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General Pharmacology 205b. Neuromuscular Blocking Agents (NMBAs) Cause skeletal muscle weakness or paralysis for purpose of preventing movement.

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Presentation on theme: "General Pharmacology 205b. Neuromuscular Blocking Agents (NMBAs) Cause skeletal muscle weakness or paralysis for purpose of preventing movement."— Presentation transcript:

1 General Pharmacology 205b

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3 Neuromuscular Blocking Agents (NMBAs) Cause skeletal muscle weakness or paralysis for purpose of preventing movement

4 Neuromuscular Blocking Agents (NMBAs) Cause skeletal muscle weakness or paralysis for purpose of preventing movement Two types 1.Depolarizing agents 2.Non-depolarizing agents

5 Depolarizing Agents  Bind to acetylcholine receptor sites causing a post-synaptic membrane depolarization  Prevention of repolarization causes the post- synaptic ending to become refractory and unexcitable, resulting in muscle flaccidity Action  Prevents acetylcholine from binding at the receptor site  Shorter acting than non-depolarizing agents  Will cause total muscle paralysis in 60 to 90 seconds that lasts from 10 to 15 minutes  Do not have reversing agents Generic nameProprietary name SuccinylcholineAnectine Indications -Short acting paralytic ideal for intubation or similar procedures Non-Depolarizing Agents  Produce paralysis and muscle weakness by competing with acetylcholine for binding at the receptor site  Prevention of the binding of acetylcholine prevents depolarization of the site, thereby preventing muscle contraction Action  Competitive inhibition of acetylcholine at muscle post-synaptic receptor site  Effects felt in 2 to 10 minutes and last for 30 to 60 minutes  May be reversed by cholinesterase inhibitors, e.g., Neostigmine Generic NameProprietary Name Tubocurarined-tubocurarine PancuroniumPavulon MetocurineMetubine VecuroniumNorcuron RocuroniumZemuron, Esmeron I ndications -Need for longer term paralysis -Patient-ventilator synchrony -Muscle relaxation during surgery -Indications -Reduction of intracranial pressure -Immobility in trauma patients- -Minimize oxygen consumption

6 Indications for NMBAs Endotracheal intubation Muscle relaxation during surgery Enhancement of patient-ventilator synchrony Reduction of intracranial pressure in intubated patients Minimizes oxygen consumption Facilitation of procedures or diagnostic studies Maintenance of immobility, e.g., trauma patients (Flail Chest)

7 Depolarizing Agents Bind to acetylcholine receptor sites causing a post-synaptic membrane depolarization

8 Depolarizing Agents Prevention of repolarization causes the post-synaptic ending to become refractory and unexcitable, resulting in muscle flaccidity

9 Non-Depolarizing Agents Produce paralysis and muscle weakness by competing with acetylcholine for binding at the receptor site

10 Non-Depolarizing Agents Prevention of the binding of acetylcholine prevents depolarization of the site, thereby preventing muscle contraction

11 Indications for NMBAs Endotracheal intubation Muscle relaxation during surgery Enhancement of patient-ventilator synchrony Reduction of intracranial pressure in intubated patients

12 Indications for NMBAs Minimize oxygen consumption Facilitation of procedures or diagnostic studies Maintenance of immobility, e.g., trauma patients

13 Depolarizing Agents Generic name –Succinylcholine Proprietary name –Anectine

14 Depolarizing Agents Action –Prevents acetylcholine from binding at the receptor site –Shorter acting than non-depolarizing agents

15 Depolarizing Agents Action –Will cause total muscle paralysis in 60 to 90 seconds that lasts from 10 to 15 minutes –Do not have reversing agents

16 Depolarizing Agents Indications –Short acting paralytic ideal for intubation or similar procedures

17 Depolarizing Agents Side effects and hazards –May induce sympathomimetic response Tachycardia Increase in blood pressure Vagal response in repeated dosages leading to bradycardia and hypotension

18 Depolarizing Agents Side effects and hazards –May induce sympathomimetic response Make provoke release of histamines Increase in intracranial pressure in patients with cerebral edema or head trauma

19 Depolarizing Agents Side effects and hazards –May induce sympathomimetic response Malignant hyperthermia – caused by genetic defect of muscle metabolism –Hypoventilation

20 Depolarizing Agents Route of administration –Intravenous administration Dosage –1.0 to 1.5 mg/kg

21 Non-Depolarizing Agents Generic NameProprietary Name Tubocurarined-tubocurarine PancuroniumPavulon MetocurineMetubine VecuroniumNorcuron

22 Non-Depolarizing Agents Action –Competitive inhibition of acetylcholine at muscle post-synaptic receptor site –Effects felt in 2 to 10 minutes and last for 30 to 60 minutes –May be reversed by cholinesterase inhibitors, e.g., Neostigmine

23 Non-Depolarizing Agents Indications –Need for longer term paralysis –Patient-ventilator synchrony –Muscle relaxation during surgery

24 Non-Depolarizing Agents Indications –Reduction of intracranial pressure –Immobility in trauma patients –Minimize oxygen consumption

25 Non-Depolarizing Agents Side effects and hazards –Vagolytic effects including tachycardia, increase in mean blood pressure, and increase in release of norepinephrine; seen most with Pancuronium

26 Non-Depolarizing Agents Side effects and hazards –Release of histamine from mast cells Vasodilation leading to flushed appearance Reflex tachycardia Bronchospasm –Hypoventilation

27 Non-Depolarizing Agents Route of administration –Intravenous

28 Non-Depolarizing Agents Dosage –Tubocurarine 0.5 – 0.6 mg/kg infused at 0.08 – 0.12 mg/kg/hr –Pancuronium 0.08 – 0.1 mg/kg infused at 1 µg/kg/min –Vecuronium 0.1 – 0.2 mg/kg infused at 1 µg/kg/min

29 QpiDjKaghttp://www.youtube.com/watch?v=W60 QpiDjKag

30 Narcotics and Analgesics Used for the relief of severe pain

31 Narcotics and Analgesics Opioid analgesics – high potency –Morphine Route of administration –Oral: (Adults > 50 kg) – 30 mg q3 – q4 hours –Intravenous: (Adults > 50 kg) »Single Dose: 4 – 10 mg q3 – q4 hours »Continuous: 0.8 – 10 mg/hr –Intramuscular: 4 – 10 mg q3 – q4 hours

32 Narcotics and Analgesics Opioid Analgesics – high potency –Oxymorphone - (proprietary name – Numorphan) Route of administration –Intravenous: 0.5 mg q3 – 6 hours –Intramuscular: 1.0 – 1.5 mg q3 – 6 hours

33 Narcotics and Analgesics Opioid analgesics – high potency –Fentanyl - (proprietary name – Sublimaze) Route of administration –Intravenous: 2 mcg/kg (moderate); 2 – 20 mcg/kg (high) –Intramuscular: same as IV –LOLLYPOP

34 Narcotics and Analgesics Opioid analgesics – high potency –Methadone - (proprietary name – Dolophine) –Used to overcome Heroine addiction also Route of administration –Oral: 10 mg –Intravenous: 5 mg

35 Methadone is mainly used in the treatment of opioid dependence. It has cross-tolerance with other opioids including heroin and morphine, offering very similar effects and a longer duration of effect. Oral doses of methadone can stabilise patients by mitigating opioid withdrawal syndrome. Higher doses of methadone can block the euphoric effects of heroin, morphine, and similar drugs. As a result, properly dosed methadone patients can reduce or stop altogether their use of these substances.

36 Narcotics and Analgesics Opioid Analgesics – high potency –Hydromorphone - (proprietary name – Dilaudid) Route of administration –Oral: 4 – 8 mg q3 – 4 hours –Intravenous »Single dose – 1.5 mg q3 – 4 hours »Continuous – 0.2 – 30 mg/hr –Intramuscular: 1.5 mg q3 – 4 hours

37 Narcotics and Analgesics Opioid analgesics – intermediate potency –Meperidine - (proprietary name – Demerol) Route of administration –Oral: 50 – 150 mg q3 – 4 hours –Intravenous »Single dose: 50 – 150 mg q3 – 4 hours »Continuous: 15 – 35 mg/hr –Intramuscular: 50 – 150 mg q3 – 4 hours

38 Narcotics and Analgesics Opioid analgesics – intermediate potency –Oxycodone - (proprietary names – Percolone, Oxycontin; with acetaminophen – Percocet Route of administration –Oral: 5 – 10 mg q3 – 4 hours –Oral: time release capsule – q12 hours

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40 Narcotics and Analgesics Opioid analgesics – low potency –Codeine - (proprietary name – Paveral) Route of administration –Oral »Analgesic: 15 – 60 mg q3 – 6 hours »Antitussive: 10 – 20 mg q4 – 6 hours –Intravenous: 15 – 60 mg q4 – 6 hours –Intramuscular: 15 – 60 mg q4 – 6 hours

41 Narcotics and Analgesics Opioid analgesics – low potency –Diphenoxylate - (proprietary name – Lomotil) Route of administration –Oral: 5 mg 3 to 4 times daily initially, then 5 mg once Daily as needed

42 Narcotics and Analgesics Opioid analgesics –Action – not completely understood, but affect neurotransmission at specific sites in the CNS, affect autonomic nervous system transmission

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44 Narcotics and Analgesics Opioid analgesics –Indications Relief of pain Fentanyl used as analgesic supplement to general anesthesia Methadone used as substitute for heroin, etc

45 Narcotics and Analgesics Opioid analgesics –Side effects and hazards Hypotension Transient hyperglycemia Depression of respiratory system Cough reflex decreased Nausea and vomiting

46 Narcotics and Analgesics Opioid analgesics –Contraindications Hypersensitivity/allergy to agent Head trauma

47 Narcotics and Analgesics Opioid analgesics –Route of administration Oral (PO) Intravenous (IV) Intramuscular (IM) Subcutaneous (SubQ)

48 Narcotic Antagonists Action –Competitive replacement of narcotic from receptor site Indication –Reversal of the effects of a narcotic –http://www.youtube.com/watch?v=U1frPJoWt kwhttp://www.youtube.com/watch?v=U1frPJoWt kw

49 Narcotic Antagonists Partial antagonists –Side effects Cause narcotic-like effects in absence of a narcotic Increased respiratory depression in non-narcotic overdose

50 Narcotic Antagonists Partial antagonists –Nalorphine - (proprietary name – Nalline) Route of administration –Initial dose: IV 5 to 10 mg –IV drip: 5 to 10 mg in 5% glucose solution

51 Narcotic Antagonists Partial antagonists –Levallorphan - (proprietary name – Lorfan) Route of administration –IV 1 mg –May be repeated as needed

52 Narcotic Antagonists Pure antagonists –Does not increase respiratory depression if administered in a non-narcotic overdose

53 Narcotic Antagonists Pure antagonists –Naloxone - (proprietary name – Narcan) Route of administration –Initial dose: 0.4 to 2 mg IV –May be repeated at 2 to 3 minute intervals –May be given IM or subcutaneously if IV unavailable

54 Sedatives and Hypnotics Causes longer generalized depression of the central nervous system Ut9DzYhttp://www.youtube.com/watch?v=68Nag Ut9DzY

55 Sedatives and Hypnotics Anti-anxiety agents –Lorazepam - (proprietary name – Ativan) Route of administration –Oral: 2 to 6 mg/d. –Intramuscular: 0.05 mg/kg –Intravenous »Intermittent dose: 0.02 to 0.06 mg/kg q2 to q6 hours »Infusion rate: 0.01 to 0.10 mg/kg/h

56 Sedatives and Hypnotics Anti-anxiety agents –Midazolam - (proprietary name – Versed) Route of administration –Intramuscular: 0.07 to 0.08 mg/kg –Intravenous (for conscious sedation) »Intermittent dose: 0.02 to 0.08 mg/kg q30 minutes to q2 hours »Infusion rate: 0.04 to 0.2 mg/kg/hr

57 Sedatives and Hypnotics Anti-anxiety agents –Haloperidol - (proprietary name – Haldol) Oral: 0.5 to 2 mg BID Intramuscular: 2 to 5 mg q4 to q8 hours as needed Intravenous –Intermittent dose: 0.03 to 0.15 mg/kg q30 minutes to q6 hours –Infusion rate: 0.04 to 0.15 mg/kg/hr –Haloperidol is a dopamine inverse agonist of the typical antipsychotic/Schizophrenic/Delerium

58 Sedatives and Hypnotics Anti-anxiety agents –Propofol - (proprietary name – Diprivan) Induction – 40 mg q10 seconds until induction achieved Maintenance – 5 to 80 µg/kg/min

59 Sedatives and Hypnotics Barbiturates –Thiopental - (proprietary name – Pentothal) Route of administration –Intravenous: 3 to 7 mg/kg –Used in some states for lethal injection

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61 Sedatives and Hypnotics Barbiturates –Pentobarbital - (Proprietary Name – Nembutal) Route of Administration –Oral: 20 mg tid –Intramuscular: 150 to 200 mg –Intravenous: 50 mg/min (Initial Dose: 100 mg in 70 kg Adult)

62 Sedatives and Hypnotics Barbiturates –Secobarbital - (proprietary name – Seconal) Route of administration –Pre-operative sedation: 200 to 300 mg 1 to 2 hours Before surgery –At night: 100 mg PO at hs

63 Sedatives and Hypnotics Barbiturates –Amobarbital - (proprietary name – Amytal) Route of administration –Intramuscular: 65 to 500 mg; no more than 5 ml in one injection –Intravenous: 65 to 500 mg at rate ≤ 1 ml/min

64 Sedatives and Hypnotics Barbiturates –Phenobarbital Route of administration –Oral »Sedation – 30 to 120 mg/d in two to three divided doses »Hypnotic – 100 to 200 mg barbiturate and the most widely used anticonvulsant worldwide, and the oldest still commonly used

65 Sedatives and Hypnotics Barbiturates –Phenobarbital Route of administration –Intramuscular »Sedation – 30 to 120 mg 60 to 90 minutes before surgery »Hypnotic – 100 to 320 mg

66 Sedatives and Hypnotics Barbiturates –Phenobarbital Route of administration –Intravenous »Same as intramuscular

67 Sedatives and Hypnotics Hypnotics –Methaqualone - (proprietary name – Quaalude) Route of administration –Oral: 75 to 300 mg –More common as a street drug

68 Sedatives and Hypnotics Hypnotics –Flurazepam - (proprietary name – Dalmane) Administered orally –15 to 30 mg at hs –In geriatric patients, 15 mg initially, but may be increased

69 Sedatives and Hypnotics Hypnotics –Diazepam - (proprietary name – Valium) Route of administration –Oral: 2 to 10 mg bid to qid –Intramuscular: 2 to 20 mg repeated in three to four hours –Intravenous: 0.03 to 0.01 mg/kg q30 minutes to q6 hours

70 Sedatives and Hypnotics Action –Depression of ascending reticular activating system resulting in loss of consciousness

71 Sedatives and Hypnotics Indications –Sleep induction –Relief of anxiety –Relief of depression

72 Sedatives and Hypnotics Indications –Anticonvulsant –Voluntary muscle relaxation

73 Sedatives and Hypnotics Side effects –Drowsiness –Impaired performance and judgment –Potential for abuse –Hangover effect

74 Sedatives and Hypnotics Contraindications –Hypothyroidism –Hypoadrenalism

75 Sedatives and Hypnotics Routes of administration –Oral (PO) –Intravenous (IV) –Intramuscular (IM) –Subcutaneous (SubQ)

76 Diuretic Agents Osmotic diuretics are solutes that oppose the passive movement of water during sodium transport. The rapid loss of sodium and water occurs by inhibiting their reabsorption in the proximal tubule. These low-molecular-weight substances create an opposing osmotic force and contribute to a decreased fluid reabsorption and increased urine volume. Osmotic diuretics also cause sodium excretion to increase because of significant back diffusion. Because water reabsorption is inhibited and sodium transport is occurring, a sodium concentration gradient develops. As a result of the high concentration gradient back diffusion occurs. Alteration of the re-absorption of water within the nephron system

77 f2KnbYohttp://www.youtube.com/watch?v=6Wc4 f2KnbYo YHAwCMs&feature=relatedhttp://www.youtube.com/watch?v=JJAM YHAwCMs&feature=related

78 Classification of Diuretics Osmotic diuretics –Interfere with the water re-absorption in the descending loop of Henle and in the proximal tubule –Used to treat or prevent acute renal failure

79 Classification of Diuretics Osmotic diuretics –Mannitol Route of administration - IV –Reduction of intracranial pressure – 1.5 to 2 g/kg as a 15% to 25% solution over 30 to 60 minutes

80 Mannitol Mannitol is used to reduce acutely raised intracranial pressure until more definitive treatment can be applied, e.g., after head trauma. It is also used to treat patients with oliguric renal failure. It is administered intravenously, and is filtered by the glomeruli of the kidney, but is incapable of being resorbed from the renal tubule, resulting in decreased water and Na + reabsorption via its osmotic effect. Consequently, mannitol increases water and Na + excretion, thereby decreasing extracellular fluid volume. Mannitol can also be used as a facilitating agent for the transportation of pharmaceuticals directly into the brain.

81 Classification of Diuretics Carbonic anhydrase inhibitors –Prevent re-absorption of sodium and bicarbonate ions in the proximal tubule –Weak agents used to lower intraocular pressure in glaucoma

82 Carbonic anhydrase inhibitors suppress the activity of carbonic anhydrase. Their clinical use has been established as antiglaucoma agents, diuretics, antiepileptics, in the management of mountain sickness, gastric and duodenal ulcers, neurological disorders, or osteoporosis

83 Classification of Diuretics Carbonic anhydrase inhibitors –Acetazolamide (proprietary name – Diamox) Route of administration - orally –Diuresis in CHF – 250 to 375 mg (5 mg/kg) qd in the morning –May be used for severe metabolic alkalosis

84 Classification of Diuretics Carbonic anhydrase inhibitors –Methazolamide - (proprietary name – Neptazane) Route of administration - orally –Reduction of intraocular pressure – 50 to 100 mg bid

85 Classification of Diuretics Loop diuretics –Inhibit absorption of chloride ions in the ascending loop of Henle –Used to treat hypertension, acute CHF, chronic renal failure, ascites

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87 Classification of Diuretics Loop diuretics –Furosemide - (proprietary name – Lasix) Route of administration - orally or IV –Acute pulmonary edema – 40 mg IV over 1 to 2 minutes

88 Lasix Furosemide, a 'water pill,' is used to reduce the swelling and fluid retention caused by various medical problems, including heart or liver disease. It is also used to treat high blood pressure. It causes the kidneys to get rid of unneeded water and salt from the body into the urine.

89 Lasix The tendency, as for all loop diuretics, to cause low potassium levels (hypokalemia) has given rise to combination products, either with potassium itself (e.g. Lasix-K) or with the potassium sparing diuretic of amiloride

90 Classification of Diuretics Loop diuretics –Furosemide Administered orally –Chronic edema – 20 to 80 mg/d PO initially; may be given q6 to q8 hrs –Hypertension – 40 mg PO bid

91 Classification of Diuretics Loop diuretics –Ethacrynic acid - (proprietary name – Edecrin) Administered orally or IV –Edema – initial dose of 50 to 100 mg/d PO; 0.5 to 1.0 mg/kg IV administered slowly over several minutes

92 Classification of Diuretics Thiazide diuretics –Block sodium and chloride ion re-absorption in the distal tubule –Used to treat hypertension and CHF

93 Classification of Diuretics Thiazide diuretics –Chlorothiazide - (proprietary name – Diuril) Administered orally or IV –Edema – 0.5 to 2.0 g PO or IV qd to bid –Hypertension – 0.5 to 2 g/d PO; IV not recommended

94 Classification of Diuretics Thiazide diuretics –Chlorthalidone - (proprietary name – Thalitone) Administered orally –Edema – 50 to 100 mg/d PO –Hypertension – 25 – 100 mg/d based on patient response

95 Classification of Diuretics Thiazide diuretics –Hydrochlorothiazide - (proprietary name – HydroDiuril) Administered orally –Edema – 25 – 200 mg qd PO –Hypertension – 12.5 – 50 mg PO initially; 25 – 100 mg qd maintenance

96 Classification of Diuretics Thiazide diuretics –Methyclothiazide - (proprietary name – Enduron) Administered orally –Edema – 2.5 – 10 mg qd PO –Hypertension – 2.5 – 5 mg qd PO

97 Classification of Diuretics Potassium sparing diuretics –Block sodium re-absorption in the distal tubule and collecting duct –Used to treat chronic liver disease and in CHF to counteract the hypokalemic effects of other diuretics

98 Classification of Diuretics Potassium sparing diuretics –Spironolactone - (proprietary name – Aldactone) Administered orally –Edema – 100 – 200 mg/d PO –Essential hypertension – 50 – 100 mg/d PO

99 Classification of Diuretics Potassium sparing diuretics –Triamterene - (proprietary name – Dyrenium) Administered orally –Diuresis – 100 mg bid PO

100 Classification of Diuretics Indications –Used for diuresis in patients with excessive fluid such as with congestive heart failure, hypertension, and acute and chronic renal failure

101 Classification of Diuretics Side effects –Hypokalemia –Acid-base alterations –Hyperglycemia

102 Steroids A class of hormonal agents produced naturally by the body to regulate various metabolic functions; artificially produced versions are used to mimic the normal agents

103 Steroids Actions –In the context of the ICU, prevention or suppression of inflammatory responses caused by hypersensitivity –Decrease capillary permeability in edema

104 Steroids Indications –Presence of allergic or non-allergic inflammatory response Asthma Chronic obstructive pulmonary disease

105 Steroids Indications –Suppression of immune response in organ transplant patients

106 Steroids Side effects from systemic administration –Cushing’s disease Moon face Hirsutism Muscle wasting Hypokalemia

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108 Steroids Side effects from systemic administration –Hypertension –Atrophy of the adrenal glands –Obesity –Suppression of growth

109 Steroids Side effects from systemic administration –Thinning of skin –Osteoporosis –Immunosuppression –Masks infection

110 Steroids Hydrocortisone –(proprietary names – Cortaid, Aquacort) –Routes of administration – oral, topical, intramuscular, intravenous Intramuscular & intravenous: 100 to 500 mg initially, then q 2 to q10 hours

111 Steroids Cortisone –(proprietary name – –Cortone) –Routes of administration Oral: 25 to 300 mg/d Intramuscular: 20 to 330 mg/d

112 Steroids Prednisone –Route of administration Oral: initial dose variable depending upon severity of symptoms; maintenance dose of 5 to 60 mg/d PO

113 Solu-Medrol Potent IV steroid for COPD/Asthma exacerbations 40, 125, 500 mg doses

114 Anti-Thrombotic Agents Anti-coagulant agents –Action Potentiates the inhibitory effect of anti-thrombin on Factor Xa and thrombin Prevents the conversion of fibrinogen to fibrin e=relatedhttp://www.youtube.com/watch?v=ac_om5HCjvg&featur e=related

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116 Anti-Thrombotic Agents Anti-coagulant agents –Indications Prophylaxis and treatment of thrombo-embolic disorders (Pulmonary emboli, stroke, MI…)

117 Anti-Thrombotic Agents Anti-coagulant agents –Side effects Excessive bleeding Hypersensitivity

118 Anti-Thrombotic Agents Anti-coagulant agents –Heparin Route of administration –Intravenous »Bolus – 10,000 units »Continuous infusion – 20,000 to 40,000 units infused over 24 hours

119 Anti-Thrombotic Agents Anti-platelet agents –Action Inhibits platelet aggregation –Indications Reduction of risk of myocardial infarction, stroke, and peripheral vascular disease Artrial fibrillation

120 The most important antiplatelet drugs are: Cyclooxygenase inhibitors –Aspirin Adenosine diphosphate (ADP) receptor inhibitors –Clopidogrel (Plavix) –Prasugrel (Effient) –Ticagrelor (Brilinta) –Ticlopidine (Ticlid)

121 Anti-Thrombotic Agents Anti-platelet agents –Side effects Increased risk of bleeding Safety not established in pregnancy

122 Anti-Thrombotic Agents Anti-platelet agents –Clopidogrel - (proprietary name – Plavix) Route of administration –Oral »Daily – 75 mg PO »Acute coronary syndrome – 300 mg initially, then 75 mg once daily

123 Anti-Thrombotic Agents Anti-platelet agents –Acetylsalicylic Acid - (proprietary name – Aspirin) Route of administration –Oral: for prevention of myocardial infarction – 300 to 325 mg/d; dosage as low as 80 mg/d may be effective

124 Anti-Thrombotic Agents Thrombolytic agents –Action Converts plasminogen to plasmin, which is then able to degrade fibrin in clots

125 Anti-Thrombotic Agents Thrombolytic agents –Indications Acute myocardial infarction Massive pulmonary embolism Deep vein thrombosis Acute ischemic stroke

126 Anti-Thrombotic Agents Thrombolytic agents –Side effects Intracranial hemorrhage Bleeding

127 Anti-Thrombotic Agents Thrombolytic agents –Streptokinase - (proprietary name – Streptase) Route of administration – intravenous –Myocardial infarction – 1.5 million units IV –Deep vein thrombosis, pulmonary emboli – 250,000 units loading dose, then 100,000 units/hr for 24 hours


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