Week 5 discussion comment advance pharmacology
1. List three classes of drugs affecting the Hematopoietic System
Examples of the classes of drugs that affect the hematopoietic system include anticoagulants, hematinics and hematopoietic growth factors (Hitner & Nagle, 2015). Anticoagulants are drugs that prevent the clotting of blood through various mechanisms. Hematinics are drugs that increase the blood volume by increasing the level of hemoglobin and the number of red blood cells while hematopoietic growth factors are drugs that are responsible for the production of various blood cells from the pluripotent stem cells (Hernandez & Rathinavelu, 2017).
2. List the mechanism of action for each class of drug
Anticoagulants include heparin, derivates of Coumadin, Factor Xa inhibitors and thrombin inhibitors. Anticoagulants interfere with the clotting process at different levels in the pathway to prevent the clotting of blood. Heparin works by activating antithrombin III to prevent the actions of thrombin and those of clotting factor Xa in the last stages of the clotting pathway. Warfarin, a coumarin, acts by inhibiting the enzyme Vitamin K reductase which is used to recycle oxidized vitamin K. This reduces the synthesis of Vitamin K hence reduced activation of clotting factors II, VII, IX and X. Factor Xa inhibitors exert their effect by reversibly blocking factor Xa actions. Thrombin inhibitors bind to thrombin to inhibit its actions (Hernandez & Rathinavelu, 2017).
Hematinics are blood nutrients required during hematopoiesis to form blood cells. They include iron, folate and Vitamin B12. Ferrous Sulphate (iron) combines with globin and pophyrin chains to form hemoglobin. Iron, Folate and Vitamin B12 are required in the formation of red blood cells. Hematinics are supplements to boost the levels of these nutrients (Hernandez & Rathinavelu, 2017).
Hematopoetic growth factors are involved in the process of formation of specific blood cells. Erythropoietin binds to its receptor on red blood cell progenitor surface to accelerate production of red blood cells. Megakaryocyte Growth Factors increase platelet production and myeloid growth factors regulate the myeloid lineage characteristics in gthe formation of white blood cells (Hernandez & Rathinavelu, 2017).
3. Choose one medication from the three classes and discuss what disorder the drug is used to treat? How often the medication is given? What labs should get monitored while the patient is taking this medication?
Ferrus Sulphate, also known as Iron, is used to treat iron deficiency anemia. It is an oral hematinics. For iron deficiency anemia, the normal dosage is 65 to 200mg per day in a maximum of three divided doses. Parameters to monitor include hemoglobin and hematocrict levels to prevent iron toxicity and overload (Hernandez & Rathinavelu, 2017). Week 5 discussion comment advance pharmacology
What would you add to the current treatment plan? Why?
I would add Isosorbide dinitrate 5mg PO BID to see if the patient’s chronic, stable angina may be better controlled.
Would you discontinue any of the currently prescribed medication? Why or why not?
This patient appears to be tolerating the current medication regimen, therefore there would be no indication to discontinue any of the medications that he is currently taking.
How does the diagnosis stage 3 chronic kidney disease affect your choices?
Ace-inhibitors have protective and therapeutic qualities for the kidneys which is important especially in cases of diabetes mellitus (DM) type II with neuropathies. It is the first-line therapy for patients with DM and should be continued in patients that are tolerating the medication. Isosorbide dinitrate does not require renal dosing, therefore it is an excellent selection for the treatment of angina in a patient with chronic kidney disease (CKD).
Why is the patient prescribed more than one antihypertensive?
For patients with myocardial infarction (MI), atenolol reduces the size of the infarct and early mortality when it is initiated early on and may lower the risk of death when continued long term (Rosenson, Reeder, & Kennedy, 2017). The benefit of beta blockers in a patient with MI include a decreased demand of oxygen and reduction in heart rate, blood pressure and contractility of the heart. Furthermore, ace-inhibitor therapy that is initiated early on after an acute MI improves left ventricular ejection fraction. The combination of both drug therapies ultimately prevents remodeling of the heart which leads to heart failure.
What is the benefit of the aspirin therapy in this patient?
There are many debates regarding the use of aspirin in patients with DM and CKD due to increased risk bleeding (Ebell, 2019), however current studies provide evidence that high-risk patients (DM and CKD) taking low-dose aspirin experienced a reduction in vascular-related death, MIs, ischemic stroke, transient ischemic attacks.
Week 5 discussion comment advance pharmacology