Home Drug Guide Tenecteplase

Drug Guide

Generic Name

Tenecteplase

Brand Names TNKase

Classification

Therapeutic: Thrombolytic agent

Pharmacological: Fibrin-specific plasminogen activator

FDA Approved Indications

Acute myocardial infarction (ST-segment elevation myocardial infarction, STEMI)

Mechanism of Action

Tenecteplase is a genetically engineered variant of tissue plasminogen activator (tPA). It binds to fibrin in a thrombus, converting plasminogen to plasmin, which then degrades fibrin and dissolves the clot.

Dosage and Administration

Adult: Typically, a single IV bolus dose of 30-50 mg, based on body weight (e.g., 0.5 mg/kg up to a maximum of 50 mg). Dosing should be administered as a rapid IV bolus over 5 seconds.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; adjust dose based on clinical judgment and risk factors.

Renal Impairment: No specific adjustment recommended, but caution advised.

Hepatic Impairment: No specific adjustment recommended.

Pharmacokinetics

Absorption: Not applicable; administered IV.

Distribution: Widely distributed with a volume of distribution around 13 mL/kg.

Metabolism: Metabolized primarily by the liver, with a half-life of approximately 20 minutes.

Excretion: Excreted via the liver with minimal renal clearance.

Half Life: Approximately 20 minutes.

Contraindications

Active internal bleeding
Previous intracranial hemorrhage
Recent stroke or head trauma
Known bleeding disorders
Suspected aortic dissection
Severe uncontrolled hypertension

Precautions

Use with caution in patients on anticoagulants or with recent surgery, trauma, or invasive procedures. Careful assessment for bleeding risk is essential.

Adverse Reactions - Common

Bleeding, including intracranial hemorrhage (Common)
Hypersensitivity reactions (Uncommon)

Adverse Reactions - Serious

Intracranial hemorrhage (Rare)
Anaphylactic reactions (Rare)

Drug-Drug Interactions

Anticoagulants (e.g., heparin, warfarin)
Antiplatelet agents (e.g., aspirin, clopidogrel)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, including neurological status, blood pressure, and bleeding at insertion sites.

Diagnoses:

Risk for bleeding related to thrombolytic therapy.

Implementation: Administer as per protocol, ensuring proper IV access and dosing. Prepare resuscitation equipment for bleeding management.

Evaluation: Monitor for bleeding complications, efficacy in clot resolution, and adverse reactions.

Patient/Family Teaching

Report signs of bleeding immediately, including unusual bruising, bleeding gums, blood in urine or stool, or severe headache.
Inform about the purpose of medication and importance of adherence.
Instruct to avoid invasive procedures unless necessary and to notify healthcare providers of all medications being taken.

Special Considerations

Black Box Warnings:

Significant risk of bleeding, including intracranial hemorrhage.
Use only in facilities equipped for management of bleeding complications.

Genetic Factors: None established.

Lab Test Interference: May affect coagulation studies; interpret results cautiously.

Overdose Management

Signs/Symptoms: Excessive bleeding, hemorrhagic shock.

Treatment: Discontinue the drug immediately, provide supportive care, and manage bleeding with blood products or surgical intervention as needed.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable until the expiration date printed on the package.