Pharmacology, part 12: Cardiovascular Medications - Hemostatic, Thrombolytic, Erythropoietic & Leukopoietic

by Cathy Parkes

In this video

Hemostatic agent (aminocaproic acid)

  • Used for
  • Mode of action
  • Easy way to remember
  • Side effects
  • What to assess

Thrombolytic medications (alteplase, reteplase, streptokinase)

  • Tip for remembering these medications
  • Used for
  • Key side effect
  • Contraindications
  • Administration
  • What to monitor

Erythropoiesis growth factor (epoetin alfa)

  • Used for
  • Mode of action
  • Easy way to remember
  • Side effects
  • Black-box warning
  • Administration
  • What to monitor

Leukopoietic growth factors (filgrastim)

  • Used for neutropenia
  • Mode of action
  • Easy way to remember
  • Side effects of filgrastim
  • Administration

Full Transcript

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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