use of warfarin sodium is hemorrhaging. This product is available in both oral and
injectable forms. This agent has over 50 documented drug-drug interactions. You must
research this drug carefully against the patient profile before dispensing.
d. "Clot Busters". As discussed above, we can administer aspirin, heparin, or
warfarin to prevent clots or stop clots from getting bigger. But none of these drugs can
dissolve a clot that is already established. In many cases we cannot wait for the body to
reabsorb these clots back into the lining of the vessel (4-6 months); we need to dissolve
the clot immediately. This is the case for the patient having heart attacks and strokes.
"Clot busters" do just that--by acting as tissue plasminogen activator and converting
plasminogen to plasmin or mimicking fibrinolytic enzymes, they break down the clot.
These agents are always administered intravenously and require close observation for
bleeding in the patient. They are most effective when administered as close to onset of
symptoms as possible (ideally within 3-6 hours).
(1) Streptokinase (Streptase), Urokinase ((Abbokinase). Streptokinase
and urokinase were some of the first clot busters developed and act as fibrinolytic
enzymes. Streptokinase comes from streptococcus species so patients with strept
antibodies may have an allergic reaction to this agent. Urokinase comes from human
kidney cells so the incidence of side effects is less. Both agents are administered via
continuous IV infusion (12-24 hours) and are rarely used with the advent of recombinant
(2) Alteplase (Activase). Alteplase, also known as tPA (tissue plasminogen
activator) was the first recombinant product developed. It offers the advantage of short
infusion time (1 hour) and is more effective than streptokinase. It is used for heart
attacks (within 4-6 hours of symptoms) and strokes (within 3 hours of symptoms).
Alteplase (2 mg) is also used to dissolve clots in IV lines. Reteplase (Retavase) and
anistreplase (Eminase) are other clot busters.
Section IV. HEMATINICS
Hematinics are drugs used to stimulate the formation of red blood cells. These
agents are used primarily in the treatment of certain types of anemias. Some of these
preparations are routinely given to women during pregnancy.
5-9. HEMATINIC AGENTS
a. Ferrous Gluconate (Fergon) Ferrous Sulfate (Feosol). Ferrous
gluconate and ferrous sulfate are used to treat iron deficiency anemia. The usual
dosage given is 1-4 times daily. Side effects associated with these agents include