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INTRODUCTION

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aminocaproic acid (a-mee-noe-ka-pro-ik)

Amicar, epsilon aminocaproic acid

Classification

Therapeutic: hemostatic agents

Pharmacologic: fibrinolysis inhibitors

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Indications
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Management of acute, life-threatening hemorrhage due to systemic hyperfibrinolysis or urinary fibrinolysis.

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Unlabelled Use: Prevention of recurrent subarachnoid hemorrhage. Prevention of bleeding following oral surgery in hemophiliacs. Management of severe hemorrhage caused by thrombolytic agents.

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Action
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Inhibits activation of plasminogen. Therapeutic Effects: Inhibition of fibrinolysis. Stabilization of clot formation.

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Adverse Reactions/Side Effects
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CNS: dizziness, malaise. EENT: nasal stuffiness, tinnitus. CV: arrhythmias, hypotension (IV only). GI: anorexia, bloating, cramping, diarrhea, nausea. GU: diuresis, renal failure. MS: myopathy.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for nosebleeds, bleeding gums, or other unusual bleeding or bruising that might indicate inadequate drug effects. Report signs of bleeding to the physician immediately.

  • Assess any signs of myopathy such as muscle pain, tenderness, or weakness. Report any unexplained musculoskeletal symptoms to the physician.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure, especially after IV administration. Compare to normal values (See Appendix F), and report low blood pressure (hypotension).

  • Monitor signs of renal failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish-brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Because of the risk of arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness. Use caution during early stages to avoid fatigue of affected muscles, and implement assistive devices (walker, cane, crutches) as needed to prevent falls and assist mobility. Increase exercise intensity as tolerated; recovery from myopathy typically takes 4–6 weeks, but can be longer in older patients or people with comorbidities.

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Patient/Client-related Instruction
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  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged malaise, nasal congestion, ringing/buzzing in the ears (tinnitus), excessive urination, or GI problems (nausea, vomiting, loss of appetite, bloating, cramping).

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Pharmacokinetics
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Absorption: Rapidly absorbed following oral administration.

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Distribution: Widely ...

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