RETEPLASE RECOMBINANT

RETEPLASE RECOMBINANT
(re'te-plase)
Retavase
Classifications: thrombolytic enzyme, tissue plasminogen activator;
Therapeutic: thrombolytic

Prototype: Alteplase
Pregnancy Category: C

Availability

10.4 IU vials

Action

DNA recombinant human tissue-type plasminogen activator (t-PA) that acts as a catalyst in the cleavage of plasminogen to plasmin. Responsible for degrading the fibrin matrix of a clot.

Therapeutic Effect

Has antithrombolytic properties.

Uses

Thrombolysis management of acute MI to reduce the incidence of CHF and mortality.

Contraindications

Active internal bleeding, history of CVA, recent neurological surgery or trauma, intercranial neoplasm, or aneurysm, bleeding disorders, severe uncontrolled hypertension; pregnancy (category C).

Cautious Use

Any condition in which bleeding constitutes a significant hazard (i.e., severe hepatic or renal disease, CVA, hypertension, acute pancreatitis, septic thrombophlebitis); lactation. Safety and efficacy in children are not established.

Route & Dosage

Thrombolysis during Acute MI
Adult: IV 10 U injected over 2 min. Repeat dose in 30 min (20 U total).

Administration

Intravenous

PREPARE: Direct: Reconstitute using only the diluent, syringe, needle, and dispensing pin provided with reteplase. Withdraw diluent with syringe provided. Remove needle from syringe, replace with dispensing pin and transfer diluent to vial of reteplase. Leave pin and syringe in place in vial and swirl to dissolve. Do NOT shake. When completely dissolved, remove 10 mL solution, replace dispensing pin with a 20-gauge needle.  

ADMINISTER: Direct: Flush IV line before & after with 30 mL NS or D5W and do NOT give any other drug simultaneously through the same IV line. Give a single dose evenly over 2 min.  

INCOMPATIBILITIES Solution/additive: Heparin. Y-site: Bivalirudin, heparin.

  • Store drug kit unopened at 2°–25° C (36°–77° F).

Adverse Effects (≥1%)

Hematologic: Hemorrhage (including intracranial, GI, genitourinary), anemia. CV: Reperfusion arrhythmias.

Diagnostic Test Interference

Causes decreases in plasminogen and fibrinogen, making coagulation and fibrinolytic tests unreliable.

Interactions

Drug: Aspirin, abciximab, dipyridamole, heparin may increase risk of bleeding.

Pharmacokinetics

Elimination: In urine. Half-Life: 13–16 min.

Nursing Implications

Assessment & Drug Effects

  • Discontinue concomitant heparin immediately if serious bleeding not controllable by local pressure occurs and, if not already given, withhold the second reteplase bolus.
  • Monitor carefully all potential bleeding sites; monitor for S&S of internal hemorrhage (e.g., GI, GU, intracranial, retroperitoneal, pulmonary).
  • Monitor carefully cardiac status for arrhythmias associated with reperfusion.
  • Avoid invasive procedures, arterial and venous punctures, IM injections, and nonessential handling of the patient during reteplase therapy.

Patient & Family Education

  • Report changes in consciousness or signs of bleeding to physician immediately.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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