University:
University of North Carolina at Chapel Hill
Course:
NURS 312 | Pharmacology
Academic year:

2020
Views:

431

Pages:

1
Author:

Accinkiquicpqw

1.4 – “Warn “Warning: ing: Bleeding Hazard”. TThrombolyt hrombolyt hrombolytics ics • In a normal setting, thrombin (Factor II) activates fibrinogen to fibrin, enabling fibrin mesh formation (stick wall looks like the thrombin beaver dam in the heparin sketch). In the case of thromboembolus, the goal is to break down the crosslinked fibrin and thrombin clots (activated general toy is breaking down the fibrin wall by shooting at it). Use of any of these will result in ↑PT, ↑PTT, and ↑D-dimer levels (other kid is blowing long PTTTTTT raspberries, playing with PT paratroopers; twigs from busted fibrin wall look like two-Ds). o tPA is released endogenously from damaged endothelium to break down fibrin (Toy Play set = tPA). tPA (alteplase) can be administered exogenously, or alternatives reteplase (rPA), tenecteplase (TNK-tPA) (playset sounds similar to -teplase.) o Streptokinase is derived from streptococci (purple beads in the playset look like Gram⊕ cocci chains). Can cause allergic reaction, including anaphylaxis in up to 0.5% of patients (kid is choking and flushed). • Indications for thrombolytic treatment: o MI, only if PCI is unavailable within 90 minutes (heart-shaped banjo with broken strings; banjo player is sitting in the sandbox but engaging with baseball player with a stent-styled bat). o Ischemic stroke, if administered within 4.5 hours (painter with black stripe on hat painting a T1-weighted MRI of a distant ischemic stroke. Note that typically there would be no findings on T1 MRI within the timeframe of 4.5 hours post-ictus!) o VTE (PE bird nest in the pulmonary tree) • Toxicities & contraindications: o Increased risk of bleeding (girl is wearing a red hat) o Contraindicated in patients with a recent h/o head trauma (shooting laser beams at MRI painting), intracranial or intraspinal surgery (bloodied scalpel), stroke (within 3 mos. except when within 4.5 hours); any h/o intracranial hemorrhage (girl has splattered red paint on her MRI painting); severe uncontrolled HTN (high pressure tube of paint squirting everywhere); evidence or high suspicion of hemorrhagic stroke (blood on T2 MRI) or intracranial conditions that may increase risk of bleeding. All d/t risk of new intercranial bleed/hemorrhagic stroke. o Non-specific reversal of thrombolytic therapy with aminocaproic acid or tranexamic acid (a mean teacher capping paint [for aminocaproic] with exams [tranexamic acid] in one hand has taken the plasmin activating general toy). FFP or cryoprecipitate may be used to reverse coagulation factor deficiencies (fresh fighter plane & cryopack on upset kid).