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52
Chapter 2
•
Cardiovascular Care
DRUG THERAPY
Several drug classes are critical to the
treatment of cardiovascular disorders.
These drug classes include:
Antianginals:
•
Beta-adrenergic blockers
•
Calcium channel blockers
•
Nitrates
Antiarrhythmics:
•
Sodium channel blockers
•
Beta-adrenergic blockers
•
Potassium channel blockers
•
Calcium channel blockers
Antiplatelet
•
Aspirin
•
P2Y12 Receptor Inhibition
•
Glycioriteub llb/llla Inhibitors
Anticoagulants:
•
Unfractionated heparin
(parenteral)
•
Low-molecular-weight heparins
(parenteral)
•
Direct thrombin inhibitors
(parenteral and oral)
•
Coumadin derivatives (oral)
•
Antifactor Xa inhibitors
(parenteral and oral)
Antihypertensives:
•
Angiotensin-converting enzymes
(ACE)
•
Angiotensin ll receptor blockers
(ARBs)
•
Beta-adrenergic blockers
•
Calcium channel blockers
•
Diuretics
•
Selective aldosterone receptor
antagonists
•
Sympatholytics
•
Vasodilators
Antilipemics:
•
Bile-sequestering drugs
•
Cholesterol absorption inhibitors
•
Fibric-acid derivatives
•
HMG-CoA reductase inhibitors
(Statins)
•
Nicotinic acid (niacin)
•
PCSK9 inhibitors
Inotropics
Thrombolytics
TREATMENTS AND PROCEDURES
How Thrombolytics Help Restore Circulation
When a thrombus forms in an artery, it obstructs the blood supply, causing
ischemia and necrosis. Thrombolytics can dissolve thrombi in the coronary
and pulmonary arteries, restoring the blood supply to the area beyond the
blockage.
OBSTRUCTED ARTERY
A thrombus blocks blood flow through the artery, causing distal ischemia.
INSIDE THE THROMBUS
The thrombolytic enters the thrombus and binds to the fibrin-plasminogen
complex, converting inactive plasminogen into active plasmin. Active
plasmin digests fibrin, dissolving the thrombus. As the thrombus dissolves,
blood flow resumes.
Blood
supply
Artery
wall
Thrombolytic
Plasminogen
Fibrin strand
Active
plasmin
Break
in fibrin
strand
Thrombus
Ischemic
area
Thrombolytics
Thrombolytics can dissolve a clot
or thrombus that has caused acute
MI, ischemic stroke or peripheral
artery occlusion, or PE. They can
also dissolve thrombi and reestablish
blood flow in arteriovenous cannulas,
grafts, and IV catheters. In an
acute or emergency situation, they
must be administered within 3 to
6 hours after the onset of symptoms.
Thrombolytics include:
•
Streptokinase (Streptase)
•
Alteplase (tPA)
•
Tenecteplase (TNKase)
•
Reteplase (Retavase)