造血系统（英文版）.ppt

Warfarin – History 1948 -51. Warfarin becomes a common rodenticide (it still is). 1951. Army inductee tried to commit suicide with Warfarin. He was saved, but the physicians remarked at how good an anticoagulant it was. 1952. Warfarin introduced into clinical use as an oral anticoagulant. 2 * ppt课件 Coumarins - structure * ppt课件 Action of Coumarins Vitamin K Coumarins are competitive inhibitors * ppt课件 Coumarins - Action Inhibits the synthesis of (in order of potency) Factor II Factor X Factor VII Factor IX * ppt课件 Coumarins - Effect The activity of anticoagulation is delayed about 12-24 hrs until the clotting factors exhaust. * ppt课件 Administered orally Biotransformed by the liver Completely absorbed – crosses all membranes Crosses GI mucosa Crosses placenta – is teratogenic Is found in breast milk – can affect infants development * ppt课件 Clinical uses 1. Prevention and treatment of thromboembolism disease, such as myocardial infarction, and use with anti platelet drugs (e.g. aspirin) may prevent venous thrombosis. 2. Decrease venous embolism caused by surgery, rheumatic heart disease. * ppt课件 Adverse Effects Bleeding: gingival（齿龈） bleeding, nose bleeding, antagonised by vitamine K1 . Cutaneous necrosis It can cross the placenta and causes hemorrhagic disorder in fetus. Serious birth abnormal bone formation and development . * ppt课件 Drug interaction Inducer of CYP enzymes such as rifampin, phenobarbital and phenytoin sodium accelerates the metabolism of warfarin. Courmarins enhance the effects of asprin and butazolidin. Lack of vitamine K and large doses of antibiotics enhance the effect of courmarins. * ppt课件 Antiplatelet agents（抗血小板药） Cyclooxygenase inhibitors Aspirin ADP receptor inhibitors Ticlopidine(噻氯匹定） Phosphodiesterase inhibitors Dipyridamole（双嘧达莫） Glycoprotein IIB/IIIA inhibitors - Abciximab（阿昔单抗） * ppt课件 COX-2 inhibitor Asprin 1. Action: Small doses (60-80 mg/d) of aspirin given orally irreversibly inhibit the synthesis of