Thrombolytic Agents (AKA clot busters)

Question 1

Action

Answer 1

activating plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot

Question 2

Thrombolytic agent drug names

Hint: end in “ase”

Answer 2

Alteplase
Reteplase
Tenecteplase
Urokinase

Question 3

Thrombolytic contraindications

Answer 3

Allergy
any condition that would be worsened by dissolution of clots (whatever leads to bleeding)
pregnancy

Question 4

Thrombolytic drug-drug interactions (DDI)

Answer 4

anticoagulants
antiplatelets
(↑ risk of hemorrhage)

Question 5

Thrombolytic cautions

Answer 5

lactation

Question 6

Thrombolytic indications

Answer 6

Acute MI
pulmonary emboli
ischemic stroke

Question 7

Thrombolytic adverse effects

Answer 7

bleeding
cardiac arrhythmias
hypotension
Hypersensitivity: Rash, flushing
bronchospasm & anaphylactic reaction

Question 8

Thrombolytic nursing implications

Answer 8

Hx: allergy, pregnancy & lactation
anything that leads to bleeding; aneurysm, blood-clotting defects, having a baby
Baseline: skin, heart, & lung sounds
VS & ECG
Labs: clotting studies, CBC renal/hepatic fxn
Discontinue heparin before giving thrombolytic agent
Evaluate pt regularly for sign of blood loss
Give tx within 6 hrs after the onset of symptoms of acute MI
Monitor cardiac rhythm
Precautions against bleeding during invasive procedures
Comfort & safety measures

Question 9

Thrombolytic prototype

Answer 9

Urokinase

Question 10

Urokinase action

Answer 10

converts endogenous plasminogen to plasmin in order to break down fibrin clots, fibrinogen, & other plasma proteins
lyses thrombi & emboli

Question 11

Urokinase adverse effects

Answer 11

headache
angioneurotic edema (edema of skin and mucus membranes)
hypotension
skin rash
bleeding
breathing difficulties
bronchospasm
pain
fever
anaphylactic shock

Question 12

Urokinase indications

Answer 12

lysis of PE (pulmonary embolism)

PE with unstable hemodynamics in adults