Uses and side effects of Abciximab

Abciximab is a prescription only anti - platelet drug. It is prescribed to prevent ischemic problems in the heart, before angiogram and short term prevention of heart attacks in patients with unstable angina. It is a platelet glycoprotein iib/iiia inhibitor. Nausea, vomiting and increased bleeding tendency are the commonest problems. Commonest brand name is Reopro® by Lilly pharmaceuticals.

 Overview

Heart attacks and ischemic problems are caused by the blockade of the arteries that supply the heart (coronary arteries). This is mainly caused by the formation of blood clots within the arteries.
 Inhibition of platelet glycoprotein iib and iiia prevent platelet aggregation. Platelet aggregation is required for the blood clot formation.'

This medication is only available as intravenous injections. It is usually used by experts in specialized units.

 What doctors should know before prescribing Abciximab?

If the patient has active internal bleeding, underwent major surgery/intracranial surgery within last two months, stroke within last two years, brain cancer, arteriovenous malformation or aneurism, severe uncontrolled hypertension, reduced platelet counts or vasculitis then doctors won’t prescribe Abciximab.

 Abciximab should not be used in breast feeding as well. The doctor should know whether the patient is pregnant or not. If the patient has kidney or liver disease, then discuss it with the doctor before prescribing Abciximab.

 What doctors do before prescribing Abciximab?

Doctors will do several blood tests before and after starting Abciximab. They are Prothrombin time, Activated clotting time, Activated partial thromboplastin time, blood hemoglobin level and blood hematocrit. These tests measure the blood clotting tendency in the patient. If the tendency is less, then the patient is not suitable for Abciximab. Doctors use this drug cautiously in elderly patients.

 What are common side effects?

Increased bleeding following a wound or increased spontaneous bleeding is the main problematic side effect. Other than that some patients can have nausea and vomiting.

 Reduced blood pressure is another side effect. This will manifest as faintish ness, dizziness and lightheadedness.

 Reduced heart rate can occur in certain patients. Some patients can complain chest pain. Back pain is another troublesome side effect. Headache can occur with certain patients.

 Irritation and pain in the injection site is another common adverse effect.

 What are the rare side effects?

Cardiac tamponade can occur rarely. Breathing difficulty and respiratory distress can occur very rarely.

 Allergic reactions such as hives, edema of the tongue and lips can occur rarely in some patients. Sometimes a life threatening complication called anaphylactic shock can occur. Widespread hives, shortness of breath and pallor is characteristic. Patients with this condition need urgent medical help.
 Sources
BNF

Treatment of Heart attacks

Myocardial infarction or Heart attack is caused by the death of heart muscles. This is usually caused by decreased blood supply to the heart muscles. Although heart pumps blood, heart muscles cannot get oxygen/nutrients from the blood it pumps. So the heart is supplied by the coronary arteries. Coronary arteries are blocked by the accumulation of cholesterol. This leads to formation of blood clots inside the arterial lumen. Treatment includes removal of the block and to prevent future blocking. If the block cannot be removed then the doctors create a separate path for the blood to travel (bypass grafting).
 Myocardial infarction is a serious disease with high mortality. Death of  large part of the heart will arrest blood circulation in the body and lack of oxygen to the brain can cause death.
  Heart muscles cannot regenerate, so death of heart muscles causes permanent damage to the heart as well. This can leads to long term heart failure with ankle edema, difficulty to breathe and poor exercise tolerance.
 Symptoms
Left side tightening type chest pain, difficulty in breathing; sweating and apprehension are the main symptoms.
 Treatment
 Giving oxygen to the patient is usually the first step. Then patient is given Aspirin 75mg orally to prevent further clot formation. Glyceryl Tri Nitrate tablets are given sub lingual (under the tongue) to dilate the coronary arteries. These measures increase the oxygen level in heart muscles.
 Patient should rest in the bed to decrease the demand put on heart muscles as well. Then the doctor will give a shot of Morphine for pain relief. Morphine has some arterial dilatation properties as well.
 Clearing the blocked arteries and maintaining adequate blood supply to the brain are the main priorities in the first 24 hours. For that powerful thrombolytics (drugs that dilutes formed clots) are used. E.g. Streptokinase, Recombinant tPA. If above steps are failed, the doctor will dilate the coronary arteries by using a balloon inserted through skin (per cutaneous angioplasty).
 Once patient recovers from the initial ordeal, doctors try to find a cause for this heart attack. This can be due to increased fats and cholesterol in the diet, Diabetes mellitus, hypertension or stressful life style. Some people can have genetic predisposition for the heart attacks and increased cholesterol in the blood as well.
 Then doctors will try to correct above problems to prevent further damage to the heart. Patient needs life style modification like eating low cholesterol diet and regular exercises to prevent heart attacks in the future. After a myocardial infarction exercises should be undertaken with expert guidance.
 Sources
Clinical Medicine by Kumar and Clark

Uses and side effects of Faximab

Faximab is a prescription only anti - platelet drug. It is prescribed to prevent ischemic problems in the heart, before angiogram and short term prevention of heart attacks in patients with unstable angina. It is a platelet glycoprotein iib/iiia inhibitor. Nausea, vomiting and increased bleeding tendency are the commonest problems. Other commonest brand name is Reopro® by Lilly pharmaceuticals.

 Overview

Heart attacks and ischemic problems are caused by the blockade of the arteries that supply the heart (coronary arteries). This is mainly caused by the formation of blood clots within the arteries.
 Inhibition of platelet glycoprotein iib and iiia prevent platelet aggregation. Platelet aggregation is required for the blood clot formation.

This medication is only available as intravenous injections. It is usually used by experts in specialized units.

 What doctors should know before prescribing Faximab?

If the patient has active internal bleeding, underwent major surgery/intracranial surgery within last two months, stroke within last two years, brain cancer, arteriovenous malformation or aneurism, severe uncontrolled hypertension, reduced platelet counts or vasculitis then doctors won’t prescribe Faximab.

 Faximab should not be used in breast feeding as well. The doctor should know whether the patient is pregnant or not. If the patient has kidney or liver disease, then discuss it with the doctor before prescribing Faximab.

 What doctors do before prescribing Faximab?

Doctors will do several blood tests before and after starting Faximab. They are Prothrombin time, Activated clotting time, Activated partial thromboplastin time, blood hemoglobin level and blood hematocrit. These tests measure the blood clotting tendency in the patient. If the tendency is less, then the patient is not suitable for Faximab. Doctors use this drug cautiously in elderly patients.

 What are common side effects?

Increased bleeding following a wound or increased spontaneous bleeding is the main problematic side effect. Other than that some patients can have nausea and vomiting.

 Reduced blood pressure is another side effect. This will manifest as faintish ness, dizziness and light headedness.

 Reduced heart rate can occur in certain patients. Some patients can complain chest pain. Back pain is another troublesome side effect. Headache can occur with certain patients.

 Irritation and pain in the injection site is another common adverse effect.

 What are the rare side effects?

Cardiac tamponade can occur rarely. Breathing difficulty and respiratory distress can occur very rarely.

 Allergic reactions such as hives, edema of the tongue and lips can occur rarely in some patients. Sometimes a life threatening complication called anaphylactic shock can occur. Widespread hives, shortness of breath and pallor is characteristic. Patients with this condition need urgent medical help.