Chp 27 - Drugs Used To Treat Thrombolitic Disorders

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Thrombolitic disease

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the process of forming a blood clot or thrombus

Fragments of a thrombus can break off and circulate until trapped in a capillary, creating an embolus

Clotting cascade is activated when a blood vessel is injured, or with increased viscosity

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Intrinsic clotting pathway

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Is initiated by the blood coming in contact with exposed collagen in the blood vessel wall, i.e., material within the blood or blood vessel wall.

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Extrinsic clotting pathway

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Is initiated with material outside of or "extrinsic" to the blood.

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Conditions that cause clots to form (Risk factors)

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Immobilization with venous stasis
Surgery, trauma to lower limbs
Heart failure, vasospasm
Cancers of the lung, prostate, stomach, pancreas
Pregnancy, oral contraceptives
Diabetes
Truck Drivers
Bed Ridden

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Stasis prevention

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leg exercises
wearing stockings
leg elevation
sequential compression devices - device that includes a wrap on your legs and is connected to a pump that squeezes so blood circulates back to the heart.

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Revascularization treatments

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(treatments that reroute blood flow through vessels)

percutaneous coronary intervention - stent (metal tube creating opening of clogged vessel)

coronary artery bypass graft - take a vessel from elswhere in the body and graft it on the coronary artery

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Drug Therapy Goals for Thromboembolic Diseases

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Primary purpose is to prevent platelet aggregation or inhibit steps in the clotting cascade

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4 types of thrombolitic treatments

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Platelet inhibitors
Anticoagulants
Glycoprotein IIb/IIIa inhibitors
Thrombolytics

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Anticoagulation therapy treatment

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Prevents new clot formation

Treats existing clots

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Thrombus interventions

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Do not massage area that may have a clot. Clot can dislodge and go to brain or lungs

evaluate pulse color temperature of skin

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Coagulation tests (blood test)

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PT (prothrombin time) - pt value will determine adjustment of coumadin.

aPTT (activated partial thromboplastin time) - aPTT value will determine the adjustment of Heparin.

INR (international normalized ratio)
Platelet counts

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PT (protrombin time) lab value

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determine increase or decrease adjustment of coumadin medication

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aPTT (activated partial thromboplastin time) lab value

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Determines the increase or decrease adjustment of Heparin.

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Aspirin - uses

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antiplatelet therapy

reduces frequency of:

TIA - transient ischemic attack - temporary stroke due to temporary lack of blood to the brain.

Ischemia= lack of blood flow

Reduces frequency of MI - Myocardio Infarction

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Aspirin - Actions

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Inhibits platelet aggregation for the life of the platelet (stops clumping)

Prolongs bleeding time

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MI - Myocardio Infarction

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heart attack

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Plavix - uses

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reduce risk of ADDITIONAL:
myocardial infarctions (MI)
Strokes
Vascular death (vessel death)

may be used together with aspirin

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Plavix - actions

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Inhibits/disrupts the ADP pathway (aggregation process) required for platelet aggregation

Prolongs bleeding time - person will bleed longer

prolonged bleeding time is beneficial for patients with weak hearts so that the blood will not thicken due to weak contractions of the heart. Same applies to Aspirin

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lovenox (eoxaparin) - actions

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Low molecular weight heparin (LMWH)
Less potential for hemorrhage
longer duration of action
Prevents coagulation cascade
no antiplatelet activity
does not affect PT or aPTT

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Lovenox - uses

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prevent DVT (deep vein thrombosus) after hip, knee or abdominal surgery

Treat DVT along with coumadin

Treatment of STEMI (ST elevation MI)

Derived from pigs - should not be given to patients allergic to pork

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Heparin - action

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natural substance extracted from gut of pigs and cows

inhibits clotting factors

No fibrinolytic qualities (cannot bust a clot)

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Heparin - Uses

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treats
DVT
Pulmonoary embolisms
peripheral arterial embolisms
MI
hemodialysis (filtering of blood by machine outside the body)
PCI - percutaneous coronary interventions (stent placement)

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Heparin - administration points to remember

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never give po
do not aspirate this drug
can be given subq or IV

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Platelet inhibitors - common adverse effects

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Abdominal distress
hypotension

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Platelet inhibitors - serious adverse effects

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Serious adverse effects
Neutropenia
agranulocytosis
bleeding

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Anticoagulant - patient education

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Diet and nutrition
Limit intake of leafy green vegetables
Drink six to eight 8-ounce glasses of fluid daily
Exercise and activity after surgery to prevent venous stasis
Do not flex knees or place pressure under knees; avoid being motionless
Medication regimen
Dose and timing, common and serious adverse effects, drug interactions

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Anticoagulants - adverse effects

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Common adverse effects
Hematoma formation, bleeding at injection site

Serious adverse effects
Bleeding, thrombocytopenia

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Anticoagulants - assessment for bleeding

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Monitor to detect hemorrhage
Symptoms of internal bleeding
Decreased blood pressure, increased pulse, cold clammy skin, faintness, disorientation
Consider all areas of the body that could begin to bleed (visible and internal)
Monitor laboratory values
aPPT, platelets, hematocrit

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Drug Class: Glycoprotein IIb/IIIa Inhibitors - drugs

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Drugs: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat)

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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Actions

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Actions
Block receptors on platelets, preventing aggregation and clot formation

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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Uses

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Uses
Prevent clots forming from the debris often released during percutaneous coronary intervention (PCI) procedures

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Drug Class: Glycoprotein IIb/IIIa Inhibitors - Serious side effects

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Serious adverse effects
Bleeding
thrombocytopenia

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Fibrinolytic Agents - uses

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Uses
Dissolve fibrin clots secondary to coronary artery occlusion (MI), pulmonary emboli, cerebral emboli, deep venous thrombosis

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Fibrinolytic Agents - actions

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Actions
Stimulate the bodies own clot-dissolving mechanism, converting plasminogen to plasmin, which digests fibrin

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Fibrinolytic Agents - drugs

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Drugs: streptokinase, alteplase (Activase), reteplase (Retavase), tenecteplase (TNKase)