Pharmacology Final Exam Review 2, 2021

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]