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ALTEPLASE RECOMBINANT
- (tPA, Activase) Thrombolytic
- Des: derived form of human tPA promotes thrombolysis by forming plasmin. Plasmin, in turn, degrades fibrin and fibrinogen and , ultimately, the clot.
- Ind: 1)to thrombolyse in acute myocardial infarction 2)acute ischemic stroke 3)pulmonary embolism
- CI: 1)active internal bleeding 2)suspected aortic dissection 3)traumatic CPR 4)recent hemmorhagic stroke (6mo) 5)intracranial or intraspinal surgery or trauma (2mo) 6)pregnancy 7)uncontrolled hypertension 8)hypersensitivity to thrombolytics
- PC: 1)recent major surgery 2)cerebral vascular disease 3)recent GI or GU bleeding 4)recent trauma 5)hypertension 6)pt > 75 y/o 7)current oral anticoagulants 8)hemorrhagic ophthalmic conditions
- Dose: n/a
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HEPARIN
- (Heparin) Anticoagulant
- Des: rapid-onset anticoagulant, enhancing the effects of antithrombin III and blocking conversion of prothrombin to thrombin and fibrinogen to fiber
- Ind: prevent thrombus formation in acute MI
- CI: 1)hypersensitivity 2)active bleeding or bleeding tendencies 3)recent eye, brain or spinal surgery 4)shock
- PC: 1)alcoholism 2)elderly 3)allergies 4)indwelling catheters 5)elderly 6)menstruation 7)pregnancy 7)cerebral embolism
- Dose: 5,000units IV, then 20,000-40,000units over 24hr
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NOREPINEPHRINE
- (Levophed) sympathomimetic agent
- Des: naturally occurring catecholamine and causes vasoconstriction, cardiac stimulation and increased BP, myocardial O2 demand and coronary blood flow
- Ind: 1)refractory hypotension 2)neurogenic shock
- CI: hypotension due to uncorrected hypovolemia
- PC: infuse drug through largest vein available as it may cause tissue necrosis
- Dose: 0.5-30mcg.min IV, titrated to BP Ped: 0.01mcg/kg/min (rarely used)
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