tenecteplase

tenecteplase /te·nec·te·plase/ (tĕ-nek´tĕ-plās) a modified form of human tissue plasminogen activator produced by recombinant DNA technology; used as a thrombolytic agent in the treatment of myocardial infarction.

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tenecteplase

[tĕ-nek′tĕ-plās]

a modified form of human tissue plasminogen activator produced by recombinant DNA technology; used as a thrombolytic agent in the treatment of myocardial infarction; administered intravenously.

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tenecteplase Warning - High-alert drug!

Metalyse (UK), TNKase

Pharmacologic class: Tissue plasminogen activator

Therapeutic class: Thrombolytic enzyme

Pregnancy risk category C

Action

Binds to fibrin and converts plasminogen to plasmin, which breaks down fibrin clots and lyses thrombi and emboli. Causes systemic fibrinolysis.

Availability

Powder for injection: 50 mg/vial with 10-ml syringe and TwinPak Dual Cannula Device and 10-ml vial of sterile water for injection

⊘Indications and dosages

➣ To reduce mortality associated with acute myocardial infarction

Adults weighing 90 kg (198 lb) or more: 50 mg I.V. bolus given over 5 seconds

Adults weighing 80 kg to 89 kg (176 to 197 lb): 45 mg I.V. bolus given over 5 seconds

Adults weighing 70 kg to 79 kg (154 to 175 lb): 40 mg I.V. bolus given over 5 seconds

Adults weighing 60 to 69 kg (132 to 153 lb): 35 mg I.V. bolus given over 5 seconds

Adults weighing less than 60 kg (132 lb): 30 mg I.V. bolus given over 5 seconds

Contraindications

• Hypersensitivity to drug or other tissue plasminogen activators
• Active internal bleeding
• Bleeding diathesis
• Recent intracranial or intraspinal surgery or trauma
• Severe uncontrolled hypertension
• Intracranial neoplasm
• Arteriovenous malformation or aneurysm
• History of cerebrovascular accident (CVA)

Precautions

Use cautiously in:
• previous puncture of noncompressible vessels, organ biopsy, hypertension, acute pericarditis, high risk of left ventricular thrombosis, subacute bacterial endocarditis, hemostatic defects, diabetic hemorrhagic retinopathy, septic thrombophlebitis, obstetric delivery
• patients taking warfarin concurrently
• patients older than age 75
• pregnant or breastfeeding patients.

Administration

• Reconstitute by mixing contents of prefilled syringe with 10 ml of sterile water for injection. Swirl gently; don't shake. Draw up prescribed dosage from vial, then discard remainder. Give I.V. over 5 seconds through designated line.
☞ Don't deliver in same I.V. line with dextrose solutions. Flush I.V. line with normal saline solution before giving drug if patient has been receiving dextrose.
☞ Give with heparin if ordered, but not through same I.V. line.

Route	Onset	Peak	Duration
I.V.	Immediate	Unknown	Unknown

Adverse reactions

CNS: intracranial hemorrhage, CVA

CV: hypotension, arrhythmia, myocardial rupture, myocardial reinfarction , cardiogenic shock, atrioventricular block, cardiac arrest, cardiac tamponade , heart failure , pericarditis , pericardial effusion , mitral regurgitation , thrombosis, embolism, hemorrhage

EENT: epistaxis, minor pharyngeal bleeding

GI: nausea, vomiting, hemorrhage

GU: hematuria

Hematologic: anemia, bleeding tendency

Respiratory: respiratory depression , pulmonary edema , apnea

Skin: bleeding at puncture sites, hematoma

Interactions

Drug-drug. Anticoagulants, aspirin, dipyridamole, indomethacin, phenylbutazone: increased bleeding risk

Drug-diagnostic tests. Coagulation tests: fibrinogen degradation in blood sample

Patient monitoring

☞ Monitor ECG. Stay alert for reperfusion arrhythmias.
☞ Monitor vital signs carefully. Watch for signs and symptoms of respiratory depression and reinfarction.
☞ Evaluate all body systems closely for signs and symptoms of bleeding. If bleeding occurs, stop drug and give antiplatelet agents, as ordered.
• Monitor CBC and coagulation studies. However, know that drug may skew coagulation results.

Patient teaching

☞ Inform patient that drug increases risk of bleeding. Advise him to immediately report signs and symptoms of bleeding.
• Teach patient safety measures to avoid bruising and bleeding.
• Tell patient he'll undergo regular blood tests during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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tenecteplase

TNKase^® Cardiology A single-bolus thrombolytic clinically similar to tPA Adverse effects Intracranial bleeding, stroke, major or minor bleeding, hematomas. See Thrombolytic, tPA.