Reteplase

A to Z Drug Facts

 Action Aids in dissolution of blood clots.

 Indications Management of acute MI, to reduce incidence of congestive heart failure and mortality associated with an acute MI.

 Contraindications Active internal bleeding; history of cerebrovascular accident; recent intracranial or intraspinal surgery or trauma; intracranial neoplasm, arteriovenous malformation or aneurysm; bleeding diathesis or severe uncontrolled hypertension because thrombolytic therapy increases the risk of bleeding.

 Route/Dosage

ADULTS: IV 10 + 10 U double-bolus injection, each bolus given over 2 mins. The second bolus given 30 mins after initiation of the first.

 Interactions

Abciximab, aspirin, dipyridamole, heparin, vitamin K antagonists: May increase the risk of bleeding. INCOMPATIBILITIES: Heparin: Do not add other medications to the same IV.

 Lab Test Interferences Results of coagulation tests may be unreliable if precautions are not taken to prevent in vitro artifacts.

 Adverse Reactions

HEMA: Bleeding, both superficial (eg, venous cutdowns, arterial punctures, sites of surgical intervention), and internal (eg, GI tract, GU tract, pericardial, retroperitoneal sites).

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Bleeding: Most frequent and serious side effect. Arrhythmias: Antiarrhythmic therapy should be available because coronary reperfusion may result in arrhythmias.

 Administration/Storage

• Available only as powder for reconstitution for IV administration.
• Administer by IV infusion only.
• Reconstitute immediately before use; only with accompanying Sterile Water for Injection (without preservatives) following reconstitution instructions. Do not shake.
• Allow to stand after reconstitution until all large bubbles are dissipated.
• Solution may be stored up to 4 hrs at room temperature (36°–86°F).
• Do not administer if solution is discolored or if particles are present.
• Store at room temperature. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note cerebrovascular disease, hypertension or recent internal bleeding.
• Obtain drug history, noting use of aspirin, dipyridamole or heparin because these drugs may increase the risk of bleeding.
• Ensure that coagulation studies have been performed before administration. These tests provide baseline values against which to monitor patient's response to therapy.
• Take pulse and BP before administration and monitor frequently during infusion.
• Observe for internal or external bleeding before and during infusion.
• Carefully monitor potential bleeding sites (eg, catheter insertion sites, arterial puncture sites) because fibrin will be lysed during therapy, resulting in new or increased bleeding.
• Avoid IM injections and nonessential handling of patient during treatment.
• Minimize number of arterial and venous punctures.
• If arterial punctures are necessary, use site accessible to manual compression. Use manual pressure for at least 30 min, apply pressure and check site frequently for evidence of bleeding.
• If serious bleeding occurs, stop infusion and any concomitant heparin and notify physician.
• Observe for indications of hypersensitivity (eg, urticaria, fever). Nausea, vomiting, hypotension and fever are frequent sequelae of MI and may or may not be attributable to therapy.
• If anaphylactic reaction occurs, stop infusion, notify physician and initiate appropriate therapy.

 Patient/Family Education

• Explain drug action and need for frequent monitoring, including blood tests and vital signs.
• Instruct patient to report any new bleeding sites or increased bleeding, dizziness, headache, numbness or tingling.
• Tell patient to report urticaria or fever.
• Instruct patient to avoid getting out of bed without assistance during treatment.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts