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Assignment 2
Jandi M. Nietes
ID# 201633309
ACCN 5507
Case 2
Tenecteplase
As a thrombolytic, Tenecteplase (TNK) would be used in this case as it breaks down the
blood clots in the coronary vessels initially by degrading fibrin with the protease enzyme
plasmin. As plasminogen binds to fibrin in the blood clots, it is activated as plasmin by tissue
plasminogen activators. As blood cells become lysed, clots continue to dissolve as plasmin
gradually breaks down fibrin and fibrinogen (Brenner and Stevens, 2018).
The best therapeutic indication would be the resolution of chest pain and discomfort as well as
the gradual resolution of ECG abnormalities and arrhythmias, although reperfusion arrhythmias
may appear in the EKG as the clot lyse. As bleeding becomes the most relative adverse effect,
patients are closely observed. Routine evaluation of the EKG for resolution of arrhythmias is
completed. Hypersensitivity reactions are also being monitored post- administration (Yazdi, et
al., 2017).
Aspirin
On the other hand, the use of Aspirin or acetylsalicylic acid (ASA) in both the ER and as
infarction, especially ion the first month (Xian, et al., 2015). As an antiplatelet, aspirin
irreversibly inhibits the action of cyclooxygenase by acetylation and as well as inhibiting the
A2. Therapeutically, the prevention of further growth of the thrombus and thus effectively
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future myocardial infarctions are the goals for treatment ion this case (Brenner and Stevens,
2018).
Bleeding remains to be the most common adverse effect from ASA. Thus, bleeding precautions
Patients with allergic reactions, especially with tartrazine, are expected to develop more
may evaluate salicylate levels to rule- out salicylate toxicity in the future (Vallerand, Sanoski and
Quiring, 2019)
Heparin
its development. It potentiates the action of antithrombin on factor X-a and as well a thrombin
itself. When used in conjunction with Aspirin, this will increase the risk for bleeding, thus CBC,
platelet count is checked and as well as bowel movements are tested for occult blood but not
routinely. aPTT is routinely checked (Vallerand, Sanoski and Quiring, 2018). The monitoring for
develop, as well as for petechial hemorrhages to the skin. Carefully monitoring skin for signs of
note, heparin promotes natriuresis but tends to inhibit kaliuresis, thus monitoring for serum
potassium levels is essential, especially when kidney function becomes impaired as this not only
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predisposes the patient for hyperkalemia but with increased bleeding tendencies as well
Nitroglycerin
Nitroglycerin is an anti-anginal medication that is indicated for the relief and inhibition
of angina or chest pain. This also causes a decrease in blood pressure and increases cardiac
output. It acts on the coronary vessels by promoting the dilation of coronary arteries and
thereby supporting adequate coronary blood flow and promoting collateral circulation in favor
lowering ventricular end- diastolic pressure and left ventricular- end diastolic volume thus
effectively lowering myocardial oxygen demand (Vallerand, Sanoski and Quiring, 2018).
Furthermore, studies suggest that efficacy off nitroglycerin should be evaluated and
intermittent dosing is favored as it shows a lesser chance for the patient to develop tolerance
(Boden, et al., 2015). Heart rate should be monitored closely as a reflex tachycardia may
develop, mores EKG should also be conducted to monitor for any changes. With excessive
vasodilation, headaches and dizziness should be monitored (Brenner and Stevens, 2018).
Metoprolol
The use of Beta-blockers in recent MI episode has shown to decrease mortality. Being a
cardioselective and lipid- soluble beta- blocker, metoprolol causes a blockade in the beta- 1
adrenergic receptor. This effectively lowers cardiac rate and increases myocardial oxygen
demand; decreases the force and velocity of myocardial contractions; causes blood pressure
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and cardiac output to decrease thus lowering the rate pressure product; lengthens the interval
The use of beta- blockers may cause hypotension, as such blood pressure monitoring is
done. Heart rate can decrease thus observing for bradycardia is essential. Medication may
conducted to rule- out any conduction blocks in the heart (Vallerand, Sanoski and Quiring,
2018).
Enalapril
Being an ACE inhibitor, enalapril is indicated as it is shown to reduce mortality and slows
the development of heart failure post- MI episode; it slows the progression of dysfunction of
the left ventricle into heart failure. By inhibiting the conversion of Angiotensin I to angiotensin
II, it lowers blood pressure. Moreover, net systemic vasodilation is expected as it increases
plasma renin levels but decreases aldosterone (Vallerand, Sanoski and Quiring, 2018).
A common adverse reaction is the development of a dry cough which is mainly due to
the release of bradykinin into the pulmonary bed. However, treatment may or may not be
discontinued depending on the patient's tolerance to the symptom. Moreover, blood pressure
necessary to assess heart and kidney function as heart failure, and kidney failure may develop.
Observing for signs and symptoms of hyperkalemia is essential, thus observing for EKG changes
and routine serum potassium pre and during treatment must be checked (Herman and Bhimji,
2018)
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Furosemide
blood pressure. By inhibiting Na and Cl reabsorption through the distal tubule and loop of
Henle, excretion of electrolytes and fluids is effectively done, even with impairment in kidney
Being a potent diuretic, monitoring the fluid and electrolyte sautés is vital during
treatment. Moreover, blood pressure is also cautiously checked. Assessing kidney function via
estimated GFR prior to treatment is necessary. Although uncommon, ototoxicity may develop
and should be considered especially in older adults and persons with impaired renal function.
Assessing the patient for hypersensitivity reactions is also necessary (Khan & Siddiqui, 2018).
Desired outcomes, in this case, would perhaps be related to decreased pulmonary crackles
Morphine
moderate to severe pain and is usually the drug of choice for pain management with
myocardial infarctions. It acts on the central nervous system (CNS) by binding to the opiate
receptors. While causing generalize CNS depression, pain response and perception are altered
morphine is used when nitroglycerin does not manage the pain. With decreased pain response,
there is a decreased heart rate, and this reduces myocardial oxygen demand, preventing
further myocardial damage due to schema and hypoxemia. However, like all opiates,
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respiratory rate is monitored closely for bradypnea as opiate toxicity can cause respiratory
depression. Blood pressure is also monitored due to possible hypotension due to vasoactive
with laxatives as this promotes straining and further increases stress, effectively increasing
heart rate and myocardial oxygen demand (Forth & Mountfort, 2018).
Milrinone
contractility and causes vasodilation in the smooth muscles. (Brenner and Stevens, 2018). Its
positive inotropic effect causes an increase in cardiac output by decreasing both preload and
and thrombocytopenia. Thus, EKG should be checked routinely as well as heart rate and blood
pressure. As patients are at higher risk for bleeding due to thrombocytopenia, platelet count
and CBC should be checked (Brenner and Stevens, 2018). As milrinone is usually used in heart
hemodynamic parameters such as blood pressure and cardiac output should be improving
REFERENCES
Boden, W. E., Padala, S. K., Cabral, K. P., Buschmann, I. R., & Sidhu, M. S. (2015). Role of short-
Brenner, G. M., & Stevens, C. W. (2018). Pharmacology (5th ed.). Philadelphia, PA: Elsevier.
Foth, C., & Mountfort, S. (2018, October 27). Myocardial Infarction, Acute, ST Elevation (STEMI).
from https://www.ncbi.nlm.nih.gov/books/NBK532281/#article-17173.s7
Herman, L. & Bhimji, S. (2018, October 27). Angiotensin Converting Enzyme Inhibitors (ACEI).
from https://www.ncbi.nlm.nih.gov/books/NBK431051/
Khan, M. I. (2015). Cardiac drug therapy (8th ed.). Totowa: Humana Press.
Khan, T., & Siddiqui, A. (2018, October 27). Furosemide. Retrieved on November 30, 2018,
from https://www.ncbi.nlm.nih.gov/books/NBK499921/
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Lincoff, M., & Cutlip, D. (2018, September). Anticoagulant therapy in acute ST elevation
from https://www.uptodate.com/contents/anticoagulant-therapy-in-acute-st-elevation-
myocardial-infarction
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from http://journal.iha.org.ir/en/journal/ArticleView/0/13//68/Volume.18.Number.2.htm
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