UEC COLLEGE OF NURSING OCHADAMU SET 5

PHARMACOLOGY PRESENTATION ON ANTICOAGULANT,

ANTIANGINAL, HAEMATINICS
BY

GROUP TWO

Group Two Members

1. Agada Agbene Emmanuel

2. Agbo Goodness Favour

3. Aguda Manasoko Mercy

4. Ajesola Deborah

5. Akogwu Blessing Nneka

6. Akwu Ojima David

7. Alaneme Prince

8. Atuluku Dorcas

SUPERVISOR

MRS. ACHEMA PATIENCE ALADI

RN, RM, BNSC, MSC (in view)

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 OBJECTIVES OF THE STUDY

1. To evaluate the efficacy of antianginal drugs in relieving symptoms of angina, the efficacy of

anticoagulants in preventing thrombotic events and the efficacy of haematinics in improving iron

status and red blood cell indices.

2. To know more on the mechanism of action, indications, side effects, adverse drug effects and

contraindications of antianginal, anticoagulant and haematinics.

3. To explore patient preferences and satisfaction with antianginal, anticoagulant and

haematinics.

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 Anticoagulant Drugs

Coagulation, also known as clotting, is the process by which blood changes from a liquid to a

gel, forming a blood clot.

Anticoagulation is the process of hindering the clotting of blood.

An anticoagulant, commonly known as a blood thinner, is a chemical substance that prevents or

reduces coagulation of blood, prolonging the clotting time. They are commonly called blood

thinners.

As a class of medications, anticoagulants are used in therapy for thrombotic disorders. Oral

anticoagulants (OACs) are taken by many people in pill or tablet form, and various intravenous

anticoagulant dosage forms are used in hospitals. Some anticoagulants are used in medical

equipment, such as sample tubes, blood transfusion bags, heart –lung machines, and dialysis

equipment. One of the first anticoagulants, warfarin, was initially approved as a rodenticide.

The use of anticoagulants is a decision based upon the risks and benefits of anticoagulation. The

biggest risk of anticoagulation therapy is the increased risk of bleeding. In otherwise healthy

people, the increased risk of bleeding is minimal, but those who have had recent surgery,

cerebral aneurysms, and other conditions may have too great a risk of bleeding. Generally, the

benefit of anticoagulation is prevention of or reduction of progression of a thromboembolic

disease.

Uses of Anticoagulants

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Anticoagulants may be used to treat blood clots or condition where the risk of blood clot is

increased.

To reduce risk, examples include:

1. Atrial fibrillation

2. Hip or knee replacement surgery

3. Myocardiac infarction (Heart attack)

4. Unstable Angina

5. Deep vein thrombosis

6. Ischemic stroke

7. Pulmonary embolism.

Types of Anticoagulants

Anticoagulants are divided into four main types:

- Coumarins and Indandiones

- Factor Xa Inhibitors

- Heparins

- Direct Thrombin Inhibitors

1. Coumarins and Indandiones (Vitamin K antagonists): These oral anticoagulants are

derived from coumarin, which is found in many plants. Coumarin anticoagulants inhibit the
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release of plasma clotting factor VII by vitamin K in liver slices from vitamin K-deficient

animals without inhibition of protein synthesis. When the ratio of vitamin K to coumarin

anticoagulant is kept constant, but the concentrations are increased, the inhibition disappears.

This suggests that the pharmacological action of coumarin anticoagulants depends on irreversible

inhibition of normal vitamin K transport to its site of action. At higher concentrations of vitamin

K the inhibition can be surmounted, because vitamin K can enter the cell by an alternate route

that is not inhibited by coumarin anticoagulants.

Examples of coumarins are; Warfarin, Dicoumarol, Acenocumarol.

Warfarin (Coumadin, Jantoven)

Class: Anticoagulant

Mode of action: Warfarin competitively inhibits the vitamin K epoxide reductase complex 1

(VKORC1), an essential enzyme for activating the vitamin K available in the body. Through this

mechanism, warfarin can deplete functional vitamin K reserves and thereby reduce the synthesis

of active clotting factors. The hepatic synthesis of coagulation factors II, VII, IX, and X, as well

as coagulation regulatory factors protein C and protein S, require the presence of vitamin K.

Vitamin K is an essential cofactor for the synthesis of all of these vitamin K-dependent clotting

factors.

Indication: Prevention of blood clot, Atrial fibrillation, venous thromboembolism, prosthetic

heart valves

Dosage: The usual warfarin dose for adults is 10mg a day for the first 2 days, then between 3mg

and 9mg a day after that. The usual warfarin dose for children depends on how much they weigh.
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Warfarin tablets come in 4 different strengths. The tablets and the boxes they come in are

different colours to make it easier for you to take the right dose.

The strengths and colours are:

0.5mg – white tablet

1mg – brown tablet

3mg – blue tablet

5mg – pink tablet

Route of administration: Orally, Intravenous.

Side effects: Nausea, loss of appetite, Hair loss, Bleeding, stomach/abdominal pain.

Adverse effects: Dizziness or weakness, severe headache, bloating, flatulence and am altered

sense of taste.

Contraindications: Hypersensitivity to warfarin or any component of the formulation,

threatened abortion, eclampsia, or preeclampsia, pregnancy, malignant hypertension.

Nursing Responsibilities:

 Nurses must closely monitor patients on warfarin therapy, including INR values, signs of

bleeding, and potential drug interactions, to ensure safe and effective administration.

 Educating patients on the importance of regular follow-ups and INR monitoring is crucial

for minimizing the risks associated with warfarin treatment and optimizing patient

outcomes.
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2. Factor Xa Inhibitors: Factor Xa inhibitors block the enzyme called factor Xa, preventing the

conversion of prothrombin to thrombin in the final common pathway of clot formation in veins

and the heart.

Examples of factor Xa inhibitors; Apixaban, Rivaroxaban, Endoxaban.

Apixaban (Eliquis)

Drug class: Anticoagulant

Mode of action: Apixaban inhibits free and clot-bound FXa, as well as prothrombinase activity,

which inhibits clot growth, by inhibiting FXa, apixaban decreases thrombin generation and

thrombus development. It has no direct effect on platelet aggregation, but indirectly inhibits

platelet aggregation induced by thrombin.

Indication: Apixaban is indicated for reducing the risk of stroke and systemic embolism in

patients who have nonvalvular atrial fibrillation, prophylaxis of deep vein thrombosis(DVT)

leading to pulmonary embolism(PE) in patients after a hip or knee replacement surgery, and

treatment of DVT and PE to reduce the risk of recurrence

Dosage: 5 mg taken orally twice daily.

Route of administration: Orally

Side effects: Bleeding, heavy menstrual bleeding, chest pain or tightness.

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Adverse effects: Joint pain or swelling, heavy vaginal bleeding, red or black, tarry stools, red,

pink or brown urine, swelling of the face or tongue

Contraindications:

Nursing responsibilities: Educate patients about signs and symptoms of bleeding and bleeding

precautions. ...

Instruct patients not to double up on dosing in an attempt to make up a missed dose. ...

Stress to patients the importance of informing healthcare providers that they're taking apixaban

due to increased bleeding risk.

3. Heparins: Heparin, also known as unfractionated heparin (UFH), is a medication and

naturally occurring glycosaminoglycan. Heparin is a blood anticoagulant that increases the

activity of antithrombin. It is used in the treatment of heart attacks and unstable angina. It can be

given intravenously or by injection under the skin. Its anticoagulant properties make it useful to

prevent blood clotting in blood specimen test tubes and kidney dialysis machines.

Examples of Heparins; enoxaparin, dalteparin, tinzaparin

Enoxaparin (Lovenox)

Drug class: Anticoagulant

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Mode of action: Enoxaparin binds to antithrombin III, a serine protease inhibitor, forming a

complex that irreversibly inactivates factor Xa, which is frequently used to monitor

anticoagulation in the clinical setting. Following factor Xa inactivation, enoxaparin is released

and binds to other anti-thrombin molecules.

Indication: Deep vein thrombosis, Unstable Angina, Certain heart or blood vessel diseases, heart

valve replacement.

Dosage: 1 mg/kg every 12 hours.

Route of administration: Intravenous, subcutaneous.

Side effects: Bleeding, anemia, pain and bruising at the site on your skin where you give the

injection, fever, increased menstrual flow or vaginal bleeding.

Adverse effects: swelling of the leg, red or black, tarry stools,

Contraindications: Known hypersensitivity to enoxaparin (urticaria, anaphylactoid reactions,

anaphylaxis) or any heparin products[, active major bleeding such as gastrointestinal bleed,

history of heparin-induced thrombocytopenia within the past 100 days or presence of circulating

antibodies.

Nursing Responsibilities:

- Administer Lovenox as prescribed.

- Ensure that the injection site is clean and that the medication is injected subcutaneously at a 90-

degree angle.

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- For toxicity and overdose, administer protamine sulfate 1 mg for each mg of Lovenox

(enoxaparin) by slow IV injection.

4. Direct Thrombin Inhibitors (DTIs): Are a class of medication that act as anticoagulants

(delaying blood clotting) by directly inhibiting the enzyme thrombin (factor IIa). Some are in

clinical use, while others are undergoing clinical development. Several members of the class are

expected to replace heparin (and derivatives) and warfarin in various clinical scenarios.

There are three types of DTIs, dependent on their interaction with the thrombin molecule. -

Bivalent DTIs (hirudin and analogs) bind both to the active site and exosite 1, while

- Univalent DTIs bind only to the active site.

- The third class of inhibitors, which are gaining importance recently, is the allosteric inhibitors.

Examples of Direct Thrombin Inhibitors: Bivalirudin, Lepirudin, Desirudin and Argatroban.

Bivalirudin (Angiomax, Angiomax RTU.)

Drug class: Anticoagulant

Mode of action: Bivalirudin specifically inhibits thrombin by binding both to the catalytic site

and the anion-binding exosite on thrombin within thrombi and the circulation.

Indication: Acute myocardial infarction, an adjunct to thrombolytic therapy.

Acute myocardial infarction - percutaneous coronary intervention - thrombosis; prophylaxis

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Deep venous thrombosis; prophylaxis

Heparin-induced thrombocytopenia with thrombosis - heart surgery - thromboembolic disorder;

prophylaxis

Peripheral arterial bypass - thromboembolic disorder; prophylaxis

Thromboembolic disorder

Thromboembolic disorder; prophylaxis - unstable angina

Dosage: 0.75 mg/kg, followed immediately by an infusion of 1.75 mg/kg

Route of administration: Intravenously

Side effects: Hypotension, backache, nausea, coughing up blood, chest tightness and heaviness.

Adverse effects: Confusing, nervousness, pounding of the ears.

Contraindications: Hypersensitivity to bivalirudin or its components. Active of major bleeding

Nursing Responsibilities:

- Monitor vital signs. May cause bradycardia, hypertension, or hypotension. An unexplained

decrease in BP may indicate hemorrhage.

- Monitor patients with STEMI undergoing primary PCI with bivalirudin for acute stent

thrombosis for at least 24 hrs in a facility capable of managing ischemic complications.

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 ANTIANGINAL DRUGS

Antianginal are drugs used in the treatment of anginal pectoris.

Angina is chest pain or chest discomfort due to an imbalance between myocardial oxygen supply

and demand. The types of angina include: stable angina, unstable angina, Microvascular angina,

Vasospastic (variant) angina, Refractory angina.

An antianginal is a drug used in the treatment of angina pectoris which is a symptom of

ischaemic heart disease. Antianginal are medicinal agents used for relieving or preventing

pathological conditions associated with coronary insufficiency and the related ischemic heart

diseases.

Angina is a predictor of future cardiovascular events; therefore, angina treatment goals are to

prevent myocardial infarction (MI) and death, and to alleviate symptoms of angina.

Classifications of Antianginal drugs

1. Beta blockers

2. Calcium channel blockers

3. Nitrates

Beta blockers antianginal drugs

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Antianginal beta blockers decrease myocardial oxygen demand by decreasing contractility and

heart rate and reducing total peripheral resistance. Beta blockers are classified as either cardio-

selective or non-selective. Cardio-selective beta blockers have a greater affinity for beta1

receptors with additional beta2 receptor inhibition at higher doses while non-selective options

have an affinity for beta1, beta2, and alpha1 receptors

Beta blockers are effective in treating stable angina; however, not all beta blockers are FDA

approved for this indication. Beta blockers can worsen symptoms of vasospastic angina and

severe peripheral arterial disease.

Examples of cardio selective beta blockers: Atenolol, metoprolol

Atenolol (Ternomin)

Drug class: Beta blockers

Mode of action: It works by relaxing blood vessels and slowing heart rate to improve blood flow

and decrease blood pressure.

Indication: hypertension, angina pectoris and acute myocardial infarction.

Dosage: 50 mg/day after 1 week, may be increased to 100 mg/day. some patients may require

200 mg/day.

Route of administration: orally

Side effects: fatigue, dizziness, cold fingers and toes, nausea and vomiting, diarrhoea.

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Adverse effects: dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of

the face, fingers, feet, or lower legs, trouble breathing.

Contraindications: asthma, kidney impairment, diabetes or low blood glucose, uncontrolled

heart failure or heart block, raynaud's disease, pregnant, planning to become pregnant or breast-

feeding.

Nursing responsibility

 Actively monitor for adverse drug reactions and be aware that the drug's effects may

mask the symptoms of hypoglycemia and thyrotoxicosis.

 Patient should not take apple juice and orange juice as it may prevent the body from fully

absorbing atenolol. It is best to avoid drinking apple/orange juice within 4 hours of taking

atenolol.

Example of non-selective beta blockers: Propranolol

Propranolol( Inderal LA, Inderal XL, InnoPran XL, Propranolol HCl Intensol)

Drug class: Beta blockers

Mode of action: it is a non-selective beta receptor antagonist. This means that it does not have

preference to β1 or β2 receptors. It competes with sympathomimetic neurotransmitters for

binding to receptors, which inhibits sympathetic stimulation of the heart.

Indication: Hypertension, angina, atrial fibrillation, myocardial infarction

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Dosage: 80-320 mg/day, 6-12hourly.

Route of administration: Oral/Intravenous.

Side effects: slower heart rate, diarrhea, dry, eyes, hair loss, nausea, weakness or tiredness.

Adverse effects: Feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares.

Contraindications: Cardiogenic shock, bronchial asthma, congestive heart failure unless the

failure is secondary to a tachyarrhythmia.

Nursing responsibility

Monitor heart rate and BP for 2 hr after propranolol initiation or dose increases. May worsen

bradycardia or hypotension. Discontinue if symptomatic bradycardia (<80 beats per min) or

hypotension (systolic BP <50 mmHg) occurs. Do not administer in the case of hypersensitivity to

non selective beta blockers.

Calcium channel blockers antianginal drugs

Calcium channel blockers decrease myocardial oxygen demand and increase oxygen supply by

causing coronary artery vasodilation, reducing total peripheral resistance, and decreasing heart

rate and ventricular contractility.

Calcium channel blockers are classified as either non-dihydropyridine or dihydropyridines. Non-

dihydropyridines have a greater effect on the myocardium compared to dihydropyridines.

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Calcium channel blockers treat stable and vasospastic angina; however, not all calcium channel

blockers are FDA-approved for these indications.

Examples of dihydropyridine Calcium Channel Blockers: Amilodopine, Nifedipine.

Amlodopine (Norvasc)

Drug class: Calcium Channel Blockers

Mode of action: Amlodipine inhibits calcium ion influx across cell membranes, with a greater

effect on vascular smooth muscle cells. This causes vasodilation and a reduction in peripheral

vascular resistance, thus lowering blood pressure.

Indication: Angina pectoris,high blood pressure, coronary artery disease.

Dosage: 5-10mg

Route of administration: Orally.

Side effects: Headache, fatigue, Dizziness, Nausea, Flushing, Abdominal pain, Palpitation.

Adverse effects: Bleeding gums, black tarry stool.

Contraindications: Cardiogenic shock, unstable angina, breast-feeding and hypersensitivity to

Dihydropyridines.

Nursing responsibility

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  Monitor BP and pulse before therapy. Assess for signs of heart failure (peripheral edema,

rales/crackles, dyspnea, weight gain, jugular venous distention).

 Do not administer if patient is hypersensitive to dihydropyridine Calcium Channel

Blockers.

Examples of non-dihydropyridine Calcium Channel Blockers: Verapamil, Diltiazem.

Verapamil (Isoptin SR, Calan SR)

Drug class: Calcium Channel Blockers.

Mode of action: By inhibiting these channels and decreasing the influx of calcium, verapamil

prolongs the refractory period of the AV node and slows conduction, thereby slowing and

controlling the heart rate in patients with arrhythmia.

Indication: angina (chronic stable, vasospastic or Prinzmetal variant), unstable angina

(crescendo, preinfarction), hypertension as add-on therapy, paroxysmal supraventricular

tachycardia (PSVT) prophylaxis, and supraventricular tachycardia (SVT).

Dosage: Initial dose: 180 mg orally once a day at bedtime; if adequate response is not obtained

with 180 mg, the dose may be titrated upward.

Maximum dose: 480 mg/day

Route of administration: orally, intravenously.

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Side effects: constipation, feeling or being sick (nausea or vomiting), flushing of the face and

neck, headaches, feeling dizzy or tired.

Adverse effects: blurred vision, confusion, severe dizziness, faintness, or lightheadedness when

getting up from a lying or sitting position suddenly, sweating or unusual tiredness or weakness .

Contraindications: Hypersensitivity to verapamil or other calcium channel blockers,

cardiogenic shock, congestive heart failure, symptomatic hypotension, sick sinus syndrome

(unless a permanent pacemaker is in place).

Nursing responsibility

 Initiating and maintaining the newest type of administration of continuous-verapamil

intravenous infusion. Monitor patient's blood pressure, heart rate, and liver function tests.

Do not administer in the case of hypersensitivity to non-dihydropyridine Calcium

Channel Blockers.

Nitrates antianginal drugs

Low-dose nitrates cause venodilation, thus decreasing preload while high doses lead to arterial

vasodilation. The latter mechanism decreases afterload, with both mechanisms resulting in a

reduction in myocardial oxygen demand.Nitrates effectively treat all forms of angina. People

who take long-acting nitrates must have a nitrate-free period of 10 to14 hours per day to help

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prevent tolerance. Anginal symptoms may occur during that time. Abrupt discontinuation can

intensify angina.

Short-acting Antianginal Nitrates

Short-acting nitroglycerin is available as sublingual tablets, sprays, ointments, and powders, and

is used for prevention and treatment of acute anginal symptoms. Onset of action is 2 to 5 minutes

with effects lasting 15 to 30 minutes. Nitrate tolerance doesn’t develop with short-acting

products. Dosing varies depending on the product.

The most common nitrate used to treat angina is glyceryl trinitrate.

Glyceryl trinitrate (GTN) also known as nitroglycerin

Brand name: Rectogesic, Minitran, Glytrin.

Drug class: Nitrates

Mode of action: relaxing the blood vessels and increasing the supply of blood and oxygen to the

heart while reducing its work load.

Indication: acute relief of an attack or acute prophylaxis of angina pectoris due to coronary

artery disease. Transdermal nitroglycerin is indicated for the prevention of angina pectoris due to

coronary artery disease.

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Dosage: in the case of anginal attack, administer 1 packet of sublingual powder for 5minutes. Do

not take more that 3 packets in 15minutes

Route of administration: sublingual

Side effects: Headache, feeling of warmth or heat

Adverse effects: Rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,

trouble breathing.

Contraindications: Increased intracranial pressure, severe anemia, right-sided myocardial

infarction, or hypersensitivity to nitroglycerin are contraindications to nitroglycerin therapy.

Nursing responsibility

 Help patient empty the contents of a packet under the tongue. Patients mouth should be

closed and him/her should breathe normally.

 Allow powder to dissolve without swallowing. Do not rinse or spit for 5 minutes after

taking this medicine. Do not take more than 3 packets in 15 minutes. If patient still have

pain after taking a total of 3 packets, this is an emergency.

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 Haematinics

A hematinic is a nutrient required for the formation of blood cells in the process of

hematopoiesis. The main hematinics are iron, Vitamin B12, and folate. Deficiency in hematinics

can lead to anaemia. In cases of hematinic deficiency, hematinics can be administered as

medicines, in order to increase the hemoglobin content of the blood. Vitamin D, which helps

maintain the health of bones, the reservoirs of new blood cells may also have a role in protecting

hemoglobin and in stimulating the formation of new blood cells.

Erythropoietin (EPO) is a hormone that stimulates erythropoiesis, which can also be given as a

medicine to increase the hemoglobin content of the blood, but EPO is not classified as a

hematinic as it is not considered a nutrient, but a hormone.

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IRON

Iron is a mineral that our bodies need for growth and development. The body uses iron to make

hemoglobin, a protein in red blood cells which carries oxygen from the lungs to all parts of the

body. Iron is also important for healthy muscles, bone marrow, and organ function. Iron is

available in supplements, either on its own or as part of many multivitamin/mineral supplements.

Types of iron supplements:

Ferrous sulfate

Ferrous gluconate

Ferric citrate

Ferric sulfate

Ferrous sulfate

Drug class: Iron supplement

Mode of action: Iron combines with porphyrin and globin chains to form hemoglobin, which is

critical for oxygen delivery from the lungs to other tissues.

Indication: to treat or prevent low blood levels of iron such as those caused by anemia(iron

deficiency anaemia) or pregnancy

Dosage: 600mg per day to be given in divided doses.

Route of administration: orally

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Side effects: Nausea and vomiting, heartburn, stomachAdvise the patient to avoid alcohol and

foods that may interfere with vitamin B12 absorption, such as tea or coffeediscomfort, loss of

appetite, constipation.

Adverse effects: Severe stomach pain or vomiting, cough with bloody mucus or vomit that looks

like coffee grounds, fever or bloody or tarry stools.

Contraindications: Porphyria, thalassemia, or hemolytic anemia, people who excessively drink

alcohol, People receiving frequent blood transfusions.

Nursing responsibility

 Observe for signs of adverse effects and/or toxicity, observe stool or check for

constipation

 Instruct the patient to take this medication with food and avoid concurrent antacid use.

 Avoid taking antacids or antibiotics within 2 hours before or after taking ferrous .sulfate

Vitamin B12

Vitamin B₁₂, also known as cobalamin, is a water-soluble vitamin which plays an essential role in

red blood cell formation, cell metabolism, nerve function and the production of DNA. Food

sources of vitamin B include poultry, meat, fish and dairy products. Vitamin B12 is also added to

some foods, such as fortified breakfast cereals, and is available as an oral supplement. Vitamin

B12 injections or nasal spray might be prescribed to treat vitamin B12 deficiency.

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Cyanocobalamin is a synthetic compound of vitamin B12 used to treat vitamin deficiencies.

Cyanocobalamin is an inexpensive drug used to treat people who can't absorb vitamin B12. It is

more popular than comparable drugs. Cyanocobalamin is only available as a generic drug; all

brands have been discontinued.

Drug class: Water soluble vitamin

Mode of action: Cyanocobalamin absorption occurs through the small intestine after binding to

intrinsic factors and other cobalamin binding proteins.

Indication: Pernicious anemia, Impairment of B12 absorption, Impairment of intrinsic factor

production, causing impaired vitamin B12 absorption, Dietary deficiency of vitamin B12

Dosage: diet-related deficiency is 50 micrograms to 150 micrograms once daily,

B12 deficiency not caused by your diet is one to two 1,000 microgram tablets, taken once or

twice a day – this is usually if you cannot have vitamin B12 injections. Injectable solution:

1000mcg/ml, nasal spray: 500mcg/spray

Route of administration: Orally, parenteral, intranasal

Side effects: Abdominal or stomach pain, bleeding from the gums or nose, blue lips and

fingernails, coughing that sometimes produces a pink frothy sputum, decreased urine output.

Adverse effects: Shortness of breath (even with mild exertion), swelling, rapid weight gain.

Pulmonary edema, congestive heart failure, peripheral vascular thrombosis. Hypokalemia--leg

cramps, irregular heartbeats, tingling/numbness, muscle weakness, or limp feeling. Numbness or

tingling and joint pain.

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Contraindications: sensitivity to vitamin B12.

Leber's disease, which affects the optic nerve.

kidney problems.

hypokalemia, or low potassium levels.

deficiencies in other nutrients, particularly folic acid and iron. omeprazole (Prilosec),

lansoprazole (Prevacid) or other stomach acid-reducing drugs.

Nursing responsibility

 Administer vitamin B12 supplements as prescribed. The route and dosage of vitamin B12

depend on the cause and severity of the deficiency.

 Advise the patient to avoid alcohol and foods that may interfere with vitamin B12

absorption, such as tea or coffee

 Observe for hypersensitivity reaction.

Folate

Folate, also known as vitamin B₉ and folacin, is one of the B vitamins.Folic acid is the lab-made

form of the vitamin and it is used in dietary supplements and added to foods. Folic acid from

enriched foods and supplements is absorbed better by our bodies than from natural food sources.

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Folate and folic acid are important for cell growth and metabolism. Studies show that certain

groups of people in the U.S., including Black women and women of childbearing age, don't get

enough folic acid.

Folic acid

Drug class: B vitamin group

Mode of action: Folic acid is the synthetic form of folate. Folate converts into tetrahydrofolic

acid (THF). This compound undergoes several transfer/methylation reactions that are important

for synthesizing nitrogenous bases in DNA and ribonucleic acid (RNA) and are necessary for the

maturation of red blood cells (RBCs).

Indication: Folate deficiency, hemolytic anemia, juvenile idiopathic arthritis, methotrexate

induced nausea, megaloblastic anemia, methanol deficiency, women who are planning to become

pregnant, could become pregnant, are pregnant or are breast-feeding.

Dosage:

Category

Folate (Folic Acid) Recommended Dietary Allowance (RDA)

0-6 month : 65 mcg/day Adequate Intake (AI)

7-12 months: 80 mcg/day Adequate Intake (AI)

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1-3 years: 150 mcg/day

4-8 years: 200 mcg/day

9-13 years: 300 mcg/day

14 years and older: 400 mcg/day

Pregnant teens and women: 600 mcg/day

Breastfeeding teens and women: 500 mcg/day

Injection: 1mg-5mg/ml

Route of administration: Orally, parenteral administration is not advocated but may be

necessary in some individuals (e.g., patients receiving parenteral or enteral alimentation).

Side effects: Nausea, loss of appetite, irritability, sleep pattern disturbance

Adverse effects: General weakness or discomfort, reddened skin, shortness of breath skin rash or

itching.

Contraindications: Hypersensitivity to folic acid, low vitamin B12 levels (vitamin B12

deficiency anaemia) or pernicious anaemia, cancer (unless you also have folate deficiency

anaemia) people on haemodialysis or have a stent in their heart.

Nursing responsibility

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 Monitor plasma folic acid levels, hemoglobin, hematocrit, and reticulocyte count before

and periodically during therapy.

 Women who are planning a pregnancy should be advised to take folic acid daily before

conception to prevent occurrence of neural tube defects.

 Administer orally if at all possible. With severe GI malabsorption or very severe disease,

give IM, IV, or subcutaneously.

 Use caution when giving the parenteral preparations to premature infants. These

preparations contain benzyl alcohol and may produce a fatal gasping syndrome in

premature infants.

 Monitor patient for hypersensitivity reaction

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 References

“Coumarin”. PubChem, National Library of Medicine, US National Institutes of Health. 4 April

2019.

Definition of haematinics, www.merriam-webster.com. Retrieved July 12, 2019.

Definition of iron: https://medlineplus.gov/iron.html#top

Di Nisio M, Middeldorp S, Büller H (2005). "Direct thrombin inhibitors"

Factor Xa Inhibitors- Hitchings, Andrew; Lonsdale, Dagan; Burrage, Daniel; Baker, Emma
(2019). The Top 100 Drugs: Clinical Pharmacology and Practical Prescribing (2nd ed.).

Heparins - "Heparin Sodium". The American Society of Health-System Pharmacists. Archived

from the original on 27 January 2020.

Medically reviewed by Melisa Puckey, BPharm, Ferrous sulfate. Last updated on Feb 29, 2024.

Antianginal drugs- Emilie White, PharmD | November 17, 2022

Medically Reviewed by Zilpah Sheikh, MD on September 05, 2023 Written by R. Morgan

Griffin. vb Folate(folic acid).

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