DRUG CLASSIFICAT DOSAGE and ROUTE
ION
Tissue Blood formers Route: IV
Plasminogen Coagulators and
Activator Anticoagulants Dosage:
Thrombolytic
Acute Myocardial
GENERIC enzyme
Infarction:
NAME:
Recommended total dose
alteplase
for AMI is based on
patient weight, not to
CLASSIFICAT
exceed 100 mg,
ION:
regardless of the selected
administration regimen
(accelerated or 3 hr)
Pulmonary Embolism:
100 mg IV infused over 2
hr; institute parenteral
anticoagulation near the
end of or immediately
following alteplase
infusion when the PTT or
thrombin time returns to
<2x normal
Acute Ischemic Stroke:
0.9 mg/kg IV; not to
exceed 90 mg total dose;
administer 10% of the
total dose as an initial IV
bolus over 1 minute and
the remainder infused
over 60 minutes
ACTION
And
tPA is a thrombolytic (i.e.,
it breaks up blood clots)
formed by aggregation of
activated platelets into
fibrin meshes by
activating plasminogen.
More specifically, it
cleaves the
zymogen plasminogen at
its Arg561-Val562 peptide
bond to form the serine
protease, plasmin.
INDICATIONS NURSING IMPLICATIONS
Contraindications
Indications: Monitor for S&S of excess
bleeding q15min for the first
FDA-approved hour of therapy, q30min for
indications for alteplase second to eighth hour, then
include pulmonary q8h.
embolism, myocardial
infarction with ST- Monitor neurological checks
segment elevation throughout drug infusion
(STEMI), ischemic q30min and qh for the first 8 h
stroke when given within after infusion.
3 hours of the start of
symptoms, and re- Protect patient from invasive
establishment of patency procedures because
in occluded intravenous spontaneous bleeding occurs
(IV) catheters. twice as often with alteplase as
with heparin.
Contraindications:
Active internal bleeding, IM injections are
history of cerebrovascular contraindicated.
accident, recent (within 2
mo) intracranial or Prevent physical manipulation
interspinal surgery or of patient during thrombolytic
trauma, intracranial therapy to prevent bruising.
neoplasm, arteriovenous
malformation, bleeding
Lab tests: Coagulation tests
disorders, severe
including APTT, bleeding
uncontrolled
time, PT, TT, INR, must be
hypertension, likelihood
done before administration of
of left heart thrombus,
drug. Also check baseline Hct,
acute pericarditis,
Hgb, and platelet counts, in
case of bleeding. Draw Hct
following drug administration
to detect possible blood loss.
 Current Recommendations for the Management of Stroke Patients in the Middle East in the Era of COVID 19 Pandemic

SUMMARY:

My chosen journal talks about the recommended managements for stroke patients during this time of pandemic. We all know how COVID 19 has
changed the way we manage illness, and it had a huge impact on stroke care worldwide. The quantities of thrombolysis and thrombectomy
treatments are declining, so as the rates and door to door to treatment times for thrombolysis and thrombectomy are expanding. The stroke
units are being redistributed to serve COVID-19 patients, and stroke groups are being redeployed to COVID-19 focuses. Coronavirus affirmed
cases and deaths are rising step by step. This pandemic has indeed compromised and threatened all stroke care accomplishments provincially.
Middle East and North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) is the primary stroke association provincially.
It desires the need to growing new systems and proposals for stroke care during this pandemic. This will require various channels of mediations
and make a defensive code stroke with quick triaging way. Some of the recommendations are infection control screening, history of infection or
contact with infected person, for pre- hospital stage. In using other services like CT- scans, a dedicated CT scan room for COVID- 19 patients
should be established if multiple rooms are available and avoiding of multiple visits there should also be implemented to minimize exposure.
This applies to all medical facilities in the hospitals. Everyone must wear PPE as we all know and for post hospital stage, tele stroke consultation
is advised. Creating and extending the tele-stroke programs are earnestly required. Incorporating such measures will prompt an improvement
and redesigning of the administrations to an acceptable level.

REFLECTION

Stroke is an illness that needs immediate action especially that it has permanent irreversible effects on a person both physically and emotionally.
I feel sad that going to the hospitals nowadays needs strict safety precautions to be followed. Of course, it’s a huge hassle to go through
especially when the patient is in an emergency situation but at the same time, I agree that there should be such protocols because it would be a
huge help especially in the rapid assessment of the stroke patients and it will also ensure the safety of the medical staff and avoid risk of
infections to the patients. This should also be applied on all cases and not just in the hospitals. I believe that this can also help not just the stroke
patients but also in minimizing the COVID cases if these rules are strictly followed. After all, these aren’t implemented for no apparent reason at
all. I just hope the medical staff does not take long to attend to stroke patients, as an effect of the strict protocols that needs to be followed
because it can cause a worse situation with him or worse, death.
Sources:

http://www.robholland.com/Nursing/Drug_Guide/

https://www.strokejournal.org/article/S1052-3057(20)30599-1/fulltext#seccesectitle0001