The two most commonly used antiplatelet agents for children are aspirin and dipyridamole. Aspirin acetylates the enzyme cyclooxygenase and thereby interferes with the production of thromboxane A2 and platelet aggregation. Dipyridamole interferes with platelet function by increasing the cellular concentration of adenosine 3,5-monophosphate (cyclic AMP). This latter effect is mediated by inhibition of cyclic nucleotide phosphodiesterase and/or by blockade of uptake of adenosine, which acts at A2, receptors for adenosine to stimulate platelet adenylcyclase. Antiplatelet agents are used in the following conditions:
Cardiac disorders (mechanical prosthetic heart valves, Blalock-Taussig shunts, endovascular shunts) Cardiovascular events Kawasaki disease.
Aspirin: 5-10 mg/kg/day Dipyridamole (3-5 mg/kg/day).
Table 11-35. Effect of Drugs on Warfarin Response
Medications that potentiate the effect of warfarin
Acetaminophen Acetohexamide Allopurinol
Antibiotics that disrupt intestinal flora (tetracyclines, streptomycin erythromycin, kanamycin, nalidixic acid, neomycin) Cephaloridine Chloramphenicol Chlorpromazine Chlorpropamide Chloral hydrate Cimetidine Clofibrate Diazoxide Disulfiram Ethacrynic acid Glucagon
Oxyphenbutazone p-Aminosalicyclic acid
Medications that reduce the effect of warfarin
All vitamin preparations containing vitamin K
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