2. SONG Hui

3. Outline Anticoagulants ( 抗凝 ) Anticoagulants ( 抗凝 ) Thrombolytic agents ( 纤溶 ) Thrombolytic agents ( 纤溶 ) Coagulants ( 促凝 ) Coagulants ( 促凝 ) Anti- Anemia ( 扶贫 ) Anti- Anemia ( 扶贫 ) White cells stimulants ( 增白 ) White cells stimulants ( 增白 ) Blood volume increasing Agents ( 扩容 ) Blood volume increasing Agents ( 扩容 )

4. Anticoagulants Thrombolytic agents Coagulants

5. Background Hemostasis Process Vessel contraction Vessel contraction Thrombokinesis Thrombokinesis Platelets aggregation Fibrin formation Fibrinolysis Fibrinolysis

6. Background Fa II II a Fg Fb PgPlasmin Pg Plasmin Activators + PAI

7. Anticoagulants

8. Classification Anti-factors: Anti-factors: Heparin, Warfarin Anti-platelet agents: Anti-platelet agents: Aspirin, Persantin,Ticlid Thrombolytic agents Thrombolytic agents SK, UK, t-PA

9. Anti-factors Heparin Heparin II a structure structure IX a MOA AT III X a(LMWH) MOA AT III X a(LMWH) XI a XI a Heparin XII a Heparin XII a

10. Heparin Uses: prevention of thrombi (DIC,MI) Dose control: PT, <10d ADR: Bleed Protamine hypersensitivity, osteoporosis Notice: HBP, ulcer, pregnancy

11. Warfarin P.O only, in vivo, effect: 24hr later MOA antagonist of V.K IIVII IX IXXPCPS II a VIIa IX a X a PCaPSa KH 2 KO Carboxylase r- 羧化酶 Warfarin

12. Warfarin Uses Uses Prevention of Thrombi in venous Prevention of Thrombi in venous interaction interaction Dose control PT Dose control PT ADR: bleeding, necrosis ADR: bleeding, necrosis

13. Anti-platelet agents Platelets aggregation MOA Platelets aggregation Agents: Agents: — COX TXA2, ADP Aspirin — COX TXA2, ADP Aspirin — PDE Camp Ca Persantin — PDE Camp Ca Persantin — PLT aggregation factors Ticlid — PLT aggregation factors Ticlid — Gp IIb/IIIa Tirofiban — Gp IIb/IIIa Tirofiban CVS Uses: to prevent thrombin formation in CVS

14. Thrombolytic agents

15. MOA plasminogen MOA plasminogen activate SK, UK, t-PA activate SK, UK, t-PA plasmin plasmin fibrinogen,fibrin fibrinogen, fibrin Uses 2-8 hs after MI

16. Coagulants

17. Classification Adrenosem,pituitrin vessel contractor (Adrenosem,pituitrin) platelet K 1,2 - nature, fat-soluble Vitamin K (K 1,2 - nature, fat-soluble K 3,4 - synthetic, WS K 3,4 - synthetic, WS ) Reptilase thrombin (Reptilase) PAMBA, AMCHA fibrinogen / fibrin (PAMBA, AMCHA)

18. Songhui

19. Outline Anti-Anemia agents White cells stimulants White cells stimulants Blood Volume Increasing agents

20. Anti-Anemia

21. Iron-deficiency anemia Iron-deficiency anemia Megaloblastic anemia Megaloblastic anemia Classification

22. Iron-deficiency anemia Backgroud Backgroud Hb Iron: Hb red meat supply: red meat absorption & storage: Fe Vit.C HCl Fe ++ Fe +++ t&s Fe ++ Fe Vit.C HCl Fe ++ Fe +++ t&s Fe ++ diagnosis: PT/TIBC < 10%(35%) Symptoms: fatigue, pica

23. Iron-deficiency anemia Agents Agents Oral ferrous sulfate Parenteral iron dextran ADR ADR stimulating reactions Overdose----phosphate deferoxamine

24. Megaloblastic anemia Backgroud: folic acid, VB 12 folic acid, VB 12 Supply: Vegetable, Animal Supply: Vegetable, Animal Function: DNA, lipin Function: DNA, lipin

25. Megaloblastic anemia L-MCoA ScCoA LIPIN FH2 E Folate E 5-MFH 4 CH3 B12 B12 E FH4 C-FH4 CH3-B12 dUMP dTMP DNA C Homocysteine Methionine A: B12 B: 半胱氨酸 蛋氨酸 甲基丙二酰 CoA 琥珀酰 CoA B12 B12 E 尿嘧啶脱氧核苷酸 胸腺嘧啶脱氧核苷酸

26. Megaloblastic anemia Folic acid RNA: DNA Megaloblastic anemia absorbed in intestine: 5-MFH 4 5-MFH 4 liver Therapy B 12 folic acid(calcium leucovorin)+ B 12

27. Megaloblastic anemia B 12 B 12 Background mainly from animal absorbed with IF Storage in liver 5-MFH4 B12 FH4 lipin synthesis of nerves

28. Megaloblastic anemia Deficiency FH4 Megaloblastic anemia & CNS symptoms Etiology Some gastrointestinal diseases IF therapy B 12 & folic acid use together. B 12 & folic acid use together.

29. Depression of the bone marrow Depression of the bone marrow Anemia associated with chronic renal failure (CRF) Anemia associated with chronic renal failure (CRF)

30. Anemia from CRF Erythropoietin (EPO) Effect: RBC Uses: CRF, Iron deficiency, Marrow injury, tumors, AIDS. Agent: ESPO

31. WBC stimulants---CSF G-CSF: PMN GM-CSF: PMN,MO,Macrophage,PLT USEs Marrow inhibited situations, Chemistry or Radiopraxis Marrow inhibited situations, Chemistry or Radiopraxis AIDS AIDS anemia anemia

32. B.V. increasing Agents (Dextran): Features (Dextran): Colloid Osmotic Pressure of plasma excretion is slow no toxicity no antigenicity

33. Questions

34. Where are the action sites of Anticoagulants and Thrombolytic agents respectively ? Which kind of drug would you choose for an AMI (<8hr.s) patient? A. Antiplatelets B. Coagulants C. Thrombolytics D. Anticoagulants

35. Questions Which factors formation dependend on V-K? And which can be inactivated by heparin? A. I A’. Ia B. II B’. IIa C. VII C’. XIa D. IX D’. IXa E. X E’. Xa F. XII F’. XIIa

36. Questions 1.What is the active form of folic acid? 2. The functions of B12. 3. Why some patients will get anemia after stomach excision?

37. Questions Which would u choose for the patients with Megaloblastic anemia? Iron agents Iron agents Folic acid only Folic acid only G-CFS G-CFS Folic acid & B12 Folic acid & B12