Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

52  Chapter 2 • Cardiovascular Care

TREATMENTS AND PROCEDURES

DRUG THERAPY Several drug classes are critical to the treatment of cardiovascular disorders. These drug classes include:

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)

Antianginals: • Beta-adrenergic blockers • Calcium channel blockers • Nitrates Antiarrhythmics:

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.

• 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

Thrombus

Blood supply

Ischemic area

Artery wall

Thrombolytic

Active plasmin

Plasminogen

Break in fibrin strand

Fibrin strand