Question

Complete drug card-

Generic /brand name

Category class

expected Pharmacological Action

Complications

Contraindications/Precautions

Interactions

Medication Administration

Evaluation of Medication Effectiveness

Therapeutic Use

Nursing Interventions

Client Education

1. Alteplase

Answer 1

ALTEPLASE

generic name/brand name;activase,actilyse,actilyse cathflo,cathflo activase(r-tpa)

category class;alteplase comes under the group of thrombolytics(antithrombotic enzymes)

pharmocological action;alteplase binds to fibrin in a thrombus and converts plasminogen to plasmin.it also produces limited conversion of plasminogen in the absence of fibrin.

alteplase binds to fibrin rich clots via the fibronectin finger like domain and the kringle 2 domain.this helps to form plasminogen to plasmin.plasmin in turn degrades the fibrin matrix of the thrombus,theirby thrombolytics action occurs.

complication;bleeding may be severe or fatal.some may get itracranial hemorhage

contraindication/precaution;should not take alteplase if you

1.are allergic to alteplaseor any of its ingredients

2.have an active bleed

3.history of brain injury

4.uncontrolled blood pressure

5.any bleeding disorder in the past

6.lactating mother

7.pregnant women or plan for pregnancy

interaction;

prothrombin;the use of alteplase with protheombin complex concentrates is contraindicated

apixaban and alteplase;both significantly increase anticoagulation

ceftaroline;increase the effect of alteplase

medication administration;

The recommended treatment dose of activase is 0.9mg/kg(not exceeds 90mg of total treatment dose)infused over 60mts

10%of the total treatment should be administrated as an initial bolus dose

the remaining dose intravenously over 60minutes.

effectiveness of medication;

depending onthe patient condition it varies,in case of AIS,neurological status may improve,in myocardial infarction also patient pain may improve,ecg shows signs of depolarization,incase of occluded venous access there will be flow of blood through that.prevention of neurologic sequalae of ais,lysys of thrombus.

therapeutic use:

a.AIS(acute ischemic stroke)

b.myocardial infraction

c.massive pulmonary embolism

d.occluded venous access devices

nursing intervention;

1.begin therapy as soon as possible to begin symptoms

2.monitor vital signs,in frequent intervels

3.monitor for bleeding every 15mts during last hour of therapy,15-30mt next 8 hours of therapy,that is bleeding from body orifices,hemoptysis,hematemisis,,maleana.

4.assess neurologic status through out the therapy, altered sensorium indicates intracranial hemorrhage.

client teaching

explain the purpose of medication and the need for close monitoring to patient .instruct patient to report hypersensitivity reactions rash,dyspnoea and bleeding bruising

explain need for rest and minimal handling during therapy to avoid ijury,instruct to avoid vigorous brushing,shaving,etc