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Thrombolytic
alteplase
| Question | Answer |
|---|---|
| What is the action of Thrombolytics | dissolve clots that are already formed |
| what is the nickname for thrombolytics | clot busters |
| What is the prototype drug for thrombolytics | alteplase (activase, tPA) |
| Other thrombolytic drugs are | streptokinase, tenecteplase, reteplase |
| Why is time important when using alteplase (thrombolytic) | if it has been more than 6 hours since symptoms began organ damage will already be done |
| When are thrombolytics (alteplase) given | acute MI, DVT, Massive pulmonary emboli, ischemic stroke |
| side effects of alteplase is | very high risk of bleeding from different sites (more serious than other therapies) & multi system anaphylaxis |
| anaphylaxis usually occurs when patients are taking | striptokinase |
| What should be done to reduce the risk of bleeding when a patient is taking alteplase | limit venepuncture, apply pressure dressings to any recent wounds, monitor V/S, LOC, Weakness, & S/S of intracranial bleeding |
| If bleeding occurs what should you do | Stop thrombolytics, give Amicar, replace blood loss w/ whole blood, PRBC, and/or Fresh Frozen plasma |
| Which types of blood have clotting factors in it | Whole blood and fresh fz plasma |
| What is the antidote for alteplase | amicar (aminocaprotic acid) |
| When would thrombolytics not be used | any prior intracranial hemorrhage,suspected aortic dissection, active internal bleeding, HX of head/facial trauma in past 3 mts, acute pericarditis, brain tumors |
| Use cation when giving thrombolytics to patients | sever HTN, recent ischemic stroke <6mts, recent major surgery <4weeks |
| Important Nursing interventions for thrombolytics are | must be given w/ 4-6 hrs of onset, must have continuous hemodynamic monitoring & close supervision before/during/after, need a baseline & continued monitoring of: H&H, aPTT,PT,INR, & platelet count |
| What is hemodynamic monitoring | cardiac & BP monitors |
| Why is it important that a patient taking alteplase have a good IV access | so emergency medications can be administered |
| Should thrombolytics be mixed with other medications | NO NEVER |
| After therapy with alteplase (thrombolytic) you should | give heparin or aspirin (as ordered),beta blockers, & H2 proton pump inhibitors |
| Why give heparin/aspirin after thrombolytic therapy | to reduce the risk of another thrombous |
| Why give beta blockers after thrombolytic (alteplase) therapy | to decrease the occurrence & severity of reperfusion arrhythmia |
| What is reperfusion arrhythmia | arrhythmias that occur as the heart is reperfused with O2 |
| Why give H2 proton pump inhibitors after alteplase therapy | to prevent GI bleeding |
| How soon after starting alteplase will you be able to see changes on the ECG | 60-90 min |
Created by:
leseanne
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