week 11

Question 1

Fibrinolytics

Answer 1

Fibrinolytics (Thrombolytics)

MOA: digest fibrin and fibrogen to dissolution of thrombus/embolus occluding coronary artery(ies)

IND: Stroke, STEMI, DVT, PE

CON: Bleeding complication, cerebral hemorrhage stroke, Trauma, gi bleeding, HTN, cardiogenic shock, liver disfunction, pt over 75, pt taking coumadin, recent surgery

Adverse: Bleeding, fever, N/V, bruising, CVA

Special: Re-thrombosis can occur following thrombolysis, and therefore anticoagulants such as heparin are usually co-administered, and continued after thrombolytic therapy for a period of time. Prego C

Examples: Activase, Kinlytic, Retavase, Streptase, TPA,

Question 2

Plavix

Answer 2

Plavix Antiplatelets/Blood thiner

Brand: Clopidogrel

MOA: 2ba3 receptor antagonist

IND: MI, Stroke, Peripherial Arterial disease

CON: Hypersensitivity, Active bleeding, renal impairment, trauma, GI disorder

Adverse: Bleeding, Hemorrhage, anemia, Stevens-Johnson syndrome, pneumonia, fever, rash

Dose/Route 300 mg PO loading dose
75 mg PO qd
Pedi not indicated

Special: Pregnancy class c

Question 3

Heparin

Answer 3

Heparin Anticoagulant

Brand: Heparin

MOA:Rapid onset anticoagulant. Direct effect on blood clotting by enhancing inhibitory actions of antithrombin III. Blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. Does not lyse all ready existing thrombi, inhibits formation of new clots

Indications: ACS, acute PE, DVT
CON: Hypersensitivity, active bleeding, bleeding tendencies, asthma, eczema,

Adverse: Numbness and tingling, Headache, bleeding, cyanosis, HTN, CP, bronchospasm

Dose/Route: cardiac 60 unit per kg max of 4000 unit
infusion 12 units/kg per hour max 1000 unit per hour
PE, DVT 80 unit/kg
infusion 18 units/kg/hour
Pedi 75 unit /kg loading
infusion 20 unit/kg/hour
Special: Pregnancy C, continuous IV infusion requires pump, watch for signs of hemorrhage (fever, drop in BP, rapid pulse) half life about 90 min

Question 4

Integrilin

Answer 4

Integrilin Antithrombotic/antiplatelet

Brand: Eptifibatide

MOA: inhibits platelet aggregation by blocking the glycoprotein 2b3a receptors on activated platelets

IND: acute coronary syndromes (ACS), percutaneous coronary interventions

CON: Active internal bleeding, GI/GU bleeding, HX of stroke with deficit, thrombocytopenia, recent major surgury or Trauma, aneurysm, uncontrolled HTN

Adverse: Intercranial bleeding, GI/GU bleeding, bleeding, anemia, thrombocytopenia

Dose/ route 180 mcg/kg max 22.6mg
infusion 2 mcg/kg/min max 15 mg/hr IV

Special: Pregnancy class B, Half life 90-120 min