1. AFAMS Blood and Blood Forming Agents (Insert Dari) EO 003.01 Part 18

2. AFAMS Lesson Overview (Insert Dari) A Review of Components of the blood. Overview of therapeutic classes Antithrombotics - Anti-platelets - Anticoagulants - Fibrinolytic Antihemmorhagics - Antifibrinolytics - Vitamin K Antianemics - Iron preparations - Vitamin B 12 and folic acid - Other antianemics Insert Dari

3. AFAMS Lesson Overview (Insert Dari) Blood Substitutes and solutions for perfusion - Plasma Proteins - IV solutions - Irrigating solutions - Other hematologic agents Insert Dari

4. AFAMS Blood خون Composed of plasma and a variety of cells Transports nutrients and wastes Contains elements used in repairing damage to blood vessels = clot formation. متشکل از پلازما (مايع) و حجرات مختلف مواد مغذى و فضله را انتقال ميدهد Insert Dari

5. AFAMS

7. What I need to know as a pharmacy technician (Insert Dari) In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under (B) Blood and Blood Forming Products For each of these medications/classes students must obtain an understanding of: (1) Mechanism of Action (2) Indications (Uses) (3) Efficacy (4) Side Effects Insert Dari

8. AFAMS A01 Antithrombotic Agents (Insert Dari)

9. AFAMS

10. Blood clotting is achieved via platelet adhesion, and activation of clotting factors. If an inappropriate blood clot becomes lodged in a vessel the following can occur: (1)Stroke – interruption of blood supply to the brain (2)Heart Attack – interruption of blood supply to the heart (3)Venous Thromboembolism – blood clot in the vein of a limb (4)Pulmonary Embolsim – blood clot in the lung Antithrombotics prevent a blood clot from lodging in a vessel and causing damage via one of two mechanism: (1)Preventing clot formation (2)Breaking down an existing clot

11. AFAMS Insert Dari

12. AFAMS Patient with a DVT of the left leg. Notice the swelling and condition of the skin. Insert Dari

13. AFAMS Anti-platelet Agents (Insert Dari) This class of drug includes both aspirin and clopidogrel. Mechanism of Action Anti-platelets prevent the adhesion of platelets to one another, preventing clot formation. Insert Dari

14. AFAMS Indications (Uses) To prevent heart attacks and strokes from occuring. It is used after a heart procedure where stents are inserted to prevent clots from occuring. Note: Aspirin also works as an anti- inflammatory and can be prescribed to a patient for that reason aswell. Anti-platelet Agents (Insert Dari) Insert Dari

15. AFAMS Stent (Insert Dari)

16. AFAMS Anti-platelets (Insert Dari) Side Effects Heartburn Upset Stomach Easy bruising Abnormal bleeding (i.e. bleeding of the gums, blood in the stool or black tarry stools). Important Points Patients should take this medication around the same time each day. Check with patients to make sure that they do not have an allergy to aspirin. Patients should not stop taking these medications unless directed by their doctor. Insert Dari

17. AFAMS Anticoagulants (Insert Dari) This class of drugs includes heparins and warfarin. Mechanism of Action Anticoagulants interfere with the activating of clotting factors which assist in clot formation. Indications (Uses) To prevent inappropriate blood clotting from occuring. Inappropriate clotting can lead to blockages, which can cause heart attacks, strokes and decreased blood supply to limbs and other organs. Patients who are prescribed these medications usually have conditions which put them at increased risk for inappropriate clot formation. Insert Dari

18. AFAMS Anticoagulants (Insert Dari) Indications (Uses) - Continued Heparins: Unfractionated Heparin (Heparin) Low Molecular Weight Heparin (i.e. Enoxaparin) Generally used to prevent clot formation in patients who are not mobile (i.e. bedridden in hospital). With lack of movement there is decreased blood blow, which increases the risk of inappropriate clot formation. Warfarin: Generally used to prevent clot formation in patients that have cardiac disorders such as atrial fibrillation, which increases the risk of inappropriate clot formation. Insert Dari

19. AFAMS Anticoagulants (Insert Dari) Side Effects Common Abnormal bruising Abnormal bleeding (i.e. gums, blood in stool) Feeling light headed or dizzy Rare but serious Heparin Signs of a serious reaction to heparin: - Skin necrosis - A blood clot, warmth, or pain in the leg or arm. Warfarin - Symptoms of a stroke Change in strength on 1 side is greater than the other, trouble speaking or thinking, change in balance, or blurred Insert Dari

20. AFAMS Anticoagulants (Insert Dari) Important Points Administration: - Heparin (IV or subcutaneous injection) - Enoxaparin (subcutaneous injection) - Warfarin (oral) Take care to avoid injury or falls as these medications disrupt the normal blood clotting process and subsequent healing. Warfarin often requires dosage adjustments and laboratory testing of blood. It is very important that patients follow the directions given to them by the doctor or pharmacist. Insert Dari

21. AFAMS Fibrinolytic (Insert Dari) Fibrinolytic: Streptokinase Mechanism of Action A ‘clot buster’. This drugs breaks down existing blood clots. Indication A suspected blood clot in the lungs or a limb. Side Effects Increased risk of major bleeding. Insert Dari

22. AFAMS B02 Anti-hemorrhagics (Insert Dari)

23. AFAMS

24. Tranexamic Acid (Insert Dari) Mechanism of Action Prevents the bodies natural process of breaking down blood clots from occuring. Use To prevent or reduce hemorrhage due to trauma. Often used in hemophiliacs (blood clotting disorder). May be used to prevent blood loss during heavy menstruation. Insert Dari

25. AFAMS Tranexamic Acid (Insert Dari) Side Effects Headache Muscle pain Nose stuffiness Upset Stomach Diarrhea Insert Dari

26. AFAMS Vitamin K (Insert Dari) Mechanism of Action Promotes production of clotting factors. Indications May be used to counteract the effects of warfarin if too much warfarin is given. Side effects Upset stomach if taken orally. Flushing of the skin. skin reaction : red pin point dots = a rash Insert Dari

27. AFAMS Antianemics (Insert Dari)

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29. Iron Supplements (Insert Dari) Mechanism of Action Minerals are chemical elements required by living organisms other than (carbon, oxygen, hydrogen and nitrogen). Indications (Use) Used to treat iron-deficient anemia. Insert Dari Side Effects Constipation and nausea. Important Points Good to tell patients to take with food if they have stomach upset.

30. AFAMS Vitamin B12 and Folic Acid (Insert Dari) Vitamins are vital nutrients that our body obtains from food (our body cannot produce these compounds on its own). Indications Used to treat pernicious anemia which is caused by a deficiency in B12 and folate. The body needs vitamin B12 for many things. For example, you need vitamin B12 to make new cells, such as red blood cells, and for your nervous system to work normally. The body needs folic acid to make new cells. It is especially important that pregnant women get enough folic acid, so that their baby can develop normally in the womb. Insert Dari

31. AFAMS Vitamin B12 and Folic Acid (Insert Dari) Side Effects Minimal side effects to include nausea and upset stomach Important Points Vitamin B12 can be administered as an injection or as an oral tablet. Folic acid is administered as an oral tablet. Insert Dari

32. AFAMS Other Antianemic Preparations (Insert Dari) Erythropoietin Occurs naturally in our body and regulates the production of red blood cells. Mechanism of Action Erythropoietin (EPO) is the growth factor the simulates the production of red blood cells. Indications Used to treat anemia in patients who are receiving hemodialysis. The kidneys produce EPO, so when kidney function decreases so does EPO production. Insert Dari

33. AFAMS Other Antianemic Preparations (Insert Dari) Erythropoietin Side Effects Headache Flu like symptoms (chills, fever etc) Hypertension Important Points Administered via intravenous administration. The use of EPO has been shown to reduce deaths in chronic kidney disease. Insert Dari

34. AFAMS B05 Blood Substitutes and Perfusion Solutions (Insert Dari)

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36. These products are generally managed by the laboratory or blood bank services. Pharmacy is not responsible for providing these products. Insert Dari

37. AFAMS Blood Substitutes and Plasma Protein Fractions (Insert Dari) Plasma In blood, the serum is the component that is neither a blood cell nor a clotting factor. Basically it is the blood plasma with the blood cells removed. Albumin Abundant protein in the serum. Generally used in patients with blood loss/trauma, where the blood volume needs to be replaced and clotting factors replaced. These are administered intravenously. Insert Dari

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39. IV Solutions (Insert Dari) Small volume solutions (50 – 100ml) are typically used for delivering medications. Large volume solutions (250 ml, 500 ml,1000 ml) are used to: - replenish fluids - to provide electrolytes - to provide nutrients such as vitamins and glucose. Insert Dari

40. AFAMS IV Solution Bags (Insert Dari)

41. AFAMS Fluid Replacement Solutions (Insert Dari) These are administered intravenously to patients for the purpose of treating dehydration or maintaining hydration. These solutions can also have medications added to provide an infusion of medication (1)NaCl 0.9% (2)Ringer’s Lactate

42. AFAMS Other Solutions (Insert Dari) Pre-made solutions are available commercially. The composition of pre-made solutions can contain added electrolytes and other molecules. For example: (1)Solutions with added electrolytes/minerals would be given to patients who are deficient in that electrolyte/mineral. (2)Nutrients (amino acids, glucose) would be given to maintain good nutritional status. Insert Dari

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44. Sodium Bicarbonate (Insert Dari) Mechanism of Action Decreases acidity. Indications To treat electrolyte imbalances (high acid level in the blood). To treat overdoses of certain medications. This is no longer used for wound irrigation – Sodium Chloride (NaCl) is preferred. Insert Dari

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46. Chymotrypsin (Insert Dari) An enzyme that aids in the digestion of proteins. Insert Dari

47. AFAMS Questions? (Insert Dari)

48. AFAMS In-class Assignment (Insert Dari) This assignment will consist of 8 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari

49. AFAMS 1. Which of the following is NOT a result of inappropriate clot formation? (Insert Dari) A)Stroke B)Heart Attack C)Constipation D)Swelling of a limb Insert Dari

50. AFAMS 1. Answer: Which of the following is NOT a result of inappropriate clot formation? (Insert Dari) A)Stroke B)Heart Attack C)Constipation D)Swelling of a limb Insert Dari

51. AFAMS 2. Which of the following correctly describes the mechanism of action for anti-platelets? (Insert Dari) A)prevent the adhesion of platelets to one another, preventing clot formation. B)Prevent the activation of clotting factors which assist in clot formation. C) Breaks down existing clots. D)Prevents the body from breaking down existing clots. (Insert Dari)

52. AFAMS 2. Answer: Which of the following correctly describes the mechanism of action for anti- platelets? (Insert Dari) A)prevent the adhesion of platelets to one another, preventing clot formation. B)Prevent the activation of clotting factors which assist in clot formation. C) Breaks down existing clots. D)Prevents the body from breaking down existing clots. (Insert Dari)

53. AFAMS 3.Match the following drugs with their correct class? (Insert Dari) A)Warfarin B)Asprin C)Heparin D)Streptokinase Drug classes can be used more than once 1)Antifibrinolytic 2)Anti-coagulant 3)Anti-platelet Insert Dari

54. AFAMS 3. Answer: Match the following drugs with their correct class? (Insert Dari) A)Warfarin (2) Anti-coagulant B)Asprin (3) Anti-platelet C)Heparin (2) Anti-coagulant D)Streptokinase (1) Antifibrinolytic Insert Dari

55. AFAMS 4. Which of the following can be used to reverse the effects of warfarin? (Insert Dari) A)Vitamin D B)Tranexamic Acid C)Vitamin K D)Sodium Bicarb Insert Dari

56. AFAMS 4. Answer: Which of the following can be used to reverse the effects of warfarin? (Insert Dari) A)Vitamin D B)Tranexamic Acid C)Vitamin K D)Sodium Bicarb Insert Dari

57. AFAMS 5. Which of the following best describes the common side effect(s) of iron? (Insert Dari) A)Diarrhea B)Constipation and nausea C)Increased heart rate D)Drowsiness Insert Dari

58. AFAMS 5. Answer: Which of the following best describes the common side effect(s) of iron? (Insert Dari) A)Diarrhea B)Constipation and nausea C)Increased heart rate D)Drowsiness Insert Dari

59. AFAMS 6. Which of the following is NOT an antianemic preparation? (Insert Dari) A)Iron (ferrous) B)Folic Acid (folate) C)Vitamin K D)Vitamin B12 Insert Dari

60. AFAMS 6. Answer: Which of the following is NOT an antianemic preparation? (Insert Dari) A)Iron (ferrous) B)Folic Acid (folate) C)Vitamin K D)Vitamin B12 Insert Dari

61. AFAMS 7. True or False: The pharmacy department is responsible for supplying blood products to the hospital. (Insert Dari)

62. AFAMS 7. True or False: The pharmacy department is responsible for supplying blood products to the hospital. (Insert Dari) Answer: False, the laboratory or blood bank services are responsible for providing blood prodcuts to the hospital. Insert Dari

63. AFAMS 8. Large volume IV solutions are used to do the following except for? (Insert Dari) A)Rehydrate B)Deliver nutrients C)Replace electrolytes D)Deliver medications Insert Dari

64. AFAMS 8. Answer: Large volume IV solutions are used to do the following except for? (Insert Dari) A)Rehydrate B)Deliver nutrients C)Replace electrolytes D)Deliver medications (generally smaller IV bags are used) Insert Dari