Pharmacology, part 20: Cardiovascular Medications - Hemostatic, Thrombolytic, Erythropoietic & Leukopoietic

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In this article, we cover hemostatic agents and thrombolytic medications that work to either help form (hemostatic) or dissolve (thrombolytic) blood clots in the body. We also cover the medication epoetin alfa, which is used to treat anemia, and filgrastim, which is used to treat neutropenia. The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

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Hemostatic agent - aminocaproic acid

Aminocaproic acid (Amicar) is in a class of medications called hemostatics. This medication is used to treat hemorrhaging (excessive bleeding) and acts as an inhibitor of fibrinolysis, thereby treating bleeding caused by blood clots being broken down too quickly.

Hemostatics are medications to stop bleeding, which you can always remember if you break the word down into its parts. Hemo- means bleeding, and -static comes from -stasis which means to slow or stop. We created our Medical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!

Mode of action

Aminocaproic acid works by inhibiting the activation of plasminogen (the inactive precursor of the enzyme plasmin, present in blood), which must be activated to dissolve fibrin and therefore allows for the formation of clots.

Cool ChickenAmigo, someone popped a cap in you, and you're bleeding. Let me get you some aminocaproic acid.

Side effects

Side effects with aminocaproic acid include possible GI upset and hypotension. Patients are also at risk of a thromboembolism, which is the formation of a clot (thrombus) that breaks loose and is carried by the blood stream causing a blockage.

Nursing care

When caring for a patient on aminocaproic acid, you’ll want to regularly assess them for bleeding. Hypercoagulation, which is a condition that causes your blood to clot more easily than normal, is also a risk of this medication and something to look out for by assessing for changes like calf pain, positive Homan's sign, red streaking up the legs, or sudden onset chest pain and dyspnea.

Thrombolytic medications - alteplase, reteplase, streptokinase

Alteplase (Activase, t-PA), streptokinase (Streptase) and reteplase (Retavase), known as “clot-busting” drugs, are used to dissolve a clot (thrombus) and reopen an artery or vein. They are commonly used in patients that have had a heart attack, stroke, deep vein thrombosis, pulmonary embolism and occlusion (blockage or closing) of a peripheral artery or indwelling catheter.

Cool Chicken Alteplase goes to the place where there is a blood clot and breaks it up.

Side effect

The key side effect for these types of medications is bleeding.

Contraindications

These medications are contraindicated in patients who have had a hemorrhagic stroke, internal bleeding, a recent trauma/surgery, and severe hypertension.

Administration

If the patient receives alteplase for an ischemic stroke, administer it within three hours of the onset of symptoms.

Nursing care

When caring for a patient on alteplase, you’ll want to closely monitor the patient's labs and vital signs and limit any kind of blood draws or intramuscular injections due to the risk of bleeding. Administration of this medication requires informed consent, so ensure that the physician has obtained informed consent prior to the nurse administering it.

Erythropoiesis growth factor - epoetin alfa

Epoetin alfa (Epogen) is a medication used to treat anemia (low red blood cell count) in patients who have chronic kidney disease, HIV, and in patients receiving chemotherapy for cancer that does not involve the bone marrow or blood cells.

Mode of action

Epoetin alfa (Epogen) works by stimulating bone marrow to increase the production of red blood cells and is very similar to the natural substance in your body (erythropoietin) that prevents anemia.

Cool Chicken Taking epoetin alfa will fix your anemia so you can grow up to be a strong alpha male.

Side effects

Epoetin alfa has a key side effect of hypertension. Patients are also at an increased risk of developing a deep vein thrombosis, a stroke, myocardial infarction (heart attack) and seizures.

Black box warning

Epoetin alfa also carries a black box warning due to the increased risk of stroke and heart attack.

Administration

When administering epoetin alfa to patients you should not agitate or shake the vial, because this denatures (unfolds) the proteins in the medication and causes it to become biologically inactive.

What to monitor

When caring for a patient on this medication, you’ll want to monitor their blood pressure due to the side effect of hypertension. The patient's hemoglobin and hematocrit levels will also need to be monitored during therapy and you’ll also need to ensure that the patient is getting enough iron to support the production of red blood cells. You may need to provide an iron supplement.

Leukopoietic growth factors (filgrastim)

Filgrastim (Neupogen) is a key medication used to treat neutropenia, which results from an abnormally low number of neutrophils (a type of white blood cell) in the blood. Low neutrophil counts place patients at a high risk for infection and usually occur following chemotherapy or radiation poisoning and in patients with HIV/AIDS.

Mode of action

Filgrastim works by causing bone marrow to increase the production of neutrophils, which helps to prevent infection in neutropenic patients.

Cool Chicken You fill up on neutrophils with filgrastim.

Side effects

Side effects of filgrastim include bone pain, leukocytosis (high white blood cell count), and splenomegaly. Splenomegaly is a fun word that you can easily break down to understand its meaning. Spleno- means spleen and -megaly means enlargement! This prefix and suffix are also covered in our Medical Terminology Flashcards.

Administration

When administering filgrastim to a patient, do not agitate or shake the vial, as this can denature the proteins and render the drug ineffective. The patient's complete blood count (CBC) levels will also need to be monitored during therapy.

Full Transcript: Pharmacology, part 20: Cardiovascular Medications - Hemostatic, Thrombolytic, Erythropoietic & Leukopoietic

In this video, we are going to go through the rest of our hematologic medications, including covering a hemostatic agent as well as a thrombolytic medication. And then we'll talk about erythropoiesis growth factors and leukopoietic growth factors as well.

Okay. So first, we'll talk about the hemostatic agent which is aminocaproic acid. If you are following along with cards, I'm on card 33.

This medication is used for hemorrhaging.

So it works by inhibiting the activation of plasminogen which, in turn, inhibits fibrinolysis, which allows for clot formation.

So the way I remember what this medication is for, if you look at the word aminocaproic acid, I think, "Amigo, someone popped a cap in you, and you're bleeding. Let me get you some aminocaproic acid to stop the bleeding." Right? Because they're hemorrhaging from their gunshot wound. And so there you go. That's my tip. It's on card number 33.

So side effects of this medication include GI upset as well as hypotension.

And then when your patient is taking this medication, you want to regularly assess the patient for bleeding to make sure we're controlling the bleeding that we're trying to treat. But you also need to assess them for or a thromboembolism because hypercoagulation is a risk with this medication.

Now let's talk about thrombolytic medications, which include medications such as alteplase, reteplase, and streptokinase. You can tell that they all end in that -ase.

So my tip for remembering these medications is that reteplase will go to the place where the blood clot is and break it up.

So these medications are going to be used for things like a stroke, an MI, a PE.

They can also be used for occluded central lines. So if you have a PICC line that you can't get a blood draw off of because it's clotted, then you can allow one of these thrombolytic medications to instill in there for a while, like 20 to 30 minutes, and then that usually helps to restore patency of that line.

So these medications break up clots by converting plasminogen to plasmin, which in turn breaks up fibrinogen.

The key side effect here is bleeding, okay? So this medication would be contraindicated in patients who have had a hemorrhagic stroke, only for an ischemic stroke. We would also not use it for patients who have internal bleeding, who have had a recent trauma or surgery, or who have severe hypertension.

If we're using this medication for an ischemic stroke, we want to administer it within three hours of the onset of symptoms of that ischemic stroke. Also we want to closely monitor the patient's labs and their vital signs, and then we want to limit any kind of blood draws or IM injections because of that risk of bleeding.

Now let's talk about an important erythropoiesis growth factor. The medication is epoetin alfa.

Epoetin alfa is used to treat anemia in patients who have chronic kidney disease, have HIV, or may be undergoing chemotherapy, any type of condition that results in anemia.

It works by stimulating the bone marrow to increase production of red blood cells.

So the way I remember this medication is that taking epoetin alfa will help fix your anemia so you can grow up to be a strong alpha male, right? So if you have anemia, you're going to feel kind of tired and weak, and you can't be that alpha male. So epoetin alfa will let you get that anemia fixed so you can be an alpha male.

So side effects. Hypertension is a really important one to know. In addition, this medication increases a patient's risk of a DVT, a stroke, or an MI and also carries a risk for seizures.

It does have a black-box warning because of that increased risk for stroke and MI.

In terms of administration, you're not going to shake the vial, so no agitating the vial.

You're going to monitor the patient's blood pressure during therapy because of that side effect of hypertension, and you're also going to monitor their hemoglobin and hematocrit levels during therapy as well.

So you also want to ensure that the patient is getting sufficient iron as well, because iron is an important component of red blood cells. So since we're trying to build up their red blood cell count, we need to make sure they're getting enough iron to be able to do so.

Okay. Finally, we're going to talk about leukopoietic growth factors.

Filgrastim is a key medication that is used for neutropenia.

So if our neutrophil count is too low, that places the patient at high risk for infection. So patients who are getting chemotherapy often have neutropenia. And so, by taking filgrastim, this causes the bone marrow to increase production of neutrophils, which helps to prevent infection in neutropenic patients.

So the way I remember this medication is that you fill up on neutrophils with filgrastim.

So side effects of filgrastim include bone pain, leukocytosis, which is a high WBC count, as well as splenomegalia, so the spleen is enlarged.

In terms of key points around administration, you do not want to agitate the vial and you definitely want to monitor your patient's CBC levels during therapy.

So we are done with hematologic medications. So next up are medications for shock. I hope these videos have been helpful for you. If so, be sure to like, subscribe to our channel, and let your classmates know about our content. Thanks so much for watching!

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