Thrombolytic Therapy and Tensilon Testing

Thrombolytic Therapy and Tensilon Testing

By: Jordan Wishon

Thromboytic Therapy

• Recombinant tissue plasminogen activator (rtPA [Retavase]) is the only approved drug for treatment of AIS
• Activates plasminogen, which degrades the thrombus by breaking down fibrin

Thank you!

Pre/During/Post Therapy

Important factors to remember

Tensilon Testing

Thrombolytic Therapy

• Infuse 0.9mg/kg (maximum dose 90mg) over 60 minuteswith 10% of the dose given as a bolus over 1 minute
• Admit the patient to a critical care or specialized stroke unit
• Perform neurological assessments, including vital signs, every 10 to 15 minutes during infusionand every 30 minutes after that for at least 6 hours; monitor hourly for 24 hours after treatment
• If systolic BP is 180mmHg or greater or diastolic is 105 mmHg or greater, give antihypertensive drugs as prescribed
• Do not place invasive tubes, such as NG tubes or indwelling urinary catheters, until patient is stable to prevent bleeding
• DC the infusion if the patient reports severe headache or has severe hypertension, bleeding, nausea, and/or vomiting; notify the health care provider immediately
• Obtain a follow-up CT scan after treatment before starting anti-platelet or anticoagulant drugs

• When was the patient last seen normal - MOST IMPORTANT
• 4.5 hours unless the patient is older than 80, INR less than or equal to 1.7, stroke scale of less than 25, history of both stroke and diabetes then the time goes down to 3 hours
• Explain procedure to patient and or family member
• Get an informed consent signed
• Dosage based on patient's weight
• Refer to hospital protocols for mixing and administering this drug

• This information can be found in our book on pages 992-993 and 1013-1014

• Also called Intravenous (systemic) fibrinolytic therapy
• Used for acute ischemic stroke (AIS)
• Dissolves cerebral artery occlusion so that blood return may occur and prevent decreased blood flow to the brain

• Test used for patients with Myasthenia Gravis
• Pharmacologic test that uses the cholinesterase inhibitors edrophonium chloride (Tensilon) and neostigmine bromide (Prostigmin)
• Older test that is referred to as the Tensilon challenge test
• This test is used most often because of its rapid onset and brief duration of action
• This drug inhibits the breakdown of ACh at the postsynaptic memebrane, which increases the availability of ACh for excitation of postsynaptic receptors

Tensilon Testing

• To perform this test, the physician first estimates the strength of the cranial muscles
• 2mg is injected IV; if this is tolerated, an additional 8mg is injected after 30 seconds
• Within 30-60 seconds of the first dose, most patients show marked improvement in muscle tone that lasts 4 minutes
• False positive results may be caused by increased muscle effort by the patient
• False-negative results may be seen if the tested muscle is extremely weak or refractory to the drug

• May be used to help whether increasing weakness in the previously diagnosed myasthenic patient is due to too much or too little cholinesterase inhibitor drugs
• If too much cholinesterase inhibitor drugs, the muscle tone does not improve after giving tensilon
• Instead, weakness may actually increase and muscle twitching around the eyes and face may occur
• This test can cause ventricular fibrillation and cardiac arrest, but only rarely
• Atropine sulfate is the antidote for tensilon if that occurs