Use of antithrombotics- because heparin, aspirin, or reteplase  may cause bleeding complications,
careful monitoring for bleeding is adviced especially in arterial punctures.

Drug /Lab interactions-  administration of reteplase may cause a decrease in plasmogen and
fibronogen during reteplase therapy. If coagulation tests and /or measurements of fibronollytic
activity are performed the results may be unreliable unless specific  precautions are taken
to prevent vitro effects,

Acute Myocardial infraction AMI

Most frequent adverse reactions associated is bleeding. The bleedings are -

Intracranial hemorrhage- the risk for intracranial damage is increased in patients with advanced
age or with elevated blood pressure.

Active internal bleeding,
history of cerebrovascular accidents,
 recent intracranial surgery

Special precautions-
Bleeding- concurrent use of heparin anticoagulation may contribute to bleeding

Injections sites-  as fibrin is lysed during reteplase therapy, bleeding from recent puntures  sites
may occur, Therefore, thrombolytic therapy required careful attention to all potential bleeding
sites, arterial  and venous punctures sites

IM- avoid IM injections and non-essetial handling of the patient during treatment with reteplase

High risk patients - carefully evaluate each patient being considered for therapy with reteplase
and weigh anticipated benefits against the potential risks associted with the therapy.

Should serious bleeding occur ( not controllable ) immediately terminate concomittant
anticoagulant therapy 

Cholesterol embolism- cholesterol embolism has been reported rarely in patients treated with
thrombolytic agents. This serious condition which could be lethal is also associated with
invasive vascular procedures eg cardiac catheterization, angiography, vascular surgery
and/or anticoagulant therapy

Arrhythmias- antiarrhythmic therapy for bradycardia and/or ventricular irritability should be
available when reteplase is administered.

Pregnancy- use reteplase only if the potential benefit justifies the potential risk to the fetus.

Lactation-  excercise caution when reteplase is administered to a nursing woman.

Children- safety and efficacy of reteplase in children have not been established

Monitoring- because heparin, aspirin, or reteplase may cause bleeding complications,
careful monitoring of bleeding is adviced, espicially in arterial puncture sites.

Indication-
Acute Myocardial infraction AMI

Dosage-

Reteplase is for IV use admin only.
Reteplase is administered as a 10+ 10 unit bolus injection. Two 10 unit bolus injections are required
for a complete treatment.
Administer each bolus as an IV injection over 2 minutes.
Give the second bolus after initiation of the first bolus injection.

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Pharmacology-
Reteplase is recombinant plasminogen activator which catalyzes the clevage of endogenous
plasminogen to generate plasmin. Plasmin in turn degrades the fibrin matrix of the thrombus, thereby
excerting its thrombolytic action

Pregnancy-
Use reteplase only if the potential benefit justifies the potential risk to the fetus.

Lactation- 
Excercise caution when reteplase is administered to a nursing woman.

Children-
Safety and efficacy of reteplase in children have not been established