Discuss NABP NAPLEX Exam Topic 5 Question 118

Alteplase is ordered for a 72 YOM who weighs 68kg for Ischemic stroke. The ER physician would like you to dose. As an ER pharmacist you know the dose is 0.9 mg/kg IV (not to exceed 90 mg); give 10% of the total dose as an IV bolus over 1 minute, then give the remaining 90% as an IV infusion over 60 minutes. After reconstitution, the concentration of Altaplace is 1mg/ml. How many ml is needed for the bolus and how many ml is needed for the infusion? Round to the nearest ml.

A6ml IV bolus, followed by 55mL IV over 60 minutes

B4ml IV bolus, followed by 57mL IV over 60 minutes

C3ml IV bolus, followed by 58mL IV over 60 minutes

D8ml IV bolus, followed by 52mL IV over 60 minutes

E9ml IV bolus, followed by 82mL IV over 60 minutes

Suggested Answer: A

68kg 0.9mg/kg = 61.2mg dose 1mg/mL = 61.2mL 61.2mg 0.1 = 6mL IV bolus 61.2mg 0.9 = 55mL IV over 60 minutes

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21 comments · newest first

Lemuel 1 month ago

I’m with A. It fits the dosing guidelines perfectly.

Myrtie 1 month ago

I agree with B. 4ml for the bolus sounds reasonable.

Nan 1 month ago

I calculated E, but it feels too much for the bolus.

Jerlene 2 months ago

I feel like D could be correct. The bolus seems high though.

Luisa 2 months ago

I’m leaning towards B. The calculations seem off for A.

Vinnie 2 months ago

This question is tricky! I think A is the right choice.

Lynsey 2 months ago

I agree, 6ml bolus, then 55ml infusion sounds right.

Renea 2 months ago

I think 9ml is excessive. 6ml makes more sense.

Eileen 2 months ago

I’m leaning towards 6ml too. It fits the weight calculation.

Jettie 3 months ago

I calculated 8ml for the bolus. Seems reasonable.

Horace 3 months ago

I feel like 4ml is too low for the bolus.

Joaquin 3 months ago

This question is tricky! I think the bolus should be around 6ml.

Judy 3 months ago

9ml for the bolus? That seems high, right?

Meghan 3 months ago

I disagree, B seems more accurate to me.

Jutta 4 months ago

Wait, how do we get 55ml for the infusion?

Val 5 months ago

I think A is correct, 6ml bolus sounds right!

Isaiah 5 months ago

The dose is 0.9 mg/kg, so for 68kg that's 61.2 mg total.

Carlee 6 months ago

I feel like I might be overthinking this. If the max dose is 90 mg, does that change how I calculate the bolus? I need to double-check my notes.

Weldon 6 months ago

I practiced a similar question where we had to calculate the total dose first. I think for this patient, the total dose would be around 61.2 mg, which makes the bolus about 6 ml.

Giuseppe 6 months ago

I think the bolus is 10% of the total dose, but I can't recall if I should round before or after calculating the ml needed.

Krissy 6 months ago

I remember the dosing for alteplase is 0.9 mg/kg, but I'm not sure how to calculate the bolus and infusion volumes correctly.

NABP NAPLEX Exam - Topic 5 Question 118 Discussion