NUR 635 Topic 16 DQ 1

Sample Answer for NUR 635 Topic 16 DQ 1 Included After Question

Using one of the following diagnoses, discuss one of the thrombolytic drugs. Document the appropriate indication for use. Share the mechanism of action of this medication and hints for monitoring, including absolute contraindications and relative contraindications, as well as side effects and drug interactions, including interactions with CAM. What ethnic, cultural, and genetic differences need to be considered when prescribing these medications? Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.

  • If your last name starts with A through D: Acute myocardial infarction (AMI)
  • If your last name starts with E through H: Deep vein thrombosis (DVT)
  • If your last name starts with I through L: Pulmonary embolism (PE)
  • If your last name starts with M through P: Acute ischemic stroke (AIS)
  • If your last name starts with N through Q: Acute peripheral arterial occlusion.
  • If your last name starts with R through U: Intracardiac thrombus formation.
  • If your last name starts with W through Z: Severe frostbite

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 16 DQ 1

Title: NUR 635 Topic 16 DQ 1

Low molecular weight heparin, Lovenox is a very important drug in critical and acute care, and I have a great example of this drug’s range of use. While going through nursing school, I knew a young man who had a mechanical aortic valve and had been anticoagulated on warfarin from 18 years old. Patients with mechanical valves require life-long anticoagulation to prevent the formation of clots on the prosthetic device. During the last semester of school, this young man unfortunately broke his tibia and had to undergo a surgical repair. However, since he was fully anticoagulated surgical repair could not happen right away. Rapid reversal of INR is not recommended unless there is uncontrolled active bleeding or if delaying surgery would be fatal. He was admitted to the surgical unit for pain control and then received a Lovenox subcutaneous injection and his normal dose of warfarin was held.  

Unfractionated heparin (intravenous and subcutaneous) remains the standard anticoagulant for patients undergoing cardiac surgery. However, systemic anticoagulation with intravenous heparin can hinder care quality, lengthen the hospital stay, or lead to adverse bleeding events for patients undergoing non-cardiac surgeries (Ilituta et al., 2022). In a data review of 380 patients with mechanical prosthetic heart valves, administration of enoxaparin (Lovenox) subcutaneous injection after non-cardiac surgeries yielded 0% incidence of prosthesis thrombosis compared to 0.53% in the unfractionated heparin group. Furthermore, patients receiving Lovenox compared to heparin were mobilized sooner and more often, had reduced major bleeding complications, lower death rate at 30 days, absent gluteal ulceration, shorter length of stay, and fewer days immobilized (Ilituta et al., 2022). Some reasons that Lovenox is contraindicated are acute or chronic renal disease, cardiac dysrhythmias such as atrial fibrillation, sepsis, thrombocytopenia, and hypersensitivity.

My college friend had to stay hospitalized and immobilized for 24 hours while his INR was safely lower from the 2.5-3.5 therapeutic range to 1-2. He received a dose of Lovenox several hours after the fracture was stabilized around 2000, a dose at 0800 the following day, and had surgery that evening at 2200. The morning after surgery, the Lovenox continued, and he was able to be discharged that afternoon with instructions to restart warfarin the following day (48hrs post-op). He was discharged with Lovenox subcutaneous 40mg BID for 5 days. I remember well because we took turns giving him the injection for practice! In addition, he went for INR testing every morning until back in the therapeutic range. Although warfarin is the most widely used anticoagulant globally, there are significant considerations that are patient-specific. This process of giving Lovenox while bridging to Coumadin is often done in acute care settings for hospitalized patients.

As discussed, prior, renal function is a criteria for Lovenox administration but renal dosing can be prescribed for patients with CrCl <30 mL/min (Rosenthal & Burchum, 2021). An IV bolus of enoxaparin is sometimes administered but is not recommended for older patients. Drug interactions include NSAIDs, platelet inhibitors, aspirin, and other drugs that affect homeostasis. Monitoring of CBC is recommended to assess for thrombocytopenia and anemia. Renal function and electrolytes are also recommended.

References

Iliuta, L., Andronesi, A., Camburu, G., & Rac-Albu, M. (2022). Enoxaparin versus unfractionated

heparin for the perioperative anticoagulant therapy in patients with mechanical prosthetic heart valve undergoing non-cardiac surgery. Medicina (1010660X)58(8), 1119. https://doi-org.lopes.idm.oclc.org/10.3390/medicina58081119

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice

nurses and physician assistants – e-book (2nd ed.). Elsevier Health Sciences.

A Sample Answer 2 For the Assignment: NUR 635 Topic 16 DQ 1

Title: NUR 635 Topic 16 DQ 1

Alteplase: Indications and Mechanism of Action

Alteplase (Activase) is a tissue plasminogen activator (tPA) and is widely used in the management of AMI. The primary indication for Alteplase is to rapidly restore blood flow to the ischemic myocardium by promoting the conversion of plasminogen to plasmin, an enzyme responsible for breaking down fibrin clots (Acheampong & Ford, 2012). The mechanism of action of Alteplase hinges on its ability to catalyze the conversion of plasminogen, an inactive precursor, into plasmin, an active enzyme. Plasmin plays a crucial role in the fibrinolysis process, where it effectively breaks down fibrin clots or thrombi. Fibrin clots are the primary culprits in obstructing blood vessels and causing ischemic events such as heart attacks. By promoting fibrinolysis, Alteplase facilitates the dissolution of these obstructive clots, ultimately restoring blood flow to the affected areas of the myocardium.

Monitoring Guidelines

Monitoring patients undergoing thrombolytic therapy with Alteplase is crucial to ensure both efficacy and safety. Key parameters to monitor include vital signs, electrocardiogram (ECG) changes, and laboratory values such as activated partial thromboplastin time (aPTT) and fibrinogen levels (Rashid et al., 2019). Continuous cardiac monitoring is essential to promptly detect and manage arrhythmias, a potential complication of thrombolytic therapy. Serial ECGs are valuable for assessing the resolution of ST-segment elevation, providing insights into the restoration of blood flow to the affected myocardial tissue.

Regular assessments of aPTT and fibrinogen levels are fundamental for guiding dosage adjustments necessary to maintain therapeutic efficacy without increasing the risk of bleeding. Monitoring these coagulation parameters allows healthcare providers to strike a delicate balance between achieving successful thrombolysis and mitigating potential hemorrhagic complications. This comprehensive approach to patient monitoring ensures timely intervention in the event of adverse effects, optimizing the overall management of individuals undergoing Alteplase thrombolytic therapy for conditions such as acute myocardial infarction.

Contraindications

Absolute contraindications for Alteplase include a history of intracranial hemorrhage, active bleeding, known structural cerebral vascular lesion, or suspected aortic dissection (Toyoda et al., 2019). Relative contraindications encompass conditions such as recent major surgery, severe uncontrolled hypertension, and non-compressible vascular punctures. Close attention should be paid to patient history to identify any contraindications that may increase the risk of adverse events.

Side Effects

While Alteplase is effective in treating AMI, it is not without side effects. Common side effects include bleeding complications, with an increased risk of intracranial hemorrhage (Amirazodi et al., 2021). Minor bleeding manifestations, such as ecchymosis and hematuria, may also occur. Careful monitoring for signs of bleeding, including neurological symptoms, is paramount during Alteplase therapy.

Interactions with Complementary and Alternative Medicine (CAM)

The interaction between Alteplase and CAM requires special consideration. Certain herbal supplements, such as ginkgo biloba and garlic, have antiplatelet properties that may potentiate the bleeding risk associated with Alteplase. Ginkgo biloba is known for its blood-thinning effects, while garlic contains compounds that can interfere with platelet function (Abebe, 2019). The combination of Alteplase and these CAM interventions may heighten the likelihood of excessive bleeding, posing a serious health risk to individuals undergoing thrombolytic therapy.

Ethnic, Cultural, and Genetic Considerations

Prescribing Alteplase requires an awareness of ethnic, cultural, and genetic differences that may impact its efficacy and safety. Studies have suggested variations in response to Alteplase among different ethnic groups, emphasizing the importance of individualized treatment approaches. Cultural beliefs and practices may influence patients’ adherence to therapy, necessitating clear communication and education. For instance, in some cultures, there may be traditional remedies or practices that patients believe are more effective or aligned with their cultural values. Genetic factors, such as polymorphisms in genes related to fibrinolysis, also contribute to variability in Alteplase response, highlighting the need for personalized medicine strategies.

References

Abebe, W. (2019). Review of herbal medications with the potential to cause bleeding: dental implications, and risk prediction and prevention avenues. EPMA Journal10, 51-64.

Acheampong, P., & Ford, G. A. (2012). Pharmacokinetics of alteplase in the treatment of ischaemic stroke. Expert opinion on drug metabolism & toxicology8(2), 271-281.

Amirazodi, E., Shamsaei, G., Rafie, S., Kashipazha, D., & Hesam, S. (2021). Comparison of efficacy and complication of alteplase injection in acute ischemic stroke. Archives of Medical Laboratory Sciences7, 1-6.

Rashid, S., Malik, A., Khurshid, R., Faryal, U., & Qazi, S. (2019). The diagnostic value of biochemical cardiac markers in acute myocardial infarction. Myocardial infarction23.

Toyoda, K., Koga, M., Iguchi, Y., Itabashi, R., Inoue, M., Okada, Y., … & Minematsu, K. (2019). Guidelines for intravenous thrombolysis (recombinant tissue-type plasminogen activator), the third edition, March 2019: a guideline from the Japan Stroke Society. Neurologia medico-chirurgica59(12), 449-491.