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Patients decrease start treatment within 24 hours ace

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Unformatted text preview: May use concurrently with clopidogrel – Should take indefinitely – Higher dose for PCI patients 52 Adjuncts to Reperfusion Therapy – Management of STEMI Management Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin-converting angiotensin II receptor blockers (ARBs) angiotensin – – – Decrease short-term mortality in all patients Decrease Start treatment within 24 hours ACE inhibitors studied more extensively than ARBs Calcium channel blockers – Antianginal, vasodilation, and antihypertensive actions Magnesium – Decreases platelet aggregation, increases coronary blood flow, Decreases reduces cardiac afterload, lowers risk of serious ventricular dysrhythmias dysrhythmias 53 Drugs for Hemophilia 54 Hemophilia Hemophilia Genetically based bleeding disorder Almost exclusively seen in males – 70% of cases result from inheriting defective 70% gene from mother gene – 30% of cases result from spontaneous gene 30% mutation mutation Hemophilia A and hemophilia B Prognosis is good with good management 55 56 56 57 57 Steps in Hemostasis Steps • Blood vessels constrict to slow blood flow Blood from injured area from • Platelet plugs form to temporarily seal the Platelet leaking small arteries and vein leaking • Blood coagulates to plug openings within Blood damaged vessels and wounds to prevent further bleeding further 58 Basic Considerations Basic Pathophysiology – Failure of hemostasis – Normal process Formation of a platelet plug followed by production Formation of fibrin of – Hemophilia Hemophilia Fibrin production does not proceed normally Fibrin 59 Hemostatic Drugs for Replacement Therapy for Hemophilia Therapy These drugs allow natural clotting to occur and prevent massive blood loss. prevent • • • Factor VIII---Recombinate Antiinhibitor coagulant complex---Autoplex Factor IX Complex---Proplex T 60 Preparations Used to Treat Hemophilia Hemophilia Factor VIII concentrates Factor – Production methods and product safety Plasma-derived factor VIII (low risk of viral Plasma-derived contaminants) Recombinant factor VIII Recombinant – Adverse effects: allergic reactions – Dosage and administration On-demand therapy Prophylactic therapy 61 Preparations Used to Treat Hemophilia Hemophilia Factor IX concentrates Factor – Nearly identical pharmacology to that of factor Nearly VIII VIII No risk of HIV/AIDS transmission Small risk of hepatitis A transmission – On-demand therapy – Prophylactic therapy 62 Preparations Used to Treat Hemophilia Hemophilia Desmopressin – Stop or prevent bleeding (mild hemophilia) Antifibrinolytic agents – Used to prevent recurrent bleeding, less Used useful to stop ongoing bleeding useful – Aminocaproic acid (Amicar), tranexamic acid Aminocaproic (Cyklokapron) (Cyklokapron) 63 Drugs for Deficiency Anemias 64 Anemias Anemias Decrease in erythrocytes (RBCs) – Number – Size – Hemoglobin content Causes – Blood loss – Hemolysis – Bone marrow dysfunction Deficiency of substances essential for RBC Deficiency formation and maturation formation 65 Red Blood Cell Development Red Development begins in the bone marrow Matures in the blood Healthy development requires: – Healthy bone marrow, erythropoietin (helps Healthy with RBC growth from the kidneys), iron, and other factors to support DNS synthesis other 66 Iron Deficiency Iron Most common nutritional deficiency and Most cause of nutrition-related anemia cause Metabolic function – Iron essential...
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