tenecteplase

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.