Hematology Pharmac😍

ANTI PLATELET DRUGS

• Tikka (Ticagrelor) in a Can (Cangrelor) → Reversible

• PAR-1 (Protease Activator Receptor) INHIBITOR:
• AtoPaxar
• VoraPaxar

1. Aspirin
• Inhibit COX → ↓TXA2

2. Clopidogrel, Ticlodipine, Prasugrel
• Reversibly inhibit ADP (P2Y12)
• It is a pro drug
• Irreversible P2Y₁₂ Inhibitors
• Ticagrelor, Cangrelor

3. Atopaxar/Vorapaxar



• Act on PAR-1 receptors of thrombin
• Mnemonic: PAR → Paxar

4. Abciximab
• Tirofiban
• Eptifibatide
• Act on GP IIb/IIIa
• Mnemonic: 2b3a → ab → Abc, fiban, fibatide ()

ANTI COAGULANTS

Oral Anti-Coagulants

1. Vitamin K inhibitors

2. Direct thrombin inhibitors

3. Factor Xa inhibitor

1. Vitamin K inhibitors

• Includes dicumarol and warfarin

Warfarin:

Warfarin → Fetal Warfarin Syndrome

• Disala syndrome
• Chondrodysplasia
• Stippled epiphysis
• Nasal hypoplasia
• CNS: Corpus callosum agenesis, microcephaly
• Cataract

• Mnemonic: War (Warfarin) nu poya Michel (Microcephaly) and salar (Disala Syndrome) nu idi kitti mookilum (Nasal hypoplasia) bone (Stipled epiphysis) ilum cartilage (Chondrodysplasia) ilum and killed his cat (Cataract)

Initial Hypercoagulable State

• Seen during first 1–2 days of warfarin therapy

• Causes increased risk of clotting

• Due to protein C deficiency (genetic or functional)

• Leads to:
• Dermal vascular necrosis
• Purple toe syndrome

Warfarin Overdose:

• Overdose of Warfarin causes bleeding.

• For bleeding tendency/warfarin overdose
• Vitamin K is antidote and treatment of choice

• For bleeding
• TOC → Four Factor complex /Prothrombin Factor complex
• Active Factors like IIa, VIIa, IXa, X
• If not available → FFP
• If not available → whole blood

2. Oral Direct Thrombin Inhibitors

Dabigatran

• Can be given Orally

• Does not require monitoring

• Antidote: Idarucizumab

• Mnemonic: Da → Direct acting; Tran → Thrombin antagonist

3. Direct factor Xa inhibitors

• DOAC/NOAC

• Drugs are:
• Rivaroxaban
• RIVAR – REVERSIBLE
• O – ORAL
• XA – XA
• B – BLOCKER (OR)
• AN – ANTAGONIST
• Apixaban
• Edoxaban
• Betrixaban

Injectable Anti-Coagulants

• 1. Indirect Thrombin Inhibitors

• 2. Direct Thrombin Inhibitors

1. Indirect Thrombin Inhibitors [Heparin]

• All activate antithrombin

• UFH
• Inhibit factor IIa = Xa (equal inhibition)
• Mnemonic: Big size → inhibit 2a
• Degraded via Reticuloendothelial system
• Safe in Renal Failure

• LMWH
• Inhibit factor Xa > IIa
• Mnemonic: Lesser size → Less inhibition of 2a
• Preferred for cancer-related thromboembolism

• Fondaparinux
• Only inhibits factor Xa
• Mnemonic: Lowest size → no inhibiton of 2a

• Heparins
• Route → S.C. or IV
• Activate anti-thrombin 3
• Immediate Action → Useful in acute conditions
• Anti-coagulant of choice in pregnancy
• Monitoring done by APTT
• Heparin is always Apt
• Antidote → Protamine Sulphate

Ciraparantag

• Universal reversal agent for anticoagulants

• Antidote for heparin, LMWH, DOACs
• NOT FOR Fondaparinux

• No known drug-drug interactions.

• Safer profile: No anaphylaxis, pulmonary hypertension, or hypotension risks.

• Cira paran → cheera () for parama (universal) problems

WARFARIN vs HEPARIN Table:

2. Injectible Direct Thrombin Inhibitors (DTI)

• Mnemonic: Din, Tran, Troban

• injectable DTI.
• Bivalirudin
• argatroban
• melagatran
• Troban and Tran → DOC for HIT

• Hirudin and lepirudin are not used now.

ANTIDOTES OF ANTI-COAGULANTS

FIBRINOLYTIC DRUGS

• Drugs:
• S – Streptokinase
• U – Urokinase
• R – Reteplase
• A – Alteplase
• T – Tenecteplase

• Antidotes:
• Epsilon AminoCaproic Acid [EACA]
• Tranexamic Acid.

• Tissue plasminogen activators.

• tPA → converts plasminogen to plasmin → breaks the thrombus.

• For acute STEMI, acute stroke and acute DVT.

• Overdose of thrombolytics → Leads to bleeding

DRUGS AFFECTING BLOOD CELLS

1. Hematinics

2. Growth factors

1. HEMATINICS

• 1. Iron (Fe)

• 2. Folic acid (FA)

• 3. Vitamin B12

Iron Deficiency Anemia

• Treatment of choice is Oral iron.

2. HEMATOPOIETIC GROWTH FACTORS