Antiplatelet Agents, Thrombolytics (Fibrinolytics) and Lipid-lowering Drugs

Question 1

What is the function of antiplatelet agents?

Answer 1

Decrease platelet aggregation by effecting platelet adhesiveness and reducing thrombus formation.

Question 2

Name two common antiplatelet agent drugs. Explain each.

Answer 2

Abciximab

• used during surgery on the heart
• intravenous infusion
• used during angioplasty in conjuction with heparin and aspirin

Dipyridamole

• oral, IV
• used following valve replacement, TIA and stroke prevention

Anagrelide

• oral
• used for thrombocytopaenia

Aspirin

• should only be taken as per doctors orders
• reduces TIAs and nonfatal MI

Clopidogrel
- used for risk of ischaemic events and history of MI, AC

Question 3

Explain the indications of antiplatelet agents.

Answer 3

• prophylaxis following cardiac valve replacement
• increased risk of thromboembolic stroke
• acute myocardial infarction
• benefits in reduced cardiovascular events must be weighed against the risks (in other words, you must balance the benefits against the risks)

Question 4

Explain the contraindications and cautions of antiplatelet.

Answer 4

• presence of any known bleeding disorder
• recent surgery
• closed head injuries
• pregnancy
• lactation

Question 5

What are thrombolytics used for?

Answer 5

• used to treat thrombo-embolic disorders by dissolving clots
• used by paramedics to reduce damage from MI, not used for suspected stroke patients
• to be effective these drugs need to be administered within 6-12 hours of vessel occlusion

Question 6

What are the indicatons of thrombolytics?

Answer 6

• myocardial infarction

- pulmonary embolism

Question 7

Name two common thrombolytic drugs.

Answer 7

• alteplase (actilyse)
• tenecteplase (metalyse)
• reteplase (rapilysin)
• streptokinase (streptase)

Question 8

Name five adverse effects of thrombolytic drugs.

Answer 8

- bleeding
 = intracranial
 = internal
 = superficial
- arrhythmias
- hypotension
- hypersensitivity
- fever

Question 9

Name three nursing considerations on thrombolytics.

Answer 9

• treatment should be started as soon as possible after onset of symptoms
• any recent puncture sites should be carefully observed for bleeding
• after IM injections apply pressure for 5-10 minutes for bleeding
  during IM injections, venepuncture and undue patient handling should be avoided
• not recommended within 10 days of surgery

Question 10

Name five care considerations with Thrombolytics.

Answer 10

• monitor vital signs and neurological status closely
• observe closely for early signs of bleeding
• educate patient about about reporting signs of bleeding (e.g. malaena, bleeding gums, haematuria)
• avoid IM injections
• advise patient that many over the counter preparations can interfere with anticoagulant therapy (e.g. herbal preparations, vitamin supplements and aspirin)
• advise patient to notify dentist of medication and avoid risky activities
• for s/c, do not rub injection site, and rotate sites
• withdrawal from oral anticoagulants occurs gradually over 3-4 weeks
• same brand of oral contraceptives as thrombolytics needs to be taken for each dose
• warfarin crosses the placenta, so can not be used in pregnancy

Question 11

Name five points of caution with thrombolytics.

Answer 11

• many drugs which either potentiate action of warfarin or reduce action of medication
• regular monitoring of patient
• patient education
• bleeding can occur within therapeutic range
• treatment of overdose is dependent on the extent of the bleed
• injections should be avoided
• if other medications are stopped or started, INR monitoring is recommended
• oral anticoagulants are usually started at the same time as heparin
• withdrawn slowly over 3-4 weeks

Question 12

Name three things that should be included in patient education of thrombolytics.

Answer 12

• wear medic alert bracelet
• take the drug same time every day
• only take prescribed dose
• avoid alcohol
• seek medical advice if dose is missed

Question 13

Name two types of lipid-lowering drugs.

Answer 13

• HMG-CoA reductase inhibitors (Statins)

- Bile-acid-binding agents

Question 14

Explain HMG-CoA reductase inhibitors (statins).

Answer 14

• reduce serum cholesterol levels thus reducing risk of cardiovascular disease
• inhibit HMG-CoA reductase, lowering cholesterol synthesis, increasing number of liver LDL receptors thus lowering LDL levels

Question 15

What are the indications of HMG-CoA reductase inhibitors (statins)?

Answer 15

Hyperlipidaemia

Question 16

Name two common HMG-CoA reductase inhibitors (statins) drugs.

Answer 16

• atorvastatin (lipitor)
• simvastatin (lipex, zocor)
• fluvastatin (lescol, vastin)
• pravastatin (pravachol)

Question 17

Name five adverse effects of HMG-CoA reductase inhibitors (statins).

Answer 17

• gastrointestinal disturbances
• headache
• myalgia
• insomnia
• rash
• constipation
• alopecia (loss of hair)
• gynaecomastia (men growing breasts)
• myopathy (rare)

Question 18

Explain bile-acid-binding agents.

Answer 18

Binds cholesterol-containing bile acids within the bowel preventing them from being reabsorbed.

Question 19

Explain the indications of bile-acid-binding agents.

Answer 19

• elevated cholesterol due to high LDL levels
• prevention of coronary heart disease
• itching due to biliary obstruction

Question 20

Name the common bile-acid-binding agents drugs.

Answer 20

• cholestyramine (questran lite)

- cholestipol (colestid granules)

Question 21

Name three adverse effects of bile-acid-binding agents.

Answer 21

• constipation
• gastrointestinal disturbances
• reduced absorption of fat soluble vitamins
• increased bleeding tendency
• osteoporosis