Thrombolytics

Question 1

Thrombolytic Use and Mechanism of Action

Answer 1

• Break up existing clots
• Convert plasminogen to plasmin
• Plasmin dissolves fibrin, breaking up the clot
• Only for urgent clinical use such as stroke

Question 2

Thrombolytic Drug Names

Answer 2

• Alteplase (tPA)
• Tenecteplase (TNK-tPA)

Question 3

TNK

Answer 3

• Used for STEMI when the patient cannot access a cath lab within an hour of chest pain onset
• Now preferred over tPA for strokes as well

Question 4

Thrombolytic Indications

Answer 4

• Acute MI
• Acute ischemic stroke
• PE
• Arterial thrombosis
• DVT
• Occlusion of shunts or catheters

Question 5

Thrombolytic Adverse Effects

Answer 5

• Major bleeding
• Nausea and vomiting
• Hypotension
• Cardiac dysrhythmia

Question 6

Thrombolytic Contraindications

Answer 6

• Active bleeding
• Recent major surgery or trauma

Question 7

Thrombolytic Drug Interactions

Answer 7

• Anticoagulants increase bleeding risk
• Antiplatelets increase bleeding risk
• NSAIDS increase risk of GI bleeding
• Combined use with any of these requires close monitoring

Question 8

Thrombolytic Nursing Considerations

Answer 8

• Monitor vitals
• Neuro vitals are important due to risk of intracranial hemorrhage
• Minimize invasive procedures and patient manipulation
• Avoid IM/SC injections
• Use caution with anticoagulants and antiplatelets
• Apply pressure to puncture sites