Pharmacology Final Exam Review 2, 2021-• Thrombolytic (Fibrinolytic) Drugs
o **Thrombolytic drugs are given to remove thrombi that have already formed**
o They are different from anti-coagulants which are given to prev
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Pharmacology Final Exam Review 2, 2021-• Thrombolytic (Fibrinolytic) Drugs
o **Thrombolytic drugs are given to remove thrombi that have already formed**
o They are different from anti-coagulants which are given to prevent thrombus formation.
o Three types of Thrombolytic Drugs:
▪ Alteplase
▪ Reteplase
▪ Tenecteplase
o These are employed acutely and only for severe thrombotic disease:
▪ Acute Myocardial Infarction
▪ Pulmonary Embolism
▪ Ischemic Stroke
o All thrombolytics pose a risk of serious bleeding, and should be administered only by clinicians skilled in their use
o Tenecteplase
▪ TNKase (Trade Name)
▪ “TNK”
▪ Promotes conversion of plasminogen to plasmin, an enzyme that degrades the fibrin matrix of thrombi
▪ Indications of this drug (ONLY used for this specific reason): Acute MI
▪ Adverse Effect: bleeding [primary adverse effect]
▪ Half-life of 20-24 minutes
▪ Intravenous: single bolus based on body weight
• Thrombolysis develops faster
• Emergency personnel are spared the trouble and headache of monitoring a longer infusion (saves precious time)
▪ Tenecteplase Dosage (given off of body weight:
• Below 60kg: dose 30mg
• 60 to 69.9kg: dose 35mg
• 70 to 79.9kg: dose 40mg
• 80 to 89.9kg: dose 45mg
• Above 90kg: dose 50mg
o Absolute Contraindications of Thrombolytic Drugs:
▪ Any prior intracranial hemorrhage
▪ Known structural cerebral vascular lesion
▪ Ischemic stroke within the last 3 months EXCEPT ischemic stroke within 4 ½ hours.
▪ Known intracranial neoplasm
▪ Active internal bleeding (other than menses)
▪ Suspected Aortic Dissection
o Relative Contraindications/Cautions [general cautions]:
▪ Severe, uncontrolled hypertension on presentation (BP above 180/110 mmHg)
▪ History of chronic, severe, poorly controlled HTN
▪ History of prior ischemic stroke, dementia, or known intracerebral pathology not covered in absolute contraindications
▪ Current use of anticoagulants in therapeutic doses (INR 2-3 or greater);
known bleeding diathesis [REMEMBER THESE DRUGS ARE USED TO BREAK UP THROMBUS/THROMBI THAT ARE ALREADY CREATED. SO THIN BLOOD OBVIOUSLY DOESN’T HAVE ANY THROMBI..]
▪ Traumatic or prolonged (more than 10min) CPR or major surgery (less than 3 weeks ago)
▪ Recent internal bleeding (within 2-4 weeks)
▪ Noncompressible vascular punctures
▪ Pregnancy
▪ Active peptic ulcer Calcium Channel Blockers
• Drugs that prevent calcium ions from entering cells
• Used widely to treat hypertension, angina pectoris(chest pain), and cardiac dysrhythmias.
• *plays a critical role in the function of vascular smooth muscle and the heart*
o [see page 515 Bottom Left paragraph]
• **In blood vessels, calcium entry causes vasoconstriction, and calcium channel blockade causes vasodilation**
• Calcium channel blockers:
o Lower heart rate
o Lower AV conduction
o Lower Myocardial contractility
• Verapamil
o Blocks calcium channels in blood vessels and in the heart
o MAJOR INDICATIONS:
▪ Angina Pectoris (chest pain)
▪ Essential Hypertension
▪ Cardiac Dysrhythmias
o Hemodynamic Effects:
▪ Dilation of blood vessels, which reduces arteriole pressure
▪ Increases coronary perfusion
▪ Reduces heart rate [blockade of SA node]
▪ *****Decreases AV nodal conduction [blockage at AV node]*****
• THE MOST IMPORTANT
• THE MOST IMPORTANT
▪ Decreased force of contraction [blockade of myocardium]
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