| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|
| Alteplase, recombinant (Activase, tPA)—IV bolus 100 mg over 90 min: 15-mg bolus given over 1–2 min; then 50 mg over 30 min; then 35 mg over 60 min | Acute MI; under investigation for pulmonary emboli, deep vein thrombosis, and peripheral artery thrombosis | Promotes conversion of plasminogen to plasmin, which is fibrinolytic | Internal or local bleeding; urticaria; dysrhythmias related to reperfusion; hypotension; nausea, vomiting |
| NURSING IMPLICATIONS: Assess for signs of reperfusion (relief of chest pain, no ST-segment elevation); observe for bleeding; avoid IM injection; do not mix other medications in line |
| Streptokinase (Stretase)—IV 1.5 million units initially diluted; infused over 60 min | Lysis of pulmonary or systemic emboli or thrombi; acute MI | Reacts with plasminogen, dissolves fibrin clots | Prolonged coagulation; allergic reactions; mild fever |
| NURSING IMPLICATIONS: Monitor for signs of excessive bleeding , particularly at injection sites; avoid nonessential handling of client |
| Urokinase—IV 4,400 IU/kg over 10 min; 1.0–1.8 mL of 5,000 IU/mL into catheter | Massive pulmonary emboli, coronary artery thrombi, occluded IV catheter | Directly activates plasminogen | Bleeding, anaphylaxis, rash |
| NURSING IMPLICATIONS: Vital signs; check q15 min for bleeding during first hr; q15–30 min for 8 hr; have epinephrine ready |