Pharmacology · chapter 20 · Anticoagulant, Antiplatelet, and Thrombolytic Drugs
Thrombolytics
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Thrombolytics break down existing clots
Conversely, thrombolytics work to quickly break down an existing clot, which is often needed when the clot is blocking blood flow to a major organ. They work by facilitating conversion of plasminogen to plasmin.
Do not abbreviate alteplase as tPA
The nurse should avoid using tPA as an abbreviation for alteplase.
What alteplase treats
Alteplase Alteplase is an intravenous thrombolytic drug that is approved to treat acute ischemic stroke, acute myocardial infarction, and pulmonary embolism. Alteplase works quickly upon administration, and the half-life is less than 5 minutes.
Uncontrolled hypertension is a contraindication
For example, severe uncontrolled hypertension increases the risk of intracranial hemorrhage in clients receiving alteplase. Thus, alteplase should be avoided in those clients.
Check contraindications before giving
Prior to administering alteplase, the nurse should confirm that the client does not have any contraindications to therapy.
Alteplase for blocked central lines
In small doses, alteplase can also be used as an agent to restore function of central venous access devices that are unable to draw blood due to thrombus formation.
Tenecteplase contraindications
Like alteplase, it has many contraindications that would put the client at an unacceptable risk of bleeding: active internal bleeding, history of cerebrovascular accident, intracranial or intraspinal surgery or trauma within 2 months, intracranial neoplasm, arteriovenous malformation, or aneurysm, known bleeding diathesis, and severe uncontrolled hypertension.
Practical advantages of tenecteplase
Some of the practical advantages of tenecteplase as compared to alteplase are that it is quicker to prepare, does not require a dedicated intravenous line or pump, and can be administered as an IV bolus.
Bleeding at puncture sites
Adverse Effects and Contraindications The main adverse effect of thrombolytic therapy is bleeding, which is sometimes severe and can be fatal. This is especially frequent at arterial and venous puncture sites, which leads to nursing implications regarding vascular access described in the next section.
Dysrhythmias after reperfusion
When used to treat coronary thrombus in a client with an acute myocardial infarction, there is an increased risk of dysrhythmias after blood flow is restored.
Avoid injections and deep punctures
Avoid intramuscular injections, internal jugular, and subclavian venous punctures during infusion.
Arterial puncture during infusion
If an arterial puncture is necessary during infusion, the nurse should use an upper extremity blood vessel that can be compressed and should apply pressure applied for 30 minutes afterward.
Keep the client on bedrest
Ensure clients remain on bedrest following thrombolytic administration to reduce falls and subsequent bleeding risk.
Alteplase needs its own IV line
Initiate an additional IV line for clients receiving alteplase because alteplase requires a dedicated IV line.
Terms to know
- Plasmin
- Plasmin then initiates fibrinolysis, or fibrin clot breakdown.
- Cathflo Activase
- For this use, it is known by the brand name Cathflo Activase.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client with acute ischemic stroke is a candidate for alteplase. The nurse finds a blood pressure that is severely elevated and uncontrolled. What should the nurse do?
- Report the finding to the provider before alteplase is given.
- Start the alteplase immediately because timing is crucial.
- Give the alteplase as an IM injection instead.
- Start alteplase through the same line as other infusions.
Answer: Report the finding to the provider before alteplase is given.
Severe uncontrolled hypertension raises the risk of intracranial hemorrhage with alteplase, and the nurse must confirm there are no contraindications before giving it. Alteplase is IV, IM injections are avoided, and it needs a dedicated line.
A client is receiving an alteplase infusion. Which nursing actions are appropriate? Select all that apply.
- Use a dedicated IV line for alteplase.
- Place a new subclavian central line during the infusion.
- Keep the client on bedrest.
- Avoid intramuscular injections.
- Monitor for signs of bleeding.
Answer: Use a dedicated IV line for alteplase., Keep the client on bedrest., Avoid intramuscular injections., Monitor for signs of bleeding.
Bedrest reduces falls and bleeding, IM injections are avoided, alteplase needs a dedicated IV line, and bleeding is the main adverse effect. Subclavian venous punctures are avoided during infusion.
During a thrombolytic infusion, an arterial blood gas must be drawn. Which approach is correct?
- Delay all labs until the next day.
- Use the femoral artery and hold pressure for 5 minutes.
- Use any artery; bleeding is not a concern with thrombolytics.
- Use a compressible upper extremity vessel and hold pressure for 30 minutes.
Answer: Use a compressible upper extremity vessel and hold pressure for 30 minutes.
If an arterial puncture is needed during infusion, the nurse uses a compressible upper extremity vessel and applies pressure for 30 minutes, then monitors the site. Bleeding is especially frequent at puncture sites, so a short hold or any artery is unsafe.
A nurse is documenting a thrombolytic order for a client with a stroke. Which practice best prevents a medication error?
- Write "TNK" because it is the same drug.
- Write the full name "alteplase".
- Write "TPN" as the accepted abbreviation.
- Write "tPA" to save time.
Answer: Write the full name "alteplase".
The abbreviation tPA can be confused with TNK (tenecteplase) or TPN (total parenteral nutrition), which has led to errors and delays, so the nurse should avoid it. TNK and TPN are different products.
Which findings in a client's history would the nurse recognise as contraindications to tenecteplase? Select all that apply.
- Active internal bleeding
- Well-controlled type 2 diabetes
- Intracranial surgery 3 weeks ago
- Known bleeding diathesis
- Severe uncontrolled hypertension
Answer: Active internal bleeding, Intracranial surgery 3 weeks ago, Known bleeding diathesis, Severe uncontrolled hypertension
Active internal bleeding, intracranial surgery within 2 months, bleeding diathesis and severe uncontrolled hypertension all create an unacceptable bleeding risk. Controlled diabetes is not a listed contraindication.
A client with an acute myocardial infarction has just received a thrombolytic, and blood flow to the coronary artery is restored. What should the nurse monitor closely?
- Blood glucose for hypoglycemia
- Cardiac rhythm for dysrhythmias
- Temperature for hypothermia
- Urine for ketones
Answer: Cardiac rhythm for dysrhythmias
After blood flow is restored in a client with an acute MI, there is an increased risk of dysrhythmias. The other findings are not described as risks of thrombolytic therapy.
Where every quote comes from
Section 20.4 Thrombolytics of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.