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TL Finbrinolytics

QuestionAnswer
Why isn’t Digoxin a good choice for angina pain? It increases the strength and contractility of the heart muscle leading to increased oxygen demand
Why is atropine an inapporopriate choice for angina pain? Increases the heart rate by blocking vagal stimulation which increases oxygen demand
When is propanolol (Inderal) considered appropriate for angina? Not good for an attack but good for long term management because it decreases vasoconstriction – more oxygen to heart
Name several Fibronolytic Agents. Streptokinase, Tenecteplase, Alteplase, Anisterplace, Reteplase, Urokinase
What are the indications for Steptokinase? DVT, pulmonary embolism, arterial thrombosis and embolism, coronary thrombosis, dissolving clots in ateriovenous cannula
What adverse reactions should we watch for with the administration of Streptokinase? Anaphylactic reactions like breathing difficulty, bronchospasm, periorbital swelling, angioedema; increased bleeding risk, hemorrhage at site of myocardial damage, reperfusion dysrhythmias
What assessments should be made when a patient receives Streptokinase? puncture site for bleeding – apply pressure to control bleeding, watch for allergic reactions and dysrhythmias, Monitor thrombin time – should be less than twice control before resuming heparin or oral anticoagulants
Describe care and activity level of a client after femoral coronary cannulation and perfusion with Streptokinase. keep leg immobile for 24 hours, assess pedal pulses for adequate perfusion
How is should Streptokinase be mixed if reconstitution is required? Do not shake. Roll and tilt vial to gently mix.
What are the indications for Tenecteplase and Reteplase? Acute management of coronary thrombosis
When would administration of tenecteplase or reteplase be contraindicated? History of uncontrolled hypertension
What are the adverse effects associated with tenecteplase and reteplase? can cause hypotension
What lab values are necessary with the administration of tenecteplase and reteplase? baseline PT, PTT, CBC, fibrinogen level, renal studies, and cardiac enzymes prior to administration
What are some signs of bleeding that would preclude the administration of tenecteplase or reteplase? abnormal pulse, nuero signs, skin lesions
What should we know about injections and tenecteplase or reteplase? avoid needle punctures due to possibililty of bleeding, Apply pressure to injection sites for 30 minutes then pressure dressing, Do not inject where pressure cannot be applied (jugular vein)
What complication should we be watchful for with the administration of tenecteplase for coronary thrombosis? Watch ECG - reperfusion arrhythmias are likely
What are the indications for Urokinase ( Abbokinase)? Pulmonary Embolism, Coronary Thrombosis, IV catheter clearance
What adverse reactions are associated with Urokinase (Abbokinase)? Same as Streptokinase except no danger of allergic reactions: increased risk of bleeding, Hemorrhage, reperfusion dysrhythmias
Urokinase is much more expensive than Streptokinase. Why would Urokinase be preferable to Streptokinase? Urokinase does not cause allergic reactions – it is nonantigenic
How is rethrombosis prevented after the administration of Urokinase? Administration of heparin or oral anticoagulant
When is Urokinase reconstituted? immediately before use
What are the indications for Alteplase and Anistreplace? DVT, Pulmonary Embolism, Coronary Thrombosis
What are the adverse effects of alteplase and anistreplace? Interacts with heparin, oral anticoagulants and anitplatelet drugs increasing the risk for bleeding
How are alteplase (Activase) and Anisteplace (Eminase) different from Streptokinase? Bleeding complications with Alteplase are reduced compared to Streptokinase because it works just on the clot not systemically. It is a human protein – less likely to cause anaphylaxis.
What is the half life of Alteplase? How soon should it be administered? 3-7 minutes, use immediately
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