CARDIO: FIBRINOLYTIC DRUGS

Question 1

FIBRINOLYTIC DRUGS: INDICATIONS

Answer 1

• Acute ischaemic stroke
• Acute ST elevation of MI
• Massive PE with haemodynamic instability

Question 2

FIBRINOLYTIC DRUGS: MOA

Answer 2

• Catalyse the conversion of plasminogen -> plasmin, which acts to dissolve fibrinous clots and re-canalise occluded vessels
• Allows reperfusion of affected tissue, preventing or limiting tissue infarction and cell death, improving patient outcomes

Question 3

FIBRINOLYTIC DRUGS: ADVERSE EFFECTS

Answer 3

• Nausea
• Vomiting
• Bruising around the injection site
• Hypotension
• Adv effects that require tx to be stopped = serious bleeding, allergic reaction, cardiogenic shock and cardiac arrest
• Reperfusion of infarcted brain or heart tissue = cerebral oedema and arrhythmias

Question 4

FIBRINOLYTIC DRUGS: WARNINGS

Answer 4

• Factors that predispose the patient to bleeding (including recent haemorrhage, recent trauma, bleeding disorders, severe hypertension, peptic ulcers)
• Acute stroke - intracranial haemorrhage must be excluded using a CT scan before tx
• Previous streptokinase tx is a CI to repeat dosing

Question 5

FIBRINOLYTIC DRUGS: IMPORTANT INTERACTIONS

Answer 5

• Anticoags
• Antiplatelet drugs
• Ace inhibitors