Tenecteplase

Question 1

Pharmacology and presentation of Tenecteplase?

Answer 1

• 50mg powder ampoule & prefilled 10ml syringe of sterile water
• Fibrinolytic that accelerates the breakdown of blood clots, it converts the plasma protein plasminogen into the active enzyme plasmin, which breaks down fibrin within blood clots

Question 2

Indicators of Tenecteplase?

Answer 2

• STEMI (Fibrinolytic pathway)

Question 3

Contraindications of Tenecteplase?
5 Head, 1 heart, 1 allergy
TIKIMAP

Answer 3

5 Head, 1 heart, 1 allergy
T - Tumour, cerebral aneurysm, aterios venous malformation
I - Ischaemic stroke within 6 months
K - Known severe allergy
I - intracranial surgery within 6 months
M - Major surgery/trauma/tbi within 6 weeks
A - Aortic Dissection
P - Previous intracerebral haemorrhage

• Major surgery, major trauma or severe brain injury within the last six weeks.
• lntracranial surgery within the last six months.
• lschaemic stroke within the last six months.
• Previous intracerebral haemorrhage.
• Known cerebral aneurysm, arteriovenous malformation or tumour.
• Suspected aortic dissection.
• Known severe allergy.

Question 4

Cautions of Tenecteplase?

6x Blood, 5x Life, 3x Brain

C.A.P.T.I.V.A.T.E.D.F.O.K.S

Answer 4

1. C - Clinically significant Bleed
2. A - Anticoagulant
3. P - Pregnant or 2 weeks PP
4. T - Ten mins of CPR
5. I - Internal Bleeding last 6 Weeks
6. V - Vascular puncture non compressible last 24hrs
7. A - Another disease shortens life expectancy
8. T - TIA within 3 months
9. E - Epidural or lumbar puncture within 6 weeks
10. D - Dependent on others for daily living
11. F - Frail very
12. O - Onset greater than 12 hrs
13. K - Known bleeding disorder
14. S - SBP >180 or DBP >110

• Clinically significant bleeding.
• Non-compressible vascular puncture within the last 24 hours.
• Internal bleeding within the last six weeks.
• Known bleeding disorder.
• Taking an anticoagulant. If the patient is taking warfarin document their last known INR result (prothrombin test) if possible.
• Systolic BP greater than 180 mmHg or diastolic BP greater than 11O mmHg.
• More than ten minutes of CPR.
• Known to be pregnant or less than two weeks postpartum.
• Dependent on others for activities of daily living.
• Another disease significantly shortens their life expectancy.
• Very frail.
• Lumbar puncture or epidural insertion within the last six weeks.
• TIA within the last three months.
• Time of onset of symptoms was greater than 12 hours ago.

Question 5

Side Effects of Tenecteplase?

Answer 5

• Superficial Bleeding.
• Dysrhythmia. Generally AIVR, other rhythms treat PRN

Question 6

Dosing Regimes of Tenecteplase?

Answer 6

Adult IV, dissolve powder into 50mg:10ml and discard down

• Age less than 75
  • <60kg = 30mg:6ml
  • 60-69kg = 35mg:7ml
  • 70-79kg = 40mg:8ml
  • 80-89kg = 45mg:9ml
  • >89kg = 50mg:10ml
• Age 75 years or older
  • <60kg = 15mg:3ml
  • 60-69kg = 17.5mg:3.5ml
  • 70-79kg = 20mg:4ml
  • 80-89kg = 22.5mg:4.5ml
  • >89kg = 25mg:5ml

Question 7

Onset and duration of Tenecteplase?

Answer 7

Onset:
- 5-10mins

Duration
- 2-6hrs