tenecteplase


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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.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

tenecteplase

Metalyse, 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.

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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

tenecteplase

TNKase® Cardiology A single-bolus thrombolytic clinically similar to tPA Adverse effects Intracranial bleeding, stroke, major or minor bleeding, hematomas. See Thrombolytic, tPA.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
References in periodicals archive ?
Tenecteplase is produced in a Chinese hamster ovary cell line using the recombinant DNA technology.
Institute for Safe Medication Practices recommendations are based, at least in part, on medical errors reported to the Institute for Safe Medication Practices and the FDA involving the abbreviations "tPA" and "TNK." Between 2000 and June 2014, the FDA alone received 21 cases of wrong drug administration errors associated with tenecteplase. (5) This included at least 7 cases where patients with AIS were inadvertently given tenecteplase in place of alteplase.
The researchers found that the primary outcome occurred in 22 and 10 percent of those treated with tenecteplase and alteplase, respectively (incidence ratio, 2.2; 95 percent confidence interval, 1.1 to 4.4; P = 0.002 for non-inferiority; P = 0.03 for superiority).
According to RxList, the internet drug index for prescription drugs and medications, "TNKaseA[R] (Tenecteplase) is indicated for use in the reduction of mortality associated with acute myocardial infarction (AMI).
The rate of Clinically Successful Thrombolysis (CST) with tenecteplase was 92%.
Lloyd et al., "Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study," The Lancet Neurology, vol.
Armstrong et al., "Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the assessment of the safety and efficacy of a new thrombolytic regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction," Circulation, vol.
Patients were divided randomly into three subgroups to receive standard dose of alteplase (0.9 mg per kilogram, the first 10% administered as an initial bolus and the remainder over a 1-hour period, with a maximum dose of 90 mg) or to tenecteplase (0.1 mg per kilogram, administered as a single bolus, with a maximum dose of 10 mg; or 0.25 mg per kilogram, administered as a single bolus, with a maximum dose of 25 mg).
She had no contraindications to thrombolytic therapy and therefore paramedics administered Tenecteplase. She also received an intravenous bolus injection of Heparin, Aspirin 300mg, Clopidogrel 300mg and sublingual Glyceryl Trinitrate spray.
The thrombolytic drugs tested included: alteplase (Cathflo Activase, Genentech, Inc, San Francisco, California), urokinase (Abbokinase, Abbott Laboratories, Abbott Park, Illinois), streptokinase (Streptase, Aventis, Paris, France), tenecteplase (TNKase, Genentech, Inc), and reteplase (Retavase, Boehringer Mannheim, Mannheim, Germany).
Though agents such as tenecteplase are now available in the Indian market, the concept of pre-hospital thrombolysis is still a distant dream as the ambulance facilities are poor and majority of the times those available are ill equipped.
Trials of a new thrombolytic, tenecteplase (TNK), have been conducted and reported in the HD population in the U.S.