Names and pronunciation
(ten-ek′ta-place) TNKase
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Drug reference
(ten-ek′ta-place) TNKase
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Func. class.: Thrombolytic/fibrinolytic
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Chem. class.: Tissue plasminogen activator
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Do not confuse: TNKase/Activase
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ACTION: Activates conversion of plasminogen to plasmin (fibrinolysin): plasmin breaks down clots (fibrin), fibrinogen, factors V, VII; occlusion of venous access lines
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USES: Acute myocardial infarction, coronary artery thrombosis
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CONTRAINDICATIONS: Hyper- sensitivity, arteriovenous malformation, aneurysm, active bleeding, intracranial/ intraspinal surgery or trauma within 2 mo, CNS neoplasms, severe hypertension, severe renal/hepatic disease, history of CVA, increased ICP/stroke Precautions: Pregnancy, breastfeeding, children, geriatric patients, arterial emboli from left side of heart, hypocoagulation, subacute bacterial endocarditis, rheumatic valvular disease, cerebral embolism/throm- bosis/hemorrhage, intraarterial diagnostic procedure or surgery (10 days), recent major surgery, dysrhythmias, hypertension
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SIDE EFFECTS CNS: Intercranial bleeding CV: Dysrhythmias, hypotension, cardio genic shock, cardiac arrest, heart failure, myocardial reinfarction, myocardial rup ture, tamponade, pericarditis, pericardial effusion, thrombosis, CVA RESP: Pulmonary edema/embolism GI: GI bleed GU: Hematuria HEMA: Decreased Hct, bleeding INTEG: Rash, urticaria, phlebitis at IV infusion site, itching, flushing SYST: Retroperitoneal bleeding, surface bleeding, anaphylaxis
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INTERACTIONS Increase: bleeding—aspirin, indometha- cin, phenylbutazone, anticoagulants, antithrombolytics, glycoprotein IIb/IIIa inhibitors, dipyridamole, clopidogrel, ticlopidine, NSAIDs, cefamandole, cefo- perazone, cefoTEtan, SSRIs, SNRIs Drug/Herb Increase: risk of bleeding—feverfew, garlic, ginger, ginkgo, green tea, horse chestnut Drug/Lab Test Increase: INR, PT, PTT
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DOSAGE AND ROUTES Total dose, max 50 mg based on patient’s weight • Adult <60 kg: IV BOL 30 mg, give over 5 sec • Adult ≥60-<70 kg: IV BOL 35 mg, give over 5 sec • Adult ≥70-<80 kg: IV BOL 40 mg, give over 5 sec • Adult ≥80-<90 kg: IV BOL 45 mg, T give over 5 sec • Adult ≥90 kg: IV BOL 50 mg, give over 5 sec, max 50 mg total dose
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Available forms: Powder for inj, lyoph- ilized 50 mg/vial
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Administer: IV bolus route • Total dose is based on patient's weight, max 50 mg • Refer to product insert for instruction on how to use product • As soon as thrombi are identified; not useful for thrombi >1 wk old • Cryoprecipitate or fresh frozen plasma if bleeding occurs • Heparin after fibrinogen level >100 mg/dL; heparin infusion to increase PTT to 1.5-2× baseline for 3-7 days; IV hepa- rin with loading dose is recommended • Aseptically withdraw 10 mL of sterile water for inj from diluent vial; use red can- nula syringe-filling device; inject all con- tents of syringe into product vial; direct into powder, swirl, withdraw correct dose; dis- card any unused sol; stand shield with dose vertically on flat surface and recap red cannula; remove entire shield assembly by twisting counterclockwise; give by IV BOL • IV therapy: use upper-extremity vessel that is accessible to manual compression • If product not used immediately, refrig- erate; use within 8 hr; not compatible with dextrose; flush dextrose-containing lines with saline before and after administration
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Assess: • Hypersensitivity: fever, rash, itching, chills; mild reaction may be treated with antihistamines • Cholesterol embolism, blue-toe syn drome, renal failure, MI, cerebral/spinal cord/bowel/retinal infarction, hyperten sion; can be fatal • Bleeding during 1st hr of treatment; hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchy mosis; may require tranfusion (rare), con tinue to assess for bleeding for 24 hr • AVM, recent surgery, actual bleed- ing: assess for contraindications before use • Blood studies: Hct, platelets, PTT, PT, TT, aPTT before starting therapy; PT or aPTT must be <2× control before starting therapy; PTT or PT q3-4hr during treat- ment; also monitor CPK, ECG, fibrin degra- dation products (FDPs), fibrinogen, INR • VS, B/P, pulse, respirations, neurologic signs, temperature at least q4hr; tempera- ture >104°F (40°C) indicates internal bleeding; systolic pressure increase >25 mm Hg should be reported to prescriber • Neurologic changes that may indicate intracranial bleeding; if suspected, a CT scan should be performed • Retroperitoneal bleeding: back pain, leg weakness, diminished pulses • Bed rest during entire course of treatment • Avoidance of venous or arterial punc- ture, inj, rectal temperature, any invasive treatment, if possible; if arterial puncture is needed, use upper extremity, use pressure dressing for at least 30 min, monitor closely • Treatment of fever with acetamino- phen or aspirin • Pressure for 30 sec to minor bleeding sites; inform prescriber if this does not attain hemostasis; apply pressure dressing • Pregnancy/breasfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: resolution of MI
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About proper dental care to avoid bleeding • To notify prescriber immediately of sudden, severe headache • To notify prescriber of bleeding; hyper sensitivity; fast, slow, or uneven heart rate; feeling of faintness; blood in urine, stools; nosebleeds
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PHARMACOKINETICS IV: Onset immediate, half-life 20-24 min, metabolized by liver
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• Adult <60 kg: IV BOL 30 mg, give over 5 sec
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• Adult ≥60-<70 kg: IV BOL 35 mg, give over 5 sec
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• Adult ≥70-<80 kg: IV BOL 40 mg, give over 5 sec
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• Adult ≥80-<90 kg: IV BOL 45 mg, T give over 5 sec
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• Adult ≥90 kg: IV BOL 50 mg, give over 5 sec, max 50 mg total dose
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