Fibrinolytics Flashcards
Clopidogrel MOA
Anti-platelet that antagonizes adenosine diphosphate (ADP) binding to platelets, impairing function
Clopidogrel Preparation
75mg tablets
Clopidogrel Indication
STEMI in conjunction with fibrinolytic therapy
Clopidogrel Contraindications
Nil
Clopidogrel Precautions
Clinically significant bleeding
At risk of bleeding
Pregnancy
Clopidogrel Doses
<75yo 300mg (x4 tablets)
>75yo 75mg (x1 tablet)
Clopidogrel Onset
30-60min
Clopidogrel Duration
The life of the platelet, 3-5 days
Clopidogrel Adverse Effects
Increased bleeding
Enoxaparin MOA
Low molecular weight Heparin (LMWH) anticoagulant that potentiates the activity of anti-thrombin III, inhibiting multiple coagulation factors- particularly Xa
Enoxaparin Preparation
100mg 1ml
Enoxaparin Indication
STEMI in conjunction with fibrinolytic therapy
Enoxaparin Contraindication
Nil
Enoxaparin Precautions
Clinically significant bleeding
At risk of bleeding
Pregnancy
Enoxaparin Doses
Based off age & weight- see chart
Enoxaparin Onset
10-30min
Enoxaparin Duration
12-24hrs
Enoxaparin Adverse Effect
Increased bleeding
Heparin MOA
Anticoagulant that potentiates activity of anti-thrombin III, inhibiting multiple coagulation factors
Heparin Preparation
5000 units 0.2ml
Heparin Indication
STEMI in conjunction with fibrinolytic therapy
Heparin Contraindication
> 75yo
Heparin Precaution
Clinically significant bleeding
At risk of bleeding
Pregnancy
Heparin Dose
5000 units diluted to a total of 5-10mls IV bolus
Heparin Onset
5-15min
Heparin Duration
2-4hrs
Heparin Adverse Effect
Increased bleeding
Metoprolol MOA
Beta blocker that antagonizes beta1 receptors, decreasing HR, CO, and BP
Metoprolol Preparation
5mg 5ml
Metoprolol Indication
HTN prior to STEMI fibrinolytics
Metoprolol Contraindications
Bradycardia
Hypotension
Metoprolol Precautions
1st degree heart block
Sick sinus syndrome without pacemaker
2nd or 3rd degree heart block without pacemaker
Asthma/COPD/HF
Metoprolol Dose
2.5mg IV
Metoprolol Onset
2-3min
Metoprolol Duration
1-2hrs
Metoprolol Adverse Effects
Bradycardia
Bronchospasm
Hypotension
Tenecteplase MOA
Fibrinolytic that accelerates the breakdown of blood clots and converts plasminogen into plasmin (active enzyme) that breaks down fibrin in clots
Tenecteplase Dose
Based off age + weight, see chart
Tenecteplase Onset
5-10min
Tenecteplase Duration
2-6hrs
Tenecteplase Preparation
50mg powder
Tenecteplase Indication
STEMI in conjunction with fibrinolytic therapy
Tenecteplase Contraindications
Suspected aortic dissection Major surgery/trauma/TBI 6/52 Intracranial surgery within 6/12 Ischaemic CVA within 6/12 Previous Intracerebral Bleed Known cerebral aneurysm/malformation/tumor
Tenecteplase Precautions
Clinically significant bleeding >10min CPR Vascular puncture within 24hrs Internal bleed within 6/52 Lumbar puncture within 6/52 TIA within 3/12 Known bleeding disorder Anticoagulant SBP >180 or DBP >110 Pregnant or <2/52 post partum Onset of sxs >12hrs Dependant activities daily living Comorbidity shortening life Frail
Tenecteplase Adverse Effects
Increased bleeding
Dysrhythmia