Which of the following is the most common adverse effect of Alteplase?

Central Institute of Psychiatry - 9 July 2022

Pharmacology

Medium

Appeared in: Central Institute of Psychiatry - 9 July 2022

Explanation

Alteplase is a powerful thrombolytic drug that works by dissolving fibrin clots, which is its intended therapeutic action.
This systemic effect on the clotting cascade makes bleeding the most common and predictable adverse effect.
Epistaxis (nosebleed) is a form of minor mucosal bleeding, which is a frequent manifestation of the drug's anticoagulant properties, more common than severe bleeding events like intracranial hemorrhage.

Option A: While headache can occur, it is not the most common adverse effect. A sudden, severe headache is a red flag for intracranial hemorrhage, a serious but less frequent complication.
Option B: Weight loss is not associated with alteplase. This drug is used for acute, short-term treatment, not long-term therapy where weight changes might be observed.
Option D: Alteplase does not affect blood glucose metabolism. Hypoglycemia is unrelated to its mechanism of action.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Adverse effects of thrombolytic agents (Alteplase) as background academic context rather than a clinical decision trigger.
The primary nursing responsibility when administering alteplase is vigilant monitoring for bleeding. This includes checking all potential bleeding sites, from IV lines and gums to internal sites (monitoring for hematuria, hematemesis, or melena).
Bleeding precautions must be implemented for any patient receiving thrombolytic therapy. This includes minimizing physical trauma, avoiding unnecessary punctures, and using soft-bristled toothbrushes.
What if? If the patient develops a sudden severe headache, altered level of consciousness, or new focal neurological deficits, the nurse must immediately stop the alteplase infusion and notify the provider. This is the classic presentation of an intracranial hemorrhage, the most feared complication.

How to Approach the Question

First, identify the drug mentioned in the question: Alteplase.
Recall the pharmacological class of Alteplase. It is a thrombolytic agent, also known as a tissue plasminogen activator (t-PA) or 'clot-buster'.
Think about the primary mechanism of action for this drug class. Thrombolytics dissolve existing blood clots.
From the mechanism, deduce the most likely and common side effect. A drug that breaks down clots throughout the body will inherently increase the risk of bleeding.
Examine the options to find the one that represents a form of bleeding. Epistaxis is a nosebleed.
Eliminate the other options by confirming they are not related to the drug's primary action (e.g., weight loss, hypoglycemia) or are less common than general bleeding (e.g., headache).

Concept Tested & Keywords

QuWNXEdCsPZACz1Pe0ou6f

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 64-66