preps. composed of molecules that are shorter than those found in unfractionarted heparin; use: prevent of DVT after surgery, treat of estabed DVT, prevent of ishcemic comp; adv effects and inter: bleeding, immune-mediated thrombocytopener, cost
Fondaparinux
(arixtra) Syn anticoag; selective inhibit; use: prevent dvt after surgery, treat acute PE, DVT(w/ warfarin); adv eff: bleeding, patient less than 50kg; spinal or epidural hematoma; enoxaparin(lovenox) mult use, STEMI
Warfarin
(Coumadin) oral anticoag; antagonist of Vit K; affects syn-factors VII, IX, X, prothrombin; use: long term prophylaxis of thrombosis; adv eff: hemorrhage, contraindicated in pregnancy, lactation; prothrombin time ratio; vit K1 overdose
Antiplatelet Drugs
Aspirin inhibit of COOG, GI bleeding; Ticlopidine(ticlid) & Clopidogrel (plavix) ADP receptor antag, prev. aggr: Tirofiban (aggrastat) blocks GP IIb/IIIa recpetors, last step aggr. most effective anti platelet drug
used to treat hemophilia; prod. mehtods and product safety, plasma-derived factor VII, recombinant factor VIII; adv eff: allergic rxn; dosage and admin: on-demand therapy, prophylactic therapy; factor IX conc.
Desmopressin
stop or prevent bleeding (mild hemophilia)
Antifibrinolytic Agents
used to treat hemophilia; aminocarproic acid, tranexamic acid; inhibit the normal process of fibrin breakdown; control bleeding in mucous membranes; control bleeding caused by dental extractions
Ferrous Sulfate(drug of choice); adv eff GI dist, Staining teeth, toxicity; Interactions: antacids, tetracycline, ascorbic acids, other oral iron salts: ferrous gluconate and ferrous fumarate
Cyanocobalamin
v 12 preparations; admin oral, parenteral, intranasal; adv eff hypokalemia (New RBCs); Long-term treatment, with lack of intrinsic facor, v b-12 lifelong
Epoerin Alfa
(erytgropoietin) Epogen, procrit) hematopoietic growth facor, rDNA; use: anemia renal failure, HIV taking zidovudine; chemo induced, anema facing surgery; adv eff: hypertension, autoimmune pure red cell aplasia(rare); cardivascular events
Filgrastim
(Neupogen) granulocute colony stimulating factor; leukopoietic GF, rDNA; use: cancer, sever chronix neutropenia; adv eff: bone pain, leukosytosis
Sargramostim
(Leukine) Sargramostim (granulocyte-macro colony stimulating factor - neutrophils, macr, hematopoietic GF, rDNA; use: adjunct to autologous bone marrow transplant, failed bone marrow trans, acute myelogenous leukemia; adveff leuko-thrombo cytosis
Acetohexamide(dymelor) Chlorpropamide(Diabinese) Tolazamide(Tolinase) Tolbutamide(orinase); oldest oral antidiab, stim B cell, less potent than 3nd gen, less tol; inexpen gen, adv eff, hypoglycemia(w/ norm. BS),worse lipid, cause wgt, fluid reten.DI:lots
Non-Sulfonylurea Secretagogues
Meglitinides,repaglinide (Prandin) and Nateglinide (starlix, MOA of Sulfonylureas, shorter acting; take with meals(1st bite); prandin 5xday. Sideff: hypoglycemia(not as bad sulfons), headache; DI: many , metab CYP450-2c9 and 3A4; Gemifibrozil(Lopoid)
Biguanides
Phenformin-precursor(lactic acidosis, 1977) Metformin (Glucophage, Glucophage XR, Riomet; MOA dec. hepatic Glucose prod70%; sensitizes cells to glucose, renal elim. A.E.: GI effects, dec app, bloat, metal taste, \/ B12
Thiazolidinediones
(Glitazones);Troglitazone(rezulin) withdrawn, liver damage Rosiglitazone (Avandia) & Pioglitazone (actos)MOA sensitize periphery insulin; dec insulin resist, SE gen mild, wgt, mild anem, perip edma, inc LDLc
Alfa-Glucosidase Inhibotors
Acarbose (precose) and Miglitol (Glyset)MOA: slows the breakdown and absorb of carbs in SI, SE: GI effect very common - fart, diarrhea, titrate does upward very slowly, no drug interactions
2nd Gen Sulfonylureas
Glimepiride(amaryl), Glipizide(Glucotrol), Glyburide-non-micronized(Diabeta, Micronase), Glyburide-Micronized(Glynase) Same MOA as 1st; better tol; most expensive
Levothyroxine
(Synthroid, Levothroid, others) syn prep of T4, conv. T3, 1/2life 7days, hypothyroidism; adv. eff tachycardia, angina, tremors; inter: drugs dec abs(colestid, questran), inc metab(phenytoin, AED), Warfarin(reduce dose of anti coag), Catechols(^cardiac res
Synthroid
formally drug of choice, relatively expensive (twice), bioequivalent to other preps; use caution when switching to another prep
Armour Thyroid
Very inexpensive, one of 1st agents on market, inconsistent levels, pig tg, rarely prescribed for new patients
Liothyronine
Cytomel; exogenous T3 - syn prep; lower dose, 1/2 of T4; rapid onset; shorter duration & 1/2life, $, not for long term
Liotrix
(thyrolar) Best, 4:1 ration(T4:T3) comparable to plasam
Hyperthyroid products
Methimazole (Tapazole)- longer half-life, 1/day; Propylthiouracil (PTU) – 3 doses/day, Indicated for short term therapy, Inhibits binding of I¯ to Thyroid globulin, PTU Inhibits peripheral conversion of T4, PTU preferred in pregnancy, placenta
Radioactive Iodine-131 (131I)
Radioactive isotope, emits gamma and beta rays; 1/2life 8days, active uptake by the thyroid, produces, clincal remission with destruction of thryoid gland, not very accurate, people usually develop hypothyroidism
(Sandostatin) syn analog of somatostatin; suppress GH release; dose-SC=3/day, IM=1/month; $$$; adv eff: GI, usually subside; Gallstones, usually asymptomatic
Somatrem
(Protropin)Growth hormone ; adv eff: hyperglycemia, hyperthyroidism(5%), antibody form. to GH(rarely V effective). omteractopm woth glucocorticoids(V effective)
Antidiuretic Preparations
Diabetes Insipidus: Vasopressin (ADH),(best) Desmopressin(mulit delivery), Other uses: Nocturnal enuresis, hemophilia A (^clotting factor VIII); adv eff intoxication, vasoconstriction
Hydrocortisone
Syn syteroid; uses: adrenal inusfficiency, allergy, inflammation, cancer chemo; adv eff: adrenal supp, cushing's syndrome
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