Thrombolytic Therapy – Pharmacology for Nurses: Practical

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Chapter 26: Coagulation Modifier Drugs Test, Thrombolytic Therapy, Pharmacology for Nurses

The key terms in this Pharmacology course include Coagulation Modifier Drugs, Thrombolytic Therapy, Adverse Effects, Pharmacology for Nurses: Practical Applications


A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?

Anaphylactic reactions

Internal and superficial bleeding

Dysrhythmias

Nausea and vomiting

Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects.


A patient who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal bleeding. The history and physical examination indicates that the patient may have taken too much warfarin. The nurse anticipates that the patient will receive which antidote?

Protamine sulfate

Vitamin E

Vitamin K

Potassium chloride

Vitamin K is given to reverse the anticoagulation effects of warfarin toxicity. Protamine sulfate is the antidote for heparin overdose. The other options are incorrect.


A patient will be taking dabigatran (Pradaxa) as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true? (Select all that apply.)

Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.

Bleeding is the most common adverse effect.

This drug is a prodrug and becomes activated in the liver.

The dose of dabigatran is reduced in patients with decreased renal function.

Idarucizumab (Praxbind) is given as an antidote in cases of uncontrolled bleeding.


A patient is being discharged on anticoagulant therapy. The nurse will include in the patient-education conversation that it is important to avoid herbal products that contain which substance?

Soy

Valerian

Ginkgo

Saw palmetto

Capsicum pepper, feverfew, garlic, ginger, ginkgo, St. John’s wort, and ginseng are some herbal products that have potential interactions with anticoagulants, especially with warfarin.


A patient will be receiving a thrombolytic drug as part of the treatment for acute myocardial infarction. The nurse explains to the patient that this drug is used for which purpose?

To prevent further clot formation

To dissolve the clot in the coronary artery

To control bleeding in the coronary vessels

To relieve chest pain

Thrombolytic drugs lyse, or dissolve, thrombi. They are not used to prevent further clot formation or to control bleeding. As a result of dissolving of the thrombi, chest pain may be relieved, but that is not the primary purpose of thrombolytic therapy.


A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse’s response is based on which rationale?

The warfarin is used to reach an adequate level of anticoagulation when heparin alone is unable to do so.

The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.

Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

The oral and injection forms work synergistically.

This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.