Pharmacology (Thrombolytic, Anticoagulants, antiplatelet)
Cecilia Marcillo
Grande Prairie Regional College
Nursing 2940
Karen Crosby - Rolston's
10 January 2014
Pharmacology (Thrombolytic, Anticoagulants, antiplatelet)
Thrombolytic Drugs Thrombotic stroke is the result of thrombosis or narrowing of the blood vessels, is the most common cause of strokes (Sanford & Lallion, 2010, p. 1603)
Thrombolytic medications are approved for the immediate treatment of Thrombotic Stroke, and Heart attack. (MI). The two main drugs are tissue plasminogen activator (t-PA) and anisoylated plasminogen streptokinase activator complex (APSAC) (Lilley, Harrington, & Synder, 2011, p. 538).
Mechanism of action and drug effect Thrombolytic convert plasminogen to plasma, which breaks down, or lyses the thrombus. Plasmin is a proteolytic enzyme, meaning it breaks down protein. Plasmin is relatively nonspecific serine protease that is capable of degrading such protein as fibrin, fibrinogen, and other procoagulant proteins. In other words, the substance that forms clots, are destroyed by plasmin. Thrombolytic drugs work by mimicking the body’s own process of clot destruction (Lilley et al., 2011, p. 539).
Streptokinase (SK), the original thrombolytic enzyme, binds with plasminogen to form SK-plasminogen complex, which then acts on other plasminogen molecules to form plasmin. The plasmin formed then lyses the clots. Sk is not clot specific, however SK activates fibrinolysis throughout the body; it breaks not only the thrombus in the coronary artery but also any clots in the body (Lilley et al., 2011, p. 539).
Indications
The purpose of all thrombolytic drugs is to activate the conversion of plasminogen to plasmin, the enzyme that breaks down a thrombus. The indication of thrombolytic therapy includes acute MI, arterial thrombosis, DVT, occlusion of shunts or catheters, pulmonary embolus and acute ischemic stroke.
Contraindications
Known drug allergy to the specific product and to any preservatives and concurrent use with other drugs that alter clotting.
Adverse effects
The most undesirable effect of thrombolytic therapy is: internal, intracranial, and superficial bleeding.
Other problems include hypersensitivity, anaphylactic reactions, nausea, vomiting, and hypotension. Also can induce cardiac dysrhythmias.
Interactions
Increased bleeding tendency resulting from the concurrent use of anticoagulant, antiplatelet, or other drugs that affect platelet function.
One laboratory test interaction that can occur with thrombolytic drugs is a reduction in the plasminogen and fibrinogen levels.
Nurse’s considerations
Iv should be administrated per manufacture guidelines and per protocol.
Iv infusion should be monitoring frequently for bleeding, redness and pain.
Intramuscular injections of other drugs are contraindicated to prevent tissue damage and bleeding.
Any bleeding from the gums or mucous membrane and increase pulse greater that 100 beats /minute should be reported to the physician.
Monitoring for hypotension, restlessness, and a decrease of hemoglobin should be reported.
Nursing interventions following thrombolysis treatment
Once thrombolysis infusion has finished, the stroke nurse accompanies the patient to the hyperacute stroke unit.
The neurologist or stroke team reviews the patient two hours following thrombolysis.
There should be a one-to-one patient-to-nurse ratio for the first 24 hours.
The patient should be in an electric bed, with cot sides up, head at a 30° angle with continuous monitoring of oxygen saturation and electrocardiogram.
Oxygen (to maintain oxygen saturation over 95%) and suction should be available at the bedside.
Observations should be taken every 15 minutes during the first two hours, every 30 minutes during the next six hours and hourly for the next 15 hours.
Neurological observations should be recorded hourly for a minimum of 24 hours.
The patient should be on strict bed rest for 24 hours. The patient should be
