Thrombolytic Drugs
TERM
□ streptokinase (Streptase, Kabikinase)
QUICK LOOK AT THE CHAPTER AHEAD
Thrombolytic drugs are administered in the hospital as close monitoring is indicated due to their toxic effects. Thrombolytic drugs dissolve clots, which may cause bleeding that is more severe and difficult to control than anticoagulants. They are used in treatment of acute thromboembolic disorders.1
It was discovered in 1933 that bacteria group A beta-hemolytic streptococci was capable of breaking down fibrin clots; this group became known as the drug streptokinase (Streptase, Kabikinase). In the 1980s, conclusive evidence demonstrated that myocardial infarctions (MIs) were coronary artery occlusions; as a result, using thrombolytics to treat early MI became popular.2
Table 47-1 Thrombolytic Drugs | ||||||||||
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THROMBOLYTIC CLIENT TEACHING
Close monitoring and bedrest with minimal activity/movement are indicated during therapy.
Report symptoms of bleeding or hypersensitivity reactions.
Avoid shaving and brushing teeth to minimize risk of bleeding during therapy.
Close monitoring and bedrest with minimal activity/movement are indicated during therapy.
Avoid shaving and brushing teeth to minimize risk of bleeding during therapy.
ACTION
The thrombolytic enzymes convert plasminogen to plasmin. The enzyme plasmin dissolves fibrin clots.
Streptokinase (Streptase, Kabikinase) and anistreplase (Eminase) indirectly activate plasminogen and are not clot specific, which means that clots can be broken down anywhere in the body.
Alteplase (Activase), reteplase (Retavase), and tenecteplase (TNKase) directly activate plasminogen.
Alteplase (Activase), reteplase (Retavase), and tenecteplase (TNKase) are clot specific, which does not cause a systemic lytic state.
USE
All thrombolytic enzymes: Treatment of acute arterial thrombus associated with acute MI
Streptokinase (Streptase, Kabikinase), alteplase (Activase), urokinase (Abbokinase): Pulmonary embolism
Streptokinase (Streptase, Kabikinase) and anistreplase (Eminase): Acute deep vein thrombosis
Alteplase (Activase): Acute ischemic stroke
Urokinase (Abbokinase): Pulmonary emboli, treat coronary thrombosis, and clear occluded intravenous catheters
ADVERSE EFFECTS AND SIDE EFFECTS
Pregnancy category C, except urokinase (Abbokinase), which is pregnancy category B
CV: Dysrhythmias, hypotension
Hematologic: Hemorrhage major adverse effect: internal, intracranial, and superficial bleeding
Hypersensitivity and anaphylaxis, especially with streptokinase (Streptase) and anistreplace (Eminase), and urokinase (Abbokenase)
CONTRAINDICATIONS
In clients prone to hemorrhage (eg, hemophilia, recent surgery or trauma, liver disease, recent GI bleeding, renal disease intracranial disorders) or severe uncontrolled hypertension
INTERACTIONS
Increased risk of hemorrhage when administered with anticoagulants and antiplatelets
Herbals ginkgo, ginseng and garlic may potentiate bleeding.
NURSING IMPLICATIONS
Administered IV.
Follow manufacturer’s directions for reconstitution and hospital protocols for administering.
For treatment of acute MI and cerebral vascular accident, begin treatment as soon as possible after the onset of symptoms (ie, within 3 hours of onset of CVA, and 4-6 hours of acute MI).
Assess and monitor clotting profiles and EKG.
Assess and monitor vital signs frequently throughout therapy.
Assess and monitor neurological status throughout therapy.
Maintain bedrest throughout treatment and immediately after treatment.
Continuously monitor for internal and external bleeding; if bleeding occurs notify health care provider.
Monitor IV sites for bleeding.
Avoid IM injections during treatment.
Assess for hypersensitivity and anaphylaxis especially with streptokinase (Streptase, Kabikinase), anistreplase (Eminase), and urokinase (Abbokinase).
For treatment of acute MI and cerebral vascular accident, begin treatment as soon as possible after the onset of symptoms (ie, within 3 hours of onset of CVA, and 4-6 hours of acute MI).
Assess and monitor clotting profiles and EKG.
Avoid IM injections during treatment.Antidote
Aminocaproic Acid (Amicar) and Tranexamic Acid (Cyklokapron)
Antifibrinolytic drugs prevent the lysis of fibrin thus promoting clot formation. Both drugs are available PO or IV.
PART VI • QUESTIONS
1. Which of the following are common side effects of digoxin (Lanoxin, Lanoxicaps)?
a. Constipation
b. Colored vision
c. Urinary retention
d. Weight gain
View Answer
1. The correct answer is b. Colored vision, especially yellow-green, or halo vision are common side effects of digoxin (Lanoxin, Lanoxicaps). Diarrhea is also a common side effect of digoxin. Weight loss vs weight gain may be seen with digoxin due to the promotion of diuresis related to improved blood circulation.
2. Which of the following is a desired effect of digoxin (Lanoxin, Lanoxicaps)?
a. Negative inotropic effect
b. Negative chronotropic effect
c. Positive dromotropic effect
d. Decrease in stroke volume
View Answer
2. The correct answer is b. Digoxin (Lanoxin, Lanoxicaps) has positive intotropic, negative chronotropic, and negative dromotropic effects, as well as increase in stroke volume.
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