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Week 2 pt B
Thrombolytics and NSAIDS
| Term | Definition |
|---|---|
| What do thrombolytic drugs do? | Remove clots fast (don't prevent clots from forming) restore blood flow quickly |
| Where would life threatening blood clots be found? | Arteries |
| What is a major caution with thrombolytics? | Bleeding |
| What are indications of thrombolytic drugs? | MI Arterial thrombolysis Pulmonary embolism Ischemic stroke |
| What is a reperfusion arrhythmia | |
| Alteplase (activase - tpa) | Tissue Plasminogen activator - a thrombolytic "clot buster" |
| What is Alteplase (activase - tpa) used for? | Ischemic stroke Acute MI Massive PE Clears occluded central lines |
| When (timing) should Alteplase (activase - tpa) be administered? What route? And what is a major risk? | Earlier use = better outcomes IV only Serious bleeding |
| What are the absolute contraindications for thrombolytic drugs? | - Prior brain bleed (intracranial hemorrhage) - cerebral vascular lesion - Ischemic stroke within the past 3 months - Intracranial neoplasm - Active internal bleeding - Suspected aortic dissection |
| What are the relative contraindications for thrombolytic drugs? | - Severe, uncontrolled hypertension on presentation (high pressure - higher risk of clot movement) - Current use of anticoagulants in therapeutic coagulants - Traumatic or prolonged CPR or surgery - Internal bleeding (within 2-4 weeks) - Pregnancy |
| What do antifibrinolytic drugs to? | - Prevent the breakdown of fibrin (opposite of thrombolytics) |
| What are antifibrinolytic drugs used for? | - Excessive bleeding - Hyperfibrinolysis - Bleeding disorders |
| Tranexamic acid | Antifibrinolytic |
| What is Tranexamic acid used for? | Prevents fibrin clot breakdown Used for: - Surgical bleeding - Trauma - Post partum hemorrhage - Menorrhagia |
| What are the AE for Tranexamic acid? | - Increases thromboembolism risk esp in those using estrogen-containing hormonal contraceptives - Visual disturbances - Venous or arterial clots |
| Describe the pathway of inflammation | Tissue injury = release of phospholipids = arachidonic acid - 1. Leukotriene pathway = Bronchoconstriction, vasoconstriction, increased permeability 2. Prostaglandin pathway - pain, fever, swelling |
| What do NSAID's do? | Aim to reduce prostaglandins = reduction of inflammation and fever Block COX-1, COX-2, or both |
| What are the key physiological roles of COX-1? | - Constitutively active (always “on”) - Promotes platelet aggregation via thromboxane A₂ - Protects gastric mucosa (↓ acid, ↑ mucus + bicarbonate) - Maintains renal blood flow |
| What triggers COX-2 activation and what are its effects? | - Inducible — activated during inflammation - Found in inflammatory cells and vascular endothelium - Produces proinflammatory prostaglandins → pain, swelling, fever, redness, loss of function |
| What are the AE for COX-1 inhibitors? | Excessive bleeding, GI upset GI bleeding Peptic ulcer Impaired renal function Hypertension |
| When using NSAID's when is the risk of kidney failure heightened? | When used alongside ACE inhibitors or ARB's |
| What cardiovascular risks are associated with NSAID use (excluding aspirin)? | Myocardial infarction (MI) and stroke; may be fatal. Risk rises with higher doses, longer duration, and pre-existing cardiovascular disease. |
| What factors increase the risk of NSAID-related adverse events? | Higher doses, prolonged use, existing cardiovascular disease, and advanced age. |
| Aspirin | Irreversibly inhibits COX-1 and COX-2 |
| What are the adverse effects of aspirin? | - GI irritation - Ulcers - Bleeding - Renal impairment - Hypersensitivity reactions |
| What are the therapeutic uses of aspirin? | - Pain - Fever - Inflammation (higher doses) - Cardioprotection at low doses |
| What are important safety precautions for aspirin? | - Avoid in children with viral illness (Reye syndrome risk) - Bleeding risk increases with higher doses - Caution in dehydration or older adults (renal risk) |
| What is the bleeding risks for aspirin? | - Taking two 325‑mg tablets can double bleeding time for about one week |
| How does naproxen differ from ibuprofen? | - Longer duration (q12h vs q6–8h) - Slightly lower cardiovascular risk - Used more for arthritis and musculoskeletal pain |
| What are the risks of ketorolac (Toradol®)? | - Renal impairment - GI bleeding - Edema |
| Ketorolac | Very potent NSAID |
| Indomethacin | NSAID |
| What are some AEs for Indomethacin? | Higher CNS and GI effects compared to ibuprofen |
| Celecoxib | COX-2 selective Nsaid (reduced GI upset but increased cardiovascular risk) |
| What allergy should Celecoxib not be administered to? | Sulfa allergy |
| What can NSAIDS be taken with to reduce GI upset? | Dairy |
Created by:
ahgecas25