by blocking the beta receptors, as a result, the HR, BP & CO reduces
Uses: sinus tachycardia, paroxysmal atrial tachycardia, PVC
4. BRETYLIUM
Actions: inhibits the release of norepinephrine. This is a class III agent
Uses: ventricular arrhythmias
Side effects: dizziness, n/v
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Adverse effects: hyper/hypotension
Drug interactions: digitalis glycosides
5. DISOPYRAMIDE:
Actions: class Ia antiarrhythmic agent
Uses: for atrial fibrillation, Wolf-Parkinson-White syndrome, ventriculartachycardias
Side effects: dryness of mouth & throat
Adverse effect: bradycardia/heart failure, urinary hesitancy, constipation
6. FLECAINIDE:
Actions: Class Ic antiarrhythmic agent. This agent has a negative inotropic effectthat can lead to worsening of heart failure.
Uses: ventricular tachycardias, PVCs.
Side effects: dizziness, syncope, blurred vision, headache, n/v
Adverse effects: edema, increasing dyspnea, arrhythmias
Drug interactions: agents that enhance its effect: amiodarone, cimetidine,
disopyramide
7. LIDOCAINE:
Actions: Class Ib agent
Uses: most commonly used drug for ventricular arrhythmias & the drug of choice
for ventricular arrhythmias secondary to AMI
Side effects: muscle twitching, light-headedness
Adverse reactions: respiratory depression
Drug interactions: Enhanced effect with- phenytoin, procainamide, tocainide, beta
blockers
8. MEXILETINE:
Actions: Class Ib anti-arrhythmic agent similar to lidocaine
Uses: PVCs, ventricular tachycardias
Side effects: n/v, dyspepsia
Adverse effects: neurotoxic, arrhythmia
Drug interaction: reduced effect with phenytoin
9. MORICIZINE:
Actions: inhibits the influx of sodium ions into the myocardial cells, making it a
class I agent
Uses: ventricular arrhythmias
Side effects: dizziness, hypotension, nausea
Adverse effects: arrhythmias, euphoria
Drug interactions: enhanced effect with digoxin, cimetidine, & propranolol
10. PHENYTOIN:
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Actions: Class Ib drug
Uses: paroxysmal atrial tachycardia, ventricular arrhythmias
Side effects: n/v, sedation, drowsiness, blurred vsion
Adverse effect: Confusion, dermatologic manifestations
Drug interactions: enhanced effect with- warfarin, disulfiram, INH,
carbamazipine, chloramphenicol, amiodarone, sulfonamides
11. PROCAINAMIDE:
Actions: Class Ia drug that has many cardiac effects similar to quinidine
Uses: ventricular & supraventricular arrhythmias
Side effects: drowsiness sedation, dizziness
Adverse effects: myalgia, arthralgias, skin eruptions
Drug interactions: Enhanced effect with- histamine receptor blockers, quinidine,
trimethoprim & beta blockers
12. PROFAPENONE:
Actions: Class Ic agent, that has a weak beta blocking & calcium channel
blocking effect
Uses: Paroxysmal atrial fibrillation, & ventricular tachycardia
Side effects: n/v, dizziness, constipation
Adverse effects: arrhythmias
Drug interactions: Enhanced effect with quinidine & cimetidine
13. QUINIDINE:
Actions: derived from the cinchona bark. It is a class Ia agent. It slows down the
heart rate & changes a rapid, irregular pulse to a slow regular pulse
Uses: atrial fibrillation, atrial flutter, PSVT, PVC Side effects: diarrhea, dizziness
Adverse effects: Cinchonism- fever, chills, tinnitus
Drug interactions: enhanced effect with- cimetidine, procainamide, digitalis,
phenothiazines, verapamil, beta blockers
14. TOCAINIDE:
Actions: Class Ib agent. This is the first available derivative of lidocaine
Uses: ventricular tachycardia
Side effects: n/v, dizziness, cofusion, numbness
Adverse effects: dyspnea, wheezing, thrombocytopenia
Drug interactions: enhanced effect with- procainamide, disopyramide, quinidine
E. DRUGS USED FOR ANGINA PECTORIS
1. NITRATES:
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Actions: oldest effective therapy for angina pectoris. They relieve angina by
inducing relaxation of peripheral vascular smooth muscles, resulting in dilatationof arteries & veins, this reduces venous blood return to the heart leading to a
decreased oxygen demand in the heart. Nitrates also increase myocardial oxygen
supply by dilating large coronary arteries & redistributing blood flow, enhancing
oxygen supply to ischemic areas Uses: Ntroglycerine- DOC for angina pectoris
Side effects: headache, tolerance
Adverse effects: excessive hypotension
Drug interactions: alcohol, calcium ion antagonist, beta blockers
Agents: amyl nitarite, ISDN, ISMN, nitroglycerine2. BETA BLOCKERS:
Actions: reduces myocardial oxygen demand by blocking the beta receptors of the
heart.
Uses: for angina
3. CALCIUM ION ANTAGONISTS
Actions: inhibits the movement of calcium ions across cellular membranes
Agents: amlodipine, nifedipine, verapamil
F. DRUGS USED FOR PERIPHERAL VASCULAR DISEASES
1. PENTOXIFYLLINE
Actions: hemorrheologic agent. It increases RBC flexibility, decreases the
concentration of fibrinogen in blood & prevent aggregation of RBc & platelets
Uses: for intermittent claudication
Side effects: n/v, dyspepsia, dizziness, HA
Adverse effects: chest pain arrhythmias, dyspnea
Drug interactions: Antihypertensive agents, theophylline
2. CYCLANDELATE:
Actions: Vasodilator. Directly relaxes smooth muscles in blood vessels
Uses: intermittent claudication, thromboangitis obliterans, leg cramps, Reynauds
disease
Side effects: flushing, tingling, n/v Adverse effects: diaphoresis
Drug interactions: no known drug interactions
3. ISOXSUPRINE HCL
Actions: vasodilator.
Uses: Buergers disease, Reynauds disease, arterial occlusive disease
Side effects: same as (2)
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Drug interactions; Antihypertensive agents
4. PAPAVERINE HCL
Actions: vasodilator
Uses: cerebral & peripheral ischemia
Side effects: same as 2 & 3 Drug interactions: antihypertensive agents
5. PHENOXYBENZAMINE HCL:
Action: vasodilator
Uses: Reynauds disease, leg ulceration, frostbite
Side effects: nasal stiffiness, tachycardia
Adverse effects: hypotension
Drug interactions: antihypertensives
6. TOLAZALINE:
Actions: vasodilator
Uses: Reynauds disease, chronic leg ulcers, frost bite gangrene
Side effects: flushing, tingling, sweating, n/v
Adverse effects: arrhythmias, tachycardias, anginal pain, hallucination
Drug interactions: antihypertensives
7. CILOSTAZOL
Actions: Platelet aggregation inhibitor. Inhibits CAMP phosphodiesterase IIIresulting in vasodilatation, & inhibited platelet aggregation
Uses: Intermittent claudication
Side effects: dyspepsia, diarrhea, dizziness Adverse effects: chest pain, palpitations, arrhythmias
Drug interactions: dilatiazem, erythromycin, omeprazole, fluconazole, sertraline,
ketoconazole, grapefruit juice
G. DRUGS USED FOR DIURESIS
1. CARBONIC ANHYDRASE INHIBITORS: ACETAZOLAMIDE
Actions: a weak diuretic that acts by inhibiting the enzyme, carbonic anhydrase
w/in the kidneys, brain and eyes. It promotes the excretion of potassium water &
bicarbonates Uses: for glaucoma patients. Not commonly used
2. METHYLXANTHINES: AMINOPHYLLINE:
Actions: acts by improving blood flow to the kidneys
Uses: rarely used as a diuretic
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3. LOOP DIURETICS:
a. BUMETAMIDE:
Actions: a potent diuretic that acts by inhibiting sodium & chloride reabsortion
from the ascending loop of Henle in the glomeruli of the kidneys. It also acts by
increasing renal blood flow into the glomeruli & inhibits electrolyte absorption in
the proximal tubule, enhancing Na, chloride, PO3, HCO3 excretion in the urine.Diuretic activity starts 30-60 minutes after administration
Uses: CHF, renal & liver disease, including nephritic syndrome
Side effects: gastric irritation, hives
Adverse effects: hypokalemia, changes in mental status
Drug interactions: alcohol, barbiturates, digitalis, aminoglycosides, cisplastin,
NSAIDS, steroids
b. ETHACRYNIC ACID:
Actions: acts on the ascending limb of the loop of Henle to prevent sodium and
chloride reabsorption. Its effect starts 30min, peaks after 2 hours and lasts for 6-8hours.
Uses: renal & liver diseases, CHF
Side effects: orthostatic hypotension
Adverse effects: Hypokalemia, change in mental status, deafness, GIT bleeding,hyperglycemia
Drug interactions: aminoglycosides, cisplastin, NSAIDS, difitalis, steroids
c. FUROSEMIDE:
Actions: acts on the ascending loop of Henle but also affects the proximal & distal
tubules to prevent sodium & chloride reabsorption. Effect starts 5-10 minutes
after IV administration peaks after 30 minutes and lasts for 2 hours
Uses: liver & renal diseases, CHF, HTN
Side effects: oral irritation, hypotension
Adverse effects: Electrolyte imbalance, dehydration, hyperuricemia,hyperglycemia
Drug interactions: Digitalis, propranolol, aminoglycosides, cisplastin, NSAIDS,
salicylates, phenytoin
d. TORSEMIDE
Actions: sulfonamide type loop diuretic
4. THIAZIDES:
Actions: Benzothiadiazides acts primarily on the distal tubules of the kidneys to
block the reabsorption of sodium & chloride ions.
Uses: CHF, renal & liver disease, obesity, premenstrual syndrome
Side effects: hypotension, n/v, constipation, gastric irritation
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Adverse effects: Electrolyte imbalance, hyperuricemia, hyperglycemia
Drug interactions: digitalis, steroids, lithium, NSAIDS, oral hypoglycemic agents
5. POTASSIUM SPARING DIURETICS:a. AMILORIDE:
Actions: exact mechanism of action is unknown, but it acts on the distal renal
tubule to retain K & excrete Na resulting in a mild diuresis
Uses: combined with other diuretics. For CHF
Side effects: n/v, anorexia, headache, flatulence
Adverse effects: electrolyte imbalance (HyperK)
Drug interactions: Lithium, K supplements
b. SPIRONOLACTONE:
Actions: blocks the sodium retaining & potassium & magnesium excretingproperties of aldosterone, resulting in loss of water with increased sodium
excretion
Uses: used in relieving edema & ascites. It also shows reduction in morbidity &
mortality in a CHF patient
Side effects: diarrhea, headache
Adverse effects: mental confusion, electrolyte imbalance, gynecomastia, reduced
libido, breast tenderness
Drug interactions: K supplements, salt substitute
c. TRIAMTERENE:
Actions: blocks the exchange of potassium for sodium in the distal tubule of thekidneys, resulting in K retention & Na excretion
Uses; Combined with thiazides
Side effects: leg cramps, nausea,
Adverse effects: electrolyte imbalance, dehydration
Drug interactions: DO NOT ADMINISTER WITH POTASSIUM
SUPPLEMENTS= HYPERKALEMIA
6. COMBINATION DIURETIC PRODUCTS:
Spironolactone + HCTZ
Triamterene + HCTZ AMILORIDE + HCTZ
H. DRUGS USED TO TREAT THROMBOEMBOLIC DISORDERS
1. PLATELET INHIBITORS
a. ASPIRIN
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Actions: Inhibits thromboxane A2 Uses: TIA
Side effects: see midterm lecture notes
b. CLOPIDOGREL:
Actions: chemically related to ticlodipine. The metabolite of this drug acts toinhibit platelet aggregation. Antiplatelet activity is seen after 3- 7 days
Uses: TIA, Post MI, Angina pectoris, peripheral arterial disease, stroke
Adverse effects: Neutropenia, agranulocytosis, GIT blleding
Drug interactions: phenytoin, tamoxifen, warfarin, torsemide, fluvastatin,
NSAIDS
c. DIPYRIDAMOLE
Actions: inhibits Thromboxane A2, increases CAMP in platelets, potentiating
prostacyclin-mediated inhibition
Uses: TIA, thromboembolism
Side effects: dizziness, GIT distress
Adverse effects: postural hypotension
2. ANTICOAGULANTS:
a. ARDEPARIN
Actions: this is a LMWH that enhances antithrombin activity against factor Xa
and thrombin which prevents completion of the coagulation cascade. (Ardeparin).
DO NOT INJECT IM
Uses: DVT
Adverse effects: Bleeding
b. DALTEPARIN:
Action: same as ardeparin
Use: DVT
Adverse effect: bleeding
d. ENOXAPARIN:
Actions: same as a and b
Uses: DVT, unstable angina
Adverse effect: bleeding
e. HEPARIN:
Actions: acts as catalyst to accelerate the rate of action of a naturally occurringinhibitor of thrombin, antithrombin III (heparin cofactor).
Uses: cerebral embolism, DVT, PE
Side effects: BLEEDING
Antidote is protamine
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f. WARFARIN:
Actions: inhibits activity of vitamin K ( Factors II, VII, IX ,X)
Uses: DVT, atrial fibrillation with embolism, PE
Adverse effect: Bleeding
Antidote: Vit K
3. FIBRINOLYTIC AGENTS:
Actions: activates the conversion of plasminogen to plasmin/ fibrinolysin, w/c
digests fibrin, dissolving the clot
Uses: Stroke, MI
Agents: streptokinase, urokinase, Anistreplase/APSAC, alteplase, reteplase
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