VARIOUS BLEEDING DISORDERS

Hemophilia Liver

disease Bone marrow disorders

ANTIHEMOPHILIC DISORDERS
Drug

used to treat hemophilia are replacement factors for the specific clotting factors that are genetically missing in the particular type of hemophilia These drugs include:
Antihemophilic factors (Bioclate, ReFacto, and others)  Coagujlation factor VIIa (NovoSeven)  Factor IX complex (Benefix, Profilnine SD, and others)


THERAPEUTIC ACTIONS AND INDICATIONS

Antihemophilic

drugs replace clotting factors that are either genetically missing or low in a particular type of hemophilia They are used to prevent blood loss from injury or surgery and to treat bleeding episodes

PHARMACOKENITICS
Agents

replace normal clotting factors and are processed as such by the body. Should used during pregnancy only if the benefit to the mother clearly outweighs the potential risk to the fetus.

CONTRAINDICATIONS AND CAUTIONS

It

is contraindicated in the presence of known allergy to mouse proteins. Factor XI is contraindicated in the presence of liver disease w/ signs of intravascular coagulation or fibrinolysis. Coagulation factor VIIa is contraindicated w/ known allergies to mouse, hamster, or bovine products

ADVERSE EFFECTS
Most

common adverse effect associated w/ antihemophilic agents involve risk associated w/ the use of blood products Headache Flushing chills Fever and Lethargy may occur as a reaction to the injection of a foreign protein Nausea and vomiting may also occur

SYSTEMIC HEMOSTATIC AGENTS

Hemostatisc

drugs are used to stop

bleeding These drugs that are used systematically include the following: Aprotinin (Tracylol) Aminocarporoic Acid (Amicar)

THERAPEUTIC ACTIONS AND INDICATIONS

The

systemic hemostatic agents stop the natural plasminogen clot-dissolving mechanism by blocking its activation or by directly inhibiting plasmin These drugs are used to prevent or treat excess bleeding in hyperfibrinolytic states, including repeat CABG surgery

PHARMACOKINETICS
Pharmacokinetic

parameters are different

for each drug

CONTRAINDICATIONS AND CAUTIONS

Systemic

hemostatic agents are contraindicated in the presence of allergy to these drugs and w/ acute DIC because of the risk of tissue necrosis. Caution should be used in the in the following conditions:
Cadiac disease  Renal and hepatic dysfunction  And Pregnancy and Lactation


ADVERSE EFFECT
Most

common adverse effect associated w/ systemic hemostatic agents is excessive clotting. CNS effects hallucinations, drowsiness, dizziness, headache, and psycotic states GI effects nausea, cramps, and diarrhea Aprotinin has been associated w/ cardiac arrythmias, MI, CHF, and hypotension

CLINICALLY IMPORTANT DRUG-DRUG INTERACTIONS

The

risk o bleeding increase if these drugs are given w/ heparin Aminocaprioc acid is associated w/ the development of hypercoagulation states if it is combined w/ oral contraceptives or estroggens

TOPICAL HEMOSTATIC AGENTS

Some

surface injuries involve so much damage to the small vessels in the area that clotting does not occur and blood is slowly and continually lost For these situations, topical or local hemostatic agents are often used:
Absorbable gelatin (Gelfoam)  Thrombin (Thrombinar, Thrombostat)


END OF PRESENTATION!
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