Blood and heamnthics pharma drug teach me in easy tabel way
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The library doesn't have a dedicated pharmacology textbook with haematinics sections. I have deep knowledge on this topic - let me now compile a thorough, easy-to-read table-based answer from my training knowledge.
Blood & Haematinics Pharmacology - Easy Table Guide
What are Haematinics?
Haematinics are drugs that supply essential nutrients needed for blood (haem) formation - mainly red blood cells. "Blood drugs" also include anticoagulants, antiplatelets, thrombolytics, and haemostatics.
PART 1 - HAEMATINICS (Drugs for Anaemia)
A. Iron Preparations
| Drug | Type | Route | Dose (Adult) | Use | Key Points |
|---|---|---|---|---|---|
| Ferrous sulphate | Oral iron | Oral | 200 mg TDS | Iron deficiency anaemia | Cheapest, most common; take on empty stomach |
| Ferrous gluconate | Oral iron | Oral | 300 mg TDS | Iron deficiency anaemia | Better tolerated than sulphate |
| Ferrous fumarate | Oral iron | Oral | 200 mg TDS | Iron deficiency anaemia | High elemental iron content |
| Iron sucrose | IV iron | IV | 100-200 mg | Severe IDA, CKD patients | Used when oral iron fails or not tolerated |
| Ferric carboxymaltose | IV iron | IV | Up to 1000 mg single dose | IDA, post-partum anaemia | Convenient single large dose |
| Iron dextran | IV/IM iron | IV/IM | Calculated by body weight | Severe IDA | Risk of anaphylaxis - test dose needed |
Iron SE (Side Effects):
- Oral: Nausea, constipation, black stools, epigastric pain
- IV: Flushing, hypotension, anaphylaxis (especially dextran)
B. Vitamin B12 (Cyanocobalamin / Hydroxocobalamin)
| Drug | Route | Dose | Use | Duration |
|---|---|---|---|---|
| Cyanocobalamin | IM/Oral | 1000 mcg/day x7, then weekly x4, then monthly | Pernicious anaemia, B12 deficiency | Life-long if pernicious anaemia |
| Hydroxocobalamin | IM | 1000 mcg on alt. days x2 weeks, then every 3 months | Pernicious anaemia | Life-long |
| Methylcobalamin | Oral/IM | 500 mcg TDS | Neuropathy, B12 deficiency | 1-3 months |
B12 Deficiency causes: Pernicious anaemia, strict vegans, gastrectomy, terminal ileum disease (Crohn's)
C. Folic Acid
| Drug | Route | Dose | Use |
|---|---|---|---|
| Folic acid | Oral | 5 mg/day (treatment); 400 mcg/day (prevention) | Megaloblastic anaemia, pregnancy (neural tube defect prevention) |
| Folinic acid (Leucovorin) | Oral/IV | Variable | Rescue after methotrexate toxicity |
Remember: Give folic acid with B12 in combined deficiency - giving folic acid alone in B12 deficiency can mask haematological symptoms but worsen neurological damage ("subacute combined degeneration")
D. Erythropoiesis-Stimulating Agents (ESAs)
| Drug | Route | Use | Key Points |
|---|---|---|---|
| Erythropoietin (EPO) | SC/IV | Anaemia of CKD, chemotherapy-induced anaemia | Monitor Hb - avoid overcorrection (risk of thrombosis) |
| Darbepoetin alfa | SC/IV | Anaemia of CKD | Longer half-life than EPO; given weekly or fortnightly |
PART 2 - ANTICOAGULANTS (Prevent Clot Formation)
A. Heparins
| Drug | Type | Route | Mechanism | Use | Antidote |
|---|---|---|---|---|---|
| Unfractionated Heparin (UFH) | Standard heparin | IV/SC | Activates antithrombin III → inhibits thrombin + Xa | DVT, PE, ACS, cardiac surgery | Protamine sulphate |
| Enoxaparin (LMWH) | Low molecular weight | SC | Mainly inhibits Factor Xa | DVT prophylaxis/treatment, ACS | Protamine (partial reversal) |
| Dalteparin (LMWH) | Low molecular weight | SC | Factor Xa inhibition | DVT/PE prevention | Protamine (partial) |
| Fondaparinux | Synthetic pentasaccharide | SC | Selectively inhibits Factor Xa | DVT/PE prophylaxis & treatment | No specific antidote |
Heparin SE: Bleeding, HIT (Heparin-Induced Thrombocytopenia), osteoporosis (long-term), hyperkalaemia
B. Oral Anticoagulants
| Drug | Class | Mechanism | Route | Monitoring | Antidote |
|---|---|---|---|---|---|
| Warfarin | Coumarin | Inhibits Vit K-dependent factors (II, VII, IX, X) | Oral | INR (target 2-3) | Vit K, FFP, PCC |
| Rivaroxaban | DOAC | Direct Factor Xa inhibitor | Oral | No routine monitoring | Andexanet alfa |
| Apixaban | DOAC | Direct Factor Xa inhibitor | Oral | No routine monitoring | Andexanet alfa |
| Edoxaban | DOAC | Direct Factor Xa inhibitor | Oral | No routine monitoring | Andexanet alfa |
| Dabigatran | DOAC | Direct thrombin inhibitor (IIa) | Oral | No routine monitoring | Idarucizumab |
DOAC = Direct Oral Anticoagulant
PART 3 - ANTIPLATELET DRUGS
| Drug | Mechanism | Use | Key Side Effect |
|---|---|---|---|
| Aspirin | Irreversibly inhibits COX-1 → blocks TXA2 | ACS, stroke, MI prevention | GI bleed, peptic ulcer |
| Clopidogrel | ADP receptor (P2Y12) blocker | ACS, post-stent, stroke | Bleeding, rarely TTP |
| Ticagrelor | Reversible P2Y12 blocker | ACS (more potent than clopidogrel) | Dyspnoea, bleeding |
| Prasugrel | Irreversible P2Y12 blocker | ACS with PCI | Bleeding (avoid in stroke hx) |
| Dipyridamole | Inhibits phosphodiesterase + adenosine uptake | Stroke prevention (with aspirin) | Headache, flushing |
| Abciximab | GPIIb/IIIa inhibitor | PCI (intravenous) | Severe bleeding, thrombocytopenia |
| Tirofiban | GPIIb/IIIa inhibitor | ACS (IV use) | Bleeding |
PART 4 - THROMBOLYTICS (Clot Busters)
| Drug | Mechanism | Use | Time Window | Key Danger |
|---|---|---|---|---|
| Streptokinase | Converts plasminogen → plasmin (indirect) | STEMI, DVT, PE | Within 12h of STEMI | Allergic reaction; can't reuse within 6 months |
| Alteplase (tPA) | Directly activates plasminogen | Ischaemic stroke, STEMI, massive PE | Stroke: within 4.5h | Intracranial haemorrhage |
| Tenecteplase | Modified tPA | STEMI | Within 12h | Bleeding |
| Reteplase | Modified tPA | STEMI | Within 12h | Bleeding |
Absolute contraindications for thrombolytics: Active bleeding, recent surgery (<10 days), haemorrhagic stroke (ever), severe uncontrolled hypertension
PART 5 - HAEMOSTATICS (Stop Bleeding)
| Drug | Mechanism | Use |
|---|---|---|
| Tranexamic acid | Antifibrinolytic (inhibits plasminogen activation) | Surgery, trauma, heavy menstrual bleeding, PPH |
| Aminocaproic acid | Antifibrinolytic | Post-surgical bleeding |
| Vitamin K | Cofactor for clotting factors II, VII, IX, X | Warfarin reversal, Vit K deficiency bleeding |
| Desmopressin (DDAVP) | Releases vWF from endothelium | Mild haemophilia A, von Willebrand disease |
| Factor VIII concentrate | Replaces clotting factor | Haemophilia A |
| Factor IX concentrate | Replaces clotting factor | Haemophilia B |
| Protamine sulphate | Binds and neutralises heparin | Heparin overdose reversal |
| Phytomenadione (Vit K1) | Reverses warfarin effect | Warfarin toxicity |
QUICK MEMORY AID
HAEMATINICS → Feed the blood cells
Iron → RBC production
B12 + Folate → DNA synthesis in RBCs
EPO → Stimulate bone marrow
ANTICOAGULANTS → Stop NEW clots
Heparin (fast, IV) → Acute setting
Warfarin (slow, oral) → Chronic (monitor INR)
DOACs (oral, no monitoring) → Modern choice
ANTIPLATELETS → Stop platelet plugs
Aspirin → COX inhibitor
Clopidogrel/Ticagrelor → P2Y12 blockers
THROMBOLYTICS → BREAK existing clots
tPA/Streptokinase → Emergency only
HAEMOSTATICS → Stop bleeding
Tranexamic acid, Vit K, Protamine
Key Exam Points:
- Iron absorption is increased by Vitamin C and decreased by antacids, tea, calcium
- B12 needs Intrinsic Factor (from gastric parietal cells) for absorption
- Warfarin takes 2-3 days to work (bridge with heparin initially)
- HIT: Treat by STOPPING heparin and using direct thrombin inhibitors (argatroban, lepirudin)
- DOACs are renally cleared - adjust/avoid in severe renal impairment (except apixaban which is partly hepatic)
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