Thrombolytic Agents (aka Clot busters)

Question 1

Thrombolytic Agents (aka Clot busters) Drug Names

Answer 1

Alteplase
Reteplase
Tenecteplase
Urokinase

“-ase”

Question 2

Thrombolytic Agents (aka Clot busters) Therapeutic Actions

Answer 2

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

Question 3

Thrombolytic Agents (aka Clot busters) Indications

Answer 3

• Acute MI
• Pulmonary emboli
• Ischemic stroke

Question 4

Thrombolytic Agents (aka Clot busters) Contraindications and Cautions

Answer 4

Contraindication:
• Allergy
• Pregnancy
• Any condition that would be worsened by dissolution of clots

Caution:
• Lactation

Question 5

Thrombolytic Agents (aka Clot busters) DDI

Answer 5

DDI:
• Anticoagulants
• Antiplatelet

Question 6

Thrombolytic Agents (aka Clot busters) Adverse Effects

Answer 6

• Bleeding
• Cardiac arrhythmias
• Hypotension
• Hypersensitivity- Rash, flushing, bronchospasm, and anaphylactic reaction

Question 7

Thrombolytic Agents (aka Clot busters):
Assessment

Answer 7

Assess:
Hx: allergy, Pregnancy and lactation, active internal bleeding, recent surgery, CVA within the last 2 months, aneurysm, obstetrical delivery, organ biopsy, serious GI bleeding, major trauma, blood-clotting defects, cerebrovascular disease, uncontrolled hypertension, liver disease
Physical: vital signs, weight, heart & lung sounds, skin, perfusion(pulses), ECG (baseline)
Labs: Clotting studies, renal and hepatic, CBC, Guaiac test for blood in stool (PT & INR)

Question 8

Thrombolytic Agents (aka Clot busters):
Diagnosis

Answer 8

Dx:

• Risk for injury
• Ineffective tissue perfusion
• Decreased cardiac output
• Deficient knowledge

Question 9

Thrombolytic Agents (aka Clot busters):
Implementation

Answer 9

Implementation:
• Discontinue heparin if it is given before administration of a thrombolytic agent
• Evaluate for signs of blood loss
• Monitor coagulation studies regularly
• Institute treatment within 6 hours after the onset of acute MI
• Arrange to type and cross-match blood
• Monitor cardiac rhythm continually if the drug is given for acute MI
• Provide increase precautions against bleeding during invasive procedures
• Mark the chart of any patieitn receiving this drug
• Provide thorough patient teaching

Question 10

Thrombolytic Agents (aka Clot busters):
Evaluation

Answer 10

Eval:
Response to the drug
Adverse effects 
Effectiveness of comfort measures Compliance with the regimen
Effectiveness of the teaching plan