Notes: Epo is one of the drugs banned by the International Olympic Committee. Darbopoetin alpha (Aranesp ®) is a glycosylated form of erythropoietin that differs only in having a 2-3 fold longer half-life. Hypoxia is the primary physiological stimulus for erythropoietin production in the body.

Notes: Primary hemochromatosis is a hereditary disease in which there is increased accumulation of iron.

Notes: Folate deficiency (in pregnant women) is implicated as a cause of congenital malformations in newborns. Folate may also play a beneficial role in preventing the development vascular disease such as ischemic heart disease & stroke (see Katzung pg 536, 9th ed.) However, folic acid supplements may mask the signs of Vit B 12 deficiency, which can produce neurological disease if undetected. Folic acid deficiency is also known as Will's disease.

Notes: Vit B12 deficiency leads to megaloblastic anemia, GI symptoms & neurological abnormalities including degeneration of myelin sheaths in axons of the spinal cord & peripheral nerves. Symptoms include: paresthesias & weakness in peripheral nerves, progressing to spasticity, ataxia & other CNS dysfunctions. Vit B12 deficiency in elderly patients due to abnormal absorption of dietary Vit B12 is relatively common and easily treated.

Notes: a small test dose should be given before the full dose, to test for the risk of hypersensitivity. Patients with a strong history of allergy or who have previously received parenteral iron are more likely to have hypersensitivity reactions.

Mechanism of Action: a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Heparin acts at multiple sites in the normal coagulation system. Heparin interacts with antithrombin (heparin cofactor) to change its conformation and enhance its ability to inhibit thrombosis by inactivating clotting factor proteases, especially thrombin (IIa), IXa and Xa by forming equimolar complexes with them.

Indications:

The agent of choice for short term anticoagulant thereapy which includes:

• Anticoagulant therapy in prophylaxis and treatment of venous thrombosis.
• In a low-dose regimen for prevention of post-operative deep venous thrombosis and pulmonary embolism in patients undergoing major abdomino-thoracic surgery or who for other reasons are at risk of developing thromboembolic disease.
• Prophylaxis and treatment of pulmonary embolism.
• Atrial fibrillation with embolization.
• Diagnosis and treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation).
• Prevention of clotting in arterial and cardiac surgery.
• Prophylaxis and treatment of peripheral arterial embolism.
• As an anticoagulant in blood transfusions, extracorporeal circulation, dialysis procedures and in blood samples for laboratory purposes.

Notes: Heparine occurs naturally in the body & is found with histamine in tissue mast cells. Commercially purified from porcine intestinal mucosa. Bleeding time is usually unaffected by heparin sodium. Clotting time is prolonged by full therapeutic doses of heparin sodium; in most cases it is not measurably affected by low doses of heparin.

Indications:

1) for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism, such as in patients:

• undergoing abdominal surgery who are at risk for thromboembolic complications
• undergoing hip replacement surgery, during and following hospitalization
• undergoing knee replacement surgery
• who are at risk for thromboembolic complications due to severely restricted mobility during acute illness.

2) Lovenox Injection is indicated for the prophylaxis of ischemic complications of unstable angina and non-Q-wave myocardial infarction, when concurrently administered with aspirin.

Indications:

• anticoagulant-induced prothrombin deficiency caused by coumarin or indanedione derivatives
• prophylaxis and therapy of hemorrhagic disease of the newborn
• hypoprothrombinemia due to antibacterial therapy
• hypoprothrombinemia secondary to factors limiting absorption or synthesis of vitamin K, e.g., obstructive jaundice, biliary fistula, sprue, ulcerative colitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas, and regional enteritis
• other drug-induced hypoprothrombinemia where it is definitely shown that the result is due to interference with vitamin K metabolism, e.g., salicylates

Notes: Protamines are simple proteins of low molecular weight that are rich in arginine and strongly basic. They occur in the sperm of salmon and certain other species of fish.

Indications: 1) Antiplatelet Effects due to irreversible inhibition of platelet COX, so that aspirin's antiplatelet effect lasts 8-10 days (the life of the platelet). 2) Anti-inflammatory Effects. Aspirin's antiinflammatory effects are believed to contribute to aspirin's beneficial effects in patients having atherosclerotic disease, since inflammatory reactions within atherosclerotic plaques can result in plaque rupture. 3) MI Prophylaxis: Aspirin is indicated to reduce the risk of death and/or nonfatal myocardial infarction in patients with a previous infarction or unstable angina pectoris. 4) Transient Ischemic Attacks: Aspirin is indicated for reducing the risk of recurrent transient ischemic attacks (TIAs) or stroke in men who have transient ischemia of the brain due to fibrin emboli. There is currently no evidence that aspirin is effective in reducing TIAs in women, or is of benefit in the treatment of completed strokes in men or women. Other thereapeutically beneficial effects (covered elsewhere): 5) Analgesia, 6) Antipyretic. .

Reference: www.rxlist.com & Katzung's text

Notes: when used to treat stroke - therapy should only be initiated within 3 hours after the onset of stroke symptoms, and after exclusion of intracranial hemorrhage by a cranial computerized tomography (CT) scan or other diagnostic imaging method sensitive for the presence of hemorrhage.

Coronary occlusion due to a thrombus is present in the infarct-related coronary artery in approximately 80% of patients experiencing a transmural myocardial infarction evaluated within 4 hours of onset of symptoms.

Notes: Reteplase is a recombinant human t-PA from which several amino acids have been deleted. Because it lacks the major fibrin-binding domain, it is less fibrin-specific than t-PA. It is less expensive to produce than t-PA.

Notes: Slightly more fibrin-specific than t-PA.