drug therapy of the muscular system

7/28/2019 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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drug therapy of the muscular system

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