Generic Name: Alteplase Trade Name(s): Activase, t-PA
MOA: It enhances the conversion of plasminogen to plasmin by binding to fibrin, initiating fibrinolysis with limited systemic proteolysis.
Uses of Medication: Acute myocardial infarction (MI). Acute ischemic stroke. Pulmonary embolism (PE). Occluded central venous access devices.
Side Effects: CNS: INTRACRANIAL HEMORRHAGE, EENT: epistaxis, gingival bleeding
Resp: bronchospasm, hemoptysis, CV: reperfusion arrhythmias, hypotension, RECURRENT ISCHEMIA/THROMBOEMBOLISM, GI: GI BLEEDING, nausea, RETROPERITONEAL BLEEDING, vomiting, GU: GU TRACT BLEEDING Derm: ecchymoses, flushing, urticarial, Hemat: BLEEDING Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, fever
Contraindications/Precautions: Aspirin, other NSAIDs, warfarin, heparin and heparin-like agents.
Usual Dosage(s): IV (Adults) 15 mg bolus, then 0.75 mg/kg (up to 50 mg) over 30 min, then 0.5 mg/kg (up to 35 mg) over next 60 min; usually accompanied by heparin therapy.
Nursing Implications: Monitor vital signs, including temperature, Assess patient carefully for bleeding, Assess patient for hypersensitivity reaction(Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.), Assess neurologic status
Patient Teaching Explain purpose of medication and the need for close monitoring to patient and family. Instruct patient to report hypersensitivity reactions (rash, dyspnea) and bleeding or bruising.Explain need for bedrest and minimal handling during therapy to avoid injury. Avoid all unnecessary procedures such as shaving and vigorous tooth brushing.
Aminocaproic acid (Amicar) may be used as an antidote
Generic Name: Amiodarone Trade Name: Cordarone, Nexterone, Pacerone Classification: antiarrhythmics (class III)
MOA: Prolongs action potential and refractory period. Inhibits adrenergic stimulation. Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular resistance (vasodilation).
Uses of Medication: PO: Management of supraventricular tachyarrhythmias. IV: management of ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) after cardiopulmonary resuscitation and defibrillation have failed; also for other life-threatening tachyarrhythmias.
Side Effects: CNS: confusional states, disorientation, hallucinations, dizziness, fatigue, malaise, headache, insomnia EENT: corneal microdeposits, optic neuritis, optic neuropathy. Resp: ADULT RESPIRATORY DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, PULMONARY TOXICITY CV: CHF, WORSENING OF ARRHYTHMIAS, bradycardia, hypotension GI: ↑ liver enzymes
Contraindications/Precautions: Bradycardia episodes whis cause syncope, Cardiogenic shock, Hypersensitivity to med or iodine, 2nd/3rd AV block, sinus bradycardia, sinus node dysfunction
Usual Dosage(s): PO: (Adults) 800–1600 mg/day in 1–2 doses for 1–3 wk, then 600–800 mg/day in 1–2 doses for 1 mo, then 400 mg/day maintenance dose.IV: (Adults) 150 mg over 10 min, followed by 360 mg over the next 6 hr and then 540 mg over the next 18 hr. Continue infusion at 0.5 mg/min until oral therapy is initiated.
Nursing Implications: Monitor ECG continuously during IV therapy or initiation of oral therapy. Assess for signs and symptoms of ARDS throughout therapy,
Patient Teaching Instruct patient to take amiodarone as directed, Advise patient to avoid drinking grapefruit juice during therapy. Teach patients to monitor pulse daily and report abnormalities. Instruct male patients to notify health care professional if signs of epididymitis, • Emphasize the importance of follow-up exams, including chest x-ray and pulmonary function tests every 3–6 mo and ophthalmic exams after 6 mo of therapy, and then annually
Generic Name: Amlodipine Trade Name (s): Norvasc
MOA: Inhibits the transport of calcium into