Pharmacotherapeutics of Antihemophilic FactorPharmacokinetics of AHFPharmacodynamics of AHFIndications of AHFSide effects of AHFInteraction with AHFPatient teaching with AHFlabs for AHFLife span issues with AHFPharmacotherapeutics of heparinpharmacokinetics of heparinPharmacodynamics of heparinAdverse effects of heparinPharmacotherapeutics of warfarinPharmacodynamics of warfarinPharmacokinetics of warfarinAdverse effects of warfarinpharmacotherapeutics of clopidogrelpharmacokinetics of clopidogrelpharmacodynamics of clopidogreladverse effects of clopidogrelMorphine PTMorphine PKMorphine PDContraindicationsNaloxone PTNaloxone PKNaloxone PDCodeine PTCodeine PKaspirin PTaspirin PKaspirin PDIbuprofen PTibuprofen PKibuprofen PDacetaminophen PTacetaminophen PKacetaminophen PDmethotrexate PTmethotrexate PKmethotrexate PDcontraindications immunosuppresion, pregnancy X, impaired bone marrow fx, psoriasisAdverse effectsstomatitis, oral ulcers, alopecia, hair thinning, GI upset, hepatic cirrhosis, interstitial pneumonitis, myleosuppressionMaximize therapydrink water, continue taking drug even if no benefits right awayMinimize adverse effectstake vitamin B everyday, remind patient photosensitive so be cautiousPatient educationschedule doses because it is not taken daily, contact doctor if starting any other drugs, no alcohol, proper nutrition lab test, benefits may take 1-2 moetanercept PTetanercept PKetanercept PDNURSL 261 1st EditionExam # 2 Study Guide Weeks: 5-8Week 5-ClottingAntihemophilic factorPharmacotherapeutics of Antihemophilic FactorFor hemophilia AFor deficiencies in factor VIIIPharmacokinetics of AHFOnly given IV-don't have to worry about metabolism or excretion because it is pooled human bloodPharmacodynamics of AHFFactor VIII is required for the conversion of prothrombin to thrombin-comes from pooled human bloodIndications of AHFHemophilia ASide effects of AHF-typical blood transfusion reaction-hypotension-tachycardia-anaphylaxisInteraction with AHF nonePatient teaching with AHFif the patient is young, teach parents how to give IVmust be kept in the fridge and thenwarmed when ready to reconstituteby adding the dilutantlabs for AHF hemoglobinhematocritAPPT PTWBCHalf life 12 hoursLife span issues with AHFsafety--possibility for HIV transmission but all donors are screened really wellHeparinPharmacotherapeutics of heparinprevents a clot from formingcan be used prophylactically to prevent a thrombus in post-op patientsparenteral anticoagulant that interferes with the final steps of the clotting cascadepharmacokinetics of heparinonly given parentally (gets destroyedby stomach acid)IV- immediate onsetSQ-onset is 20 to 60 minsmetabolism: liverexcretion: kidneyPharmacodynamics of heparin-inactivates factor X which prevents the conversion of prothrombin to thrombin-limits the effects of fibrin-prolongs clotting time (increases aPTT)Heparin has no effect on blood clots that have already formedAdverse effects of heparinbleedingheparin-induced thrombocytopeniaEnoxaprinpharmacotherapeutics of enoxaprin prevent formation of blood clotspreferred treatment for DVTpharmacokinetics of enoxaprin given SQwidely distributedsafer than heparinpharmacodynamics of enoxaprin has an effect on factor X but little and almost limited effect on thrombin thus it has little effect on aPTTAdverse effects Bleeding, thrombocytopeniaPatient teaching How to give injection, use soft bristletoothbrush and electric razorWarfarinPharmacotherapeutics of warfaringiven to patients for 3 to 6 months after heparin therapy to complete treating a thrombus or embolismused prophylactically for patients with risk of thrombus formation or atrial fibrillationPharmacodynamics of warfarincompetitively blocking vitamin K andthus prevents the activation of factors II, VII, IX, and Xhas no effects on factors that have already been activatedPharmacokinetics of warfarinoralbound to albumin in plasmaAdverse effects of warfarinbleeding and hemorrhagePatient teaching Longterm therapy need weekly labsLabs PT and longterm and the INRInteractions Don’t eat lots of green leafy vegatables (causes a vitamin K to warfarin imbalance)Don’t drink alcoholIf needed give vitamin K which is theantidoteClopidogrelpharmacotherapeutics of clopidogrelreduce the occurrence of atherosclerotic events such as MI, stroke, and vascular deathalso used to treat peripheral arterial diseasepharmacokinetics of clopidogrel oralrapidly absorbed in GI metabolism: liverexcretion: kidneyspharmacodynamics of clopidogrel inhibits the binding of adenosine diphosphate to its platelet receptors and the subsequent ADP mediated activation of the glycoprotein IIB/IIIacomplex and this inhibits platelet aggregationprolongs bleeding timehas great additive effect when taken with aspirinadverse effects of clopidogrel GI distress-abdominal pain-indigestionNeutropenia, BleedingInteractions Chemotherapy drugs, proton pump inhibitorsPentoxifyllinePharmacotherapeutics Manages symptom of intermittent claudicationPharmacodynamics Oral 2-4 week onset/several more weeks before therapeutic level is reachedPharmacokinetics Decreases platelet aggregationVasodilatesDecreases viscosity of bloodSide effects BleedingDizzinessBlurred VisionGI upsetInteractions Methylzalthines (asthma and bronchitis)Patient teaching Tell physician you are on this medicationTake with foodUse soft toothbrush and electric razor- Clottingo The process in which blood is converted to a semi-solid gelo Starts in the veins and arteries and can move to other places in the bodyo When clotting doesn’t occur pts are at risk for bleedingo When too much clotting occurs (thrombus) blood flow can be obstructed to major organs- Excessive Clottingo Deep Vein Thrombosiso Polycythemiao Atrial fibrillation If the pt has an arrhythmia because the atria doesn’t contract normally, then stasis of the blood can cause clotting- Deficient Clottingo Hemophilia o Thrombocytopenia- Risk Factorso Age (older or less mobile)o Genetics (hemophilia)o Immobility (DVT)o Smoking Vasoconstriction can cause hypercoagubility of blood- Physiology of Coagulationo Blood circulates through blood vesselso Clotting prevents excess blood losso Cells and substances maintain a balance (protective mechanism) of coagulationand anticoagulationo Tissue damage and platelet activation initiate clotting factorso The clotting cascade occurs over two pathways, intrinsic and extrinsic Intrinsic- Result of endothelial injury, hypoxia, or burns Extrinsic-