第33章作用于血液及造血器官药物
第33章 作用于血液及造血器官药物
作用于血液与造血器官的药物■抗凝血药纤维蛋白溶解药■抗血小板药Plasma (55%)促凝血药Whitebloodcellsandplatelets(<1%)■抗贫血药Redbloodcells(45%)■血容量扩充剂ADAM
作用于血液与造血器官的药物 ▪ 抗凝血药 ▪ 纤维蛋白溶解药 ▪ 抗血小板药 ▪ 促凝血药 ▪ 抗贫血药 ▪ 血容量扩充剂
Neck Swelling:EMERGENCYSoft tissue bleedspotentialairwayand bruisingcompromisenofunctionaltreatwthamajorimpairmentdose of factortenderness,butno severe painno factorneededDeltoid/forearmbleedand bruisingliopsoas bleedsroutinefsctordosemajorfactor doseitTiexedhippain,inabaitytoacompartmentextend theied onsyndromeisthe aected sidesuspectedtreatwithamajordoseof factorButtockbleedspainThigh/calrbleedswith/withoutswellingpainroutinetactor doseApainting by Ivar Arosenius,one of Sweden'swith/withoutswellingmajor factor dose if-impaired mobilitythe legon the affectedbest-know artists inthe early 20th centuryroutinefactor doseside exhibits tingling orasajurfactordoseifSwellingArosenius suffered fromhemophilia A andcompartmentsyndromeissuspectedrepresented the horror and fear of bleedingto death in many paintings,including thoseforfairy tales(still familiarto manySwedishchildren)forhis little daughterLillan
Embolism:clotthat travels fromsite whereitwasformedThrombus:bloodClot that forms inavesselADAM
溶血凝血
凝血 溶血
而液凝固过程为多种凝而因子参与的一系列蛋白质有限水解过程。已知的凝血因子有十二种，尚有前激肽释放酶、激肽释放酶、高分子激肽原和血小板磷脂。凝血过程分为三个阶段：·因子×的激活·凝血酶的形成·纤维蛋白的形成
血液凝固过程 为多种凝血因子参与的一系列蛋白质有限水 解过程。已知的凝血因子有十二种，尚有前 激肽释放酶、激肽释放酶、高分子激肽原和 血小板磷脂。凝血过程分为三个阶段： • 因子Ⅹ的激活 • 凝血酶的形成 • 纤维蛋白的形成
intrinsicpathwaydamagedtissuekininogenkallikreinXIDXIIextrinsicpathwaytraumaXIXIvIDIXIXVIIthrombintissue factorVILIVIIDXXX4thrombinVVprothrombinthrombin*fibrinogenfibrinllthrombinXIXIIIfibrin!@1999-2004NewSciencePress
内源性抗凝血药HMWK、KaXIXIa外源性HMWKTPLXIXIaVIa-VIIXIXa凝血过程Ca2+ PL TPLCa2+ PL VIIXXaCa2+ PL V1-HaIIaEXEa
凝 血 过 程 内源性 Ⅻ─→Ⅻa Ⅺ─→Ⅺa Ⅸ─→Ⅸa Ⅶa←─Ⅶ Ⅹ─→Ⅹa Ⅱ─→Ⅱa ⅩⅢ→ⅩⅢa HMWK、Ka HMWK Ⅰ─→Ⅰa 外源性 TPL 抗凝血药 Ca2+ PL Ⅷ Ca2+ PL Ⅴ Ca2+ PL TPL
intrinsicpathwayfactor XII>XIIaRemember that all these serineproteolysisproteases need calcium ions.This is why citrate and EDTAfactor XIXIawork as anti-coagulants forblood samples.proteolysisfactorIXIXaextrinsic pathwayfactor VIIaproteolysisfactorVII +tissuefactorphospholipidby"tenasefrom plateletscomplex"calciumionsfactor X>Xathrombinproteolysisproteolysis4fibrinogen>fibrin
Extrinsic pathwayIntrinsic pathwayHMw-karinogonFaxaFadloKallikroinHMw.kininogenFictorXFachocxoCalTissvefactorContactactivation patiwayFoctorViayFactoViCa2-EorFactortxCaztCal+PlatolotsVoCommon pathway+FactorXanFactorxFoctorXaCaPlatuletsWPeoenronbinIvomn(la)ProthrombinactvationFsccrtromotsFibrinogenFibrinFibrnopegtidesAandBWound healing