Drug Class - Thrombolytics

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Name 6 thrombolytics?: alteplase
anistreplase
reteplase
streptokinase
tenecteplase
urokinase
Thrombolytics are used for the acute management of coronary _______ _______.: pulmonary emboli
Streptokinase andn urokinase are used in the management of? (3): massive pumonary emboli
deep vein thrombosis
arterial thrombo-embolism
Which agent is used in the management of acute ischemic stroke?: altepase
Thrombolytics convert plasminogen to _____, which then degrades fibrin in _____.: plasmin
clots
Alteplase, reteplase, and urokinase directly activates _____ to form activator complexes, which then convert plasminogen to plasmin. This results in lysis of _____ in coronary arteries, pulmonary emboli, or deep vein thrombosis, or clearing of clots in c: plasminogen
thrombi
Contraindications? Hypersensitivity. Cross-sensitivity with _____ and ____ may occur.: anistreplase
streptokinase
Contraindications? Contraindicated in active internal 1______ bleeding, history of 2_____ accident, recent 3____ trauma or surgery, neoplasm, or arteriovenous malformation.: 1 bleeding
2 cerebrovascular
3 CNS
Contraindications? Severe uncontrolled _____ and known bleeding tendencies.: hypertension
Interactions? Concurrent use with (name 7) may increase the risk of bleeding, although these agents are frequently used together or in sequence.: aspirin
NSAIDs
warfarin
heparins
abciximab
ticlopidine
dipyridamole
Interactions? Risk of bleeding may also be increase by concurrent use with (name 4)?: cefotetan
cefoperazone
plicamycin
valproic acid
Assessment for thrombolytics is VERY lengthy. Begin therapy ASAP after onset of symptoms. Name 7 INDICATIONS that require assessment.: 7 INDICATIONS:

coronary thrombosis
pulmonary embolism
DVTs/acute arterial occlusion
cannula/catheter occlusion
acute ischemic stroke
lab tests
toxicity and overdose
ASSESSMENT: First, monitor VS, including temperature, continuously for _____ thrombosis and at least every 4 hr during therapy for other INDICATIONS. DO NOT use ___ ____ to monitor blood pressure.: CORONARY
lower extremities
ASSESS patient carefully for ______ every 15 minutes during first hour of therapy, every 15-30 min during the next 8 hrs, and at least every 4 hrs for the duration of therapy.: BLEEDING
1st Hour - (time) 2nd-9th Hour - (time) Remaining therapy - (time): every 15 min
15 to 30 min
every 4 hours
ASSESSMENT: Frank (clinically evident, unmistakable) bleeding may occur from sites of _____ procedures or from body orifices.: invasive
ASSESSMENT: ______ bleeding may also occur (decreased neurologic status, abdominal pain with coffee-ground emesis or black, tarry stools, hematuria, joint pain).: Internal
ASSESSMENT: If uncontrolled bleeding occurs, what should nurse do?: stop medication and notify physician IMMEDIATELY!
ASSESSMENT: Inquire about previous anistreplase or streptokinase therapy. ASSESS patient for hypersensitivity reaction...symptoms are? (6) IF THESE OCCUR, INFORM PHYSICIAN IMMEDIATELY! KEEP EPINEPHRINE, AN ANTIHISTAMINE and RESUSCITA: rash
wheezing
swelling around eyes
changes in facial color
dyspnea
FEVER
What 3 items should the nurse have on hand when a patient is on thrombolytics and why?: KEEP EPINEPHRINE, AN ANTIHISTAMINE and RESUSCITATION EQUIPMENT CLOSE BY IN THE EVENT OF AN ANAPHYLACTIC REACTION!
What are the symptoms of an anaphylactic attack?: OVARIAN CANCER LECTURE SYMPTOMS:
hypotension
urticaria
rash
tachycardia

pruritis (severe itching)
ANAPHYLACTIC
wheezing
swelling facial

TABER'S SYMPTOMS:
dyspnea
violent cough
chest constriction
cyanosis
fever
skin eruptions
pulse variations
convulsions
collapse

TABOR'S TREATMENT: vasopressor agents, esp epinephrine, corticosteroids, oxygen, artificial respiration
ASSESSMENT: Inquire about recent ______ infection. Anistreplase and streptokinase may be less effective if administered between 5 days and 6 mos of a ______ infection.: streptococcal
streptococcal
Assess neurologic status throughout therapy.: okay
Altered sensorium or neurologic changes may be indicative of _____ _____.: intracranial bleeding
What is the ASSESSMENT for CORONARY THROMBOSIS? Monitor 1_____ continuously. Notify physician if significant 2_____ occur. IV lidocaine or procainamide (Pronestyl) may be ordered prophylactically. Cardiac enzymes should be monitored.: 1 ECG
2 arrhythmias

radionuclide scanning and/or myocardial
scanning
coronary angiography
When ASSESSING CORONARY THROMBOSIS, monitor heart sounds and breath sounds frequently. Inform physician if signs of ____ occur. What are the signs?: CHF

rales/crackles
dyspnea
S3 heart sound
jugular venous distention
relieved CVP
What should be monitored when ASSESSING for PULMONARY EMBOLISM?: pulse
blood pressure
hemodynamics
respiratory status (rate,
degree of dyspnea, arterial
blood gases)
What should be monitored when ASSESSING for DVT/acute arterial occlusion?: observe extremities and
palpate pulses of affected
extremities every hour
notify physician immediately
if circulatory impairment
occurs
What diagnostics may be performed when ASSESSING for DVT/acute arterial occlusion?: computed tomography
impedance plethysmography
quanitative doppler effect
determination
angiography
venography
(repeated venograms are not
recommended)
What are the symptoms of acute arterial occlusion?: (online source)
sudden onset of severe pain, coldness, numbness, and pallor in an extremity. The extremity is cold and pale, and pulses are absent distal to the obstruction. Acute occlusion may cause severe ischemia manifested by sensory and motor loss and eventually (after 6 to 8 h) tender induration of muscles on palpation.
What is monitored when ASSESSING for cannula/catheter occlusion?: monitor ability to aspirate blood as indicator of patency...
ensure that patient exhales and holds breath when connecting and disconnecting IV syringe to prevent air embolism
When ASSESSING for ACUTE ISCHEMIC STROKE, assess neurologic status. Determine time of onset of stroke symptoms. Which drug must be administered within 3 hours of onset?: alteplase
What lab tests should be considered when assessing for thrombolytic use?: hematocrit...
hemoglobin...
platelet count...
fibrin/fibrin degradation
product (FDP/fdp) titer...
fibrinogen concentration...
prothrombin time...
thrombin time...
activated partial thrombo-
plastin time...
bleeding time may be
evaluated prior to therapy
if patient has received
platelet aggregation
inhibitors...
obtain type and cross match
and have blood available at
all times in case of
hemorrhage...
stools should be tested for
occult blood loss and urine
for hematuria periodically
during therapy...
What procedures should take place in the event of toxicity and overdose? Discuss local bleeding, severe or internal bleeding, etc.): If local bleeding occurs, apply pressure to site...
if severe or internal bleeding occurs, discontinue
infusion...clotting factors and/or blood volume may be restored through infusions of whole blood, packed RBCs, fresh frozen plasma, or cryoprecipitate...do not administer dextran, as it has antiplatelet activity...aminocaproic acid (Amicar) may be used as an antidote.
Apply pressure to site if ____ ____ occurs.: local bleeding
Discontinue infusion if severe or internal ____ occurs.: bleeding
Clotting factors and/or blood volume may be restored through infusions of (4)?: whole blood
packed RBCs
fresh frozen plasma
cryoprecipitate
Do not administer _____, as it has antiplatelet activity: dextran
aminocaproic acid (Amicar) may be used as an ______.: antidote
List three potential nursing diagnoses?: Tissue perfusion, ineffective
Injury, risk for
Knowledge, deficient, related
to disease processes and
medication regimen
IMPLEMENTATION: This medication should be used only in settings in which _____ function and _____ response can be adequately monitored.: hematologic
clinical
Starting TWO IV lines prior to therapy is recommended: one for the ______ agent, the other for any ______ infusions.: thrombolytic
additional
Avoid invasive procedures, such as 1___ injections or 2_____ punctures, with this therapy. If such procedures must be performed, apply pressure to all arterial and venous puncture sites for at least 3____ minutes. Avoid venipunctures at noncompressible s: 1 IM
2 arterial
3 30 min

jugular vein
subclavian site
Systemic anticoagulation with ____ is usually begun several hours after the completion of thrombolytic therapy.: heparin
______ may be ordered to control fever.: acetaminophen
Explain purpose of medication and the need for close monitoring to patient and family. Instruct patient to report 3 conditions.: hypersensitivity (rash,
dyspnea)
bleeding
bruising
Explain need for bedrest and minimal handling during therapy to avoid injury. Avoid all unnecessary procedures such as _____ and vigorous _____ _____.: shaving
tooth brushing
EVALUATION: Effectiveness of therapy can be demonstrated by? Name 3: 1. Lysis of thrombi and restoration of blood flow.
2. Prevention of neurologic sequelae in acute ischemic stroke.
3. Cannula or catheter patency.

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