Fibrinolytic Drugs Flashcards
What are common indications for fibrinolytic drug use?
- Acute ischaemic stroke
- Acute STEMI
- Massive PE
What is the mechanism of action of firbinolytic drugs?
Catalyse the conversion of plasminogen to plasmin, which acts to dissolve fibrinous clots and re-canalise occluded vessels. This allows reperfusion of affected tissue, preventing or limiting tissue infarction and cell death.
What fibrinolytic drugs are usually used in acute ischamic stroke?
Alteplase
How soon after an ischaemic stroke begins can alteplase be given?
Within 4.5 hours - after this risk outweighs benefit
What fibrinolytic drugs are used to treat STEMI?
- Alteplase
- Streptokinase
What are important adverse effects of fibrinolytic drugs?
- Nausea
- Vomiting
- Bruising
- Hypotension
- Bleeding
- Allergic reaction
- Cardiogenic shock
- Cardiac arrest
What adverse reactions would prompt you to immediately stop giving fibrinolytic drugs?
- Serious Bleeding
- Allergic reaction
- Cardiogenic shock
- Cardiac arrest
What can happen with reperfusion of the brain using fibrinolytics?
Cerebral oedema
What can happen with reperfusion of the heart using fibrinolytics?
Arrythmias
What are contraindications to thrombolysis?
- Recent haemorrhage
- Recent trauma or surgery
- Bleeding disorders
- Severe hypertension
- Peptic ulcers
- Intracranial haemorrhage
What is one of the main contraindications to thrombolysis use in stroke?
Intracranial haemorrhage
What drug groups can increase the risk of anaphylactoid reactions when using fibrinolytics?
ACEi
How are fibrinolytics administered?
IV bolus, followed by infusion
Where should fibrinolytics be administered?
High dependency area - ED, hyperacute stroke unit, CCU
What monitoring should be done whilst someone is on fibrinolytic drugs?
Vital signs every 15 minutes, including signs of bleeding, anaphylaxis and neuro deterioration
