Alteplase, rTPA, Activase

Question 1

Class

Answer 1

Fibrinolytic

Question 2

Mechanism of Action

Answer 2

Enzyme binds to fibrin-bound plasminogen at the clot, converts plasminogen to plasmin and digests clot to restore perfusion

Question 3

Indication

Answer 3

MI, STEMI, Pulmonary Emboli, CVA

Question 4

Contraindications

Answer 4

Active internal bleed, 2-3 weeks post op, CVA Hx, Siezure at onset, prolonged CPR, 3 month intracranial/intraspinal post op, aneurysm or arteriovenous malformation, recent trauma, HTN >185/110

Question 5

Adverse Reactions

Answer 5

Intracranial bleeding, HA, reperfusion dysrhythmias, CPx, hypotension, GI Bleed, N/V, Abd Px

Question 6

Drug Interactions

Answer 6

Acetylsalicylic acid (ASA), heparin and other anticoagulants may increase risk of bleed.

Question 7

How Supplied

Answer 7

50-100mg powders, reconstitute with sterile water at EC of 1mg/ml

Question 8

Dosage and Administration

Answer 8

Adult: 15mg IV bolus over 2 min, then .75 mg/kg over 30 min (not to exceed 50mg), then .5 mg/kg over 60 min, Max total dose 100mg
For ischemic stroke: .9mg 1kg infused over 60 min with 10% infused in 1 min and rest of dose infused over 60 min
Ped: Safety unknown

Question 9

Duration of Action

Answer 9

Onset: 60-90 min
Peak Effect : Variable
Duration: 30 min w/ 80% clearance in 10min

Question 10

Special Considerations

Answer 10

Pregnancy: Cat C
Observe for bleeding, do not administer IM to pts receiving plasminogen activator, avoid invasive procedures (IV, NG, …)