DAVAO DOCTORS

COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
STUDY
Name of Patient: ______________________________ Date of Admission: ____________________ Room:
__________
Age: _________ Sex: __________ Civil Status: _____________ Attending Physician: _____________________

DRUG NAME CLASSIFICATION / MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING

ACTION RESPONSIBILITY
Acute Ischemic Stroke: Hemorrhagic Stroke: CNS: cerebral ● Monitor vital
CLASSIFICATION Actilyse is used to treat acute Actilyse should not be hemorrhage & signs
PHARMACOTHERAPEUTIC: Tissue ischemic stroke, particularly used in cases of fever ● perform
Plasminogen activator (tPA) is a drug when administered within a hemorrhagic stroke, CV: arrhythmias, assessment
used to break up a blood clot and specific time frame, usually where bleeding is the hypotension, ● measure
Brand Name: Actilyse
restore blood flow to the brain within 4.5 hours of symptom primary issue, as it can edema, stroke severity
CLINICAL: thrombolytic onset. This helps to dissolve worsen bleeding. cholesterol, ● ALERT: aware
Generic Name:
blood clots that may be embolization, & when used it
Thrombolytic: Alteplase
MECHANISM OF ACTION causing the stroke. Recent Major Surgery venous for acute
(Activase )
Binfs to fibrin in a thrombus and or Trauma: It is generally thrombosis ischemic
converts entrapped plasminogen to Myocardial Infarction (Heart contraindicated in GI: bleeding, stroke, give
Route: IV infusion plasmin, initiating local fibrinolysis Attack): Actilyse can be used patients who have had hematologic: drug within 3
Therapeutic Effect: Degrades fibrn to treat certain types of heart major surgery, trauma, or spontaneous hours after
Dosage: clots, fibrinogen, other plasma proteins attacks to restore blood flow in significant head injury bleeding symptoms

● Acute MI the coronary arteries. The within the previous two SKIN: occur and only
PHARMACOKINETICS specific protocols for weeks, as there is an ecchymosis when
IV infusion: ADULTS
ACUTERapidly metabolized in liver. administration may vary increased risk of Other: intracranial
WEIGHING MORE THAN Primarilly excreted in urine depending on the patient's bleeding. anaphylaxis bleeding has
67 KG: Total dose: 100 mg
 DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
over Half-life: 35 min condition STUDY (cathflo activase), been ruled out
ADULTS WEIGHING 67 KG and the medical facility. Active Bleeding or bleeding at ● Drug may
OR LESS: Total dose: Pregnancy/Lactation: Use only when Bleeding Disorders: puncture sites, given to

Maximum total dose: 100 benefit outweighs potential risk to fetus. Pulmonary Embolism: In Actilyse is contraindicated hypersensitivity menstruating

mg. Unknown if drug crosses placenta or is cases of massive or high-risk in patients with active reaction women
distributed in breast milk. pulmonary embolism, Actilyse internal bleeding, ● To recannulize
Children: Safety and efficacy not can be used to break down bleeding disorders (e.g., occluded
● Acute Pulmonary
established. Elderly: May have clots in the pulmonary arteries hemophilia), or a history coronary
Emboli increased risk of bleeding; monitor to improve blood flow to the of recent bleeding. arteries and
ADULTS: 100 mg closely. lungs. improve heart
Recent Gastrointestinal function, begin
Bleeding: Patients with treatment as
● Acute Ischemic
recent gastrointestinal soon as
stroke
bleeding are typically not possible after
Recommended total candidates for Actilyse symptom start
dose: 0.9 mg/kg. treatment. ● Anticoagulant
Maximum: 90 mg. and antiplatelet
Hypertension: Severe therapy is
uncontrolled hypertension commonly
● Central Venous
(high blood pressure) is a started during
Catheter
contraindication due to or after
Clearance
the increased risk of treatment, to
ADULTS, ELDERLY: Up to 2
bleeding. decrease risk
mg of thrombosis
 DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
STUDY Aneurysm: Actilyse is ● Monitor vital
generally not used in signs and
● Usual Neonatal
cases of suspected or neurological
Dosage
confirmed aortic status
Occluded IV catheter: Use
dissection, or other carefully. Keep
1 mg/mL conc (maximum: conditions involving blood patient on strict
2 mg/2 mL) leave in lumen vessel abnormalities or bed rest.
up to 2 hrs, then aspirate. aneurysms. ● Avoid
Systemic thrombosis: 0.1– noninvasive
0.6 mg/kg/ hr for 6 hrs. Severe Liver Disease: procedures, IM
Usual dose: 0.5 mg/kg/hr. Patients with severe liver injections and
disease are at an nonessential

Frequency: increased risk of bleeding handling of

and may not be suitable patients during
candidates for Actilyse thrombolytic
● Acute MI
treatment. therapy.
ADULTS WEIGHING MORE Closely

THAN 67 KG: Total dose: Intracranial Neoplasm monitor

starting with 15-mg bolus (Tumor): Actilyse is patients for

typically not used in signs of
over 1–2 min, then 50 mg
patients with known or internal
over 30 min, then 35 mg
suspected intracranial bleeding, and
over 60 min.
neoplasms (tumors) due frequently
ADULTS WEIGHING
to the risk of bleeding. check for all
67 KG OR LESS: Total
 DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
dose: Start with 15-mg STUDY puncture sites.
bolus over 1–2 min, then Recent Anticoagulant Bleeding is the
0.75 mg/kg over 30 min Use: The use of most common

(maximum: 50 mg), then anticoagulant adverse effect

0.5 mg/kg over 60 min medications, such as and may occur

heparin, within the internally and
● Acute Pulmonary
previous 48 hours, can be at external
Emboli a contraindication. puncture sites.
May give as a 10-mg bolus ● If an arterial
followed by 90 mg over 2 Allergy or puncture is
hrs. Institute or reinstitute Hypersensitivity: necessary
heparin near end or Patients with a known during activase

immediately after infusion hypersensitivity or allergy infusion, use

when activated partial to Alteplase or its an arm vessel

components should not that can be
thromboplastin time
receive this medication. manually
(aPTT) or thrombin time
compressed.
(TT) returns to twice
Apply pressure
normal
for at least 30
minutes
or less.
followed by a
● Acute Ischemic pressure

stroke dressing.
Check the
Dose should be given
 DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
within the first 3 hrs of the STUDY sites regularly
onset of symptoms. for bleeding.
ADULTS WEIGHING 100 ● If

KG OR LESS: 0.09 mg/kg uncontrollable

as IV bolus over 1 min, bleeding occur,

stop infusion
then 0.81 mg/kg as
(and parenteral
continuous infusion over
anticoagulant)
60 min.
and notify
WEIGHING MORE THAN
prescriber
100 KG: 9 mg bolus over 1
● Don't use “tPA”
min, then 81 mg as
abbreviation
continuous infusion over when or during
60 min. this drug. “
● Central Venous tPA” has been
mistaken for
Catheter
TNKase
Clearance
(tenecteplase),
ADULTS, ELDERLY: Up to 2
TPN, or TXA
mg; may repeat after 2
(error-prone)
hrs. If catheter functional,
● Don't confuse
withdraw 4–5 mL blood to
alteplase with
remove drug and residual altace. Don't
clot. confuse
 DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
STUDY activase with
● Usual Neonatal
cathflo
Dosage
activase or
Occluded IV catheter: Use
TNKase
1 mg/mL conc (maximum:
2 mg/2 mL) leave in umen PATIENT
up to 2 hrs, then aspirate. TEACHING:
Systemic thrombosis: 0.1– ● Explain the
0.6 mg/kg/ hr for 6 hrs. use and
Usual dose: 0.5 mg/kg/hr. administration
of drug to
patient and
family
● Tell patient to
report any
adverse
reaction
promptly and
to immediately
report any
report signs
and symptoms
of bleeding,
urinary
DAVAO DOCTORS
COLLEGE
General Malvar St., Davao
Nursing
Program
DRUG
STUDY problems,
abdominal
pain, nausea,
vomiting,
confusion,
severe
headache,
one-sided
weakness,
trouble
speaking and
thinking, visual
disturbance,
dizziness,
passing out,
chest pain, or
catheter-site
pain.