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Drug Administration Guidelines / Tenecteplase XXX

ST-ELEVATION MYOCARDIAL INFARCTION

DATE/TIME /

PROCEDURE

Admission
Day 0 / Insert 2 insytes
ECG
Bloods: G&S, APTT, INR, FBE, ECU, LFT, Mg, Glu, Chol, Trig,
CK, CKMB, Troponin T
ASPIRIN 150-300mg oral chew or dissolve in water
00:00 /

HEPARIN IV BOLUS (weight adjusted dose according to CIC guidelines)

Flush line with 20mL Normal Saline

TENECTEPLASE (TNK) INTRAVENOUS BOLUS: Choose vial size according to patient's body weight.Reconstitute. Withdraw appropriate volume of Tenecteplase solution based on patient's body weight. (see table)Administer Tenecteplase as a single intravenous bolus in ~10 seconds.

Flush line with 20mL Normal Saline
Note: Tenecteplase is incompatible with Glucose 5%

HEPARIN INFUSION: 25,000unit in 500mL Glucose 5%

Commence Heparin Infusion (weight adjusted) according to CIC guidelines
Titrate according to APTT/Heparin nomogram
Continue for at least 24 hours
20 minutes / Assess pain
30 minutes /

Consider: Beta-Blocker

ECG

6 hours /

APTT - adjust Heparin rate according to nomogram

CK
12 hours / Consider: ACE Inhibitor, 'Statin'
APTT – adjust IV heparin rate according to Heparin/APTT nomogram
CK
18 hours / APTT if required (if subtherapeutic at 1200)
CK
24 hours / APTT – adjust IV heparin rate according to nomogram
CK, TropT, ECU, LIPIDS, FBE
36 hours / APTT if indicated


RECOMMENDED ADMINISTRATION:

TENECTEPLASE (TNK) RECONSTITUTION: (1)
Reconstitute Tenecteplase powder by adding the complete volume of water for Injections from the prefilled syringe.
Ensure appropriate vial size is chosen according to patient's body weight.
Swirl gently.
Immediately before the solution is to be administered, invert the vial with the syringe still attached , so syringe is below the vial.
Withdraw into syringe appropriate volume of Tenecteplase based on patient's weight.

Body weight (kg) / Tenecteplase
(IU) / Tenecteplase
(mg) / Volume from vial
(mL)
<60.0 / 6,000 / 30 / 6
60.0 - 69.9 / 7,000 / 35 / 7
70.0 - 79.9 / 8,000 / 40 / 8
80.0 - 89.9 / 9,000 / 45 / 9
³ 90.0 / 10,000 / 50 / 10

TENECTEPLASE INFUSION: Guidelines attached

COMPATIBLE FLUIDS: Sodium Chloride 0.9%(2)

INCOMPATIBLE FLUIDS: Glucose 5%(2)

OTHER NAMES: METALYSE, TNK

PRESENTATION: 8,000 IU (40mg) & 10,000 IU (50mg)
THROMBOLYTIC INDICATIONS: (Reference: Aylward & Burns 6/1999)

A thrombolytic agent is indicated in patients who meet the following criteria:1) 18 years and older (no upper age limit) (x)

2) within 12 hours of onset of symptoms suggestive of an acute myocardial infarction (x)

3) chest pain >30minutes duration (x)

4) abnormal ECG (x)
ST elevation ³ 1mm in two or more continguous leads
LBBB (new or confirmed CK rise)
ST depression in precordial leads suggesting posterior MI

THROMBOLYTIC EXCLUSION CRITERIA: (Reference: Aylward & Burns 6/1999)

1) Active bleeding
2) History of CVA or CNS damage within past 6 months
3) Major surgery or trauma in the past 2 months
4) Non-compressible vascular puncture in the past 2 weeks
5) Uncontrolled hypertension, i.e. systolic >200, diastolic >110
6) Consider PTCA in women who are breast-feeding or pregnant

SIDE EFFECTS: Bleeding
Tenecteplase has a terminal half-life of ~ 2hrs.
Bleeding risk after TNK should be diminished after 10 hours.

REFERENCES:

 Manufacturer 99

 Trissel 10th ed.

 Australian Injectable Drugs Handbook, SHPA, 2nd Ed. 1999

 Martindale 32nd ed.

 FMC Formulary 9th ed. 1999/2000

 Resuscitation from Cardiac Arrest Committee, F.M.C.

 Cardiovascular Drug Guidelines 3rd Ed., 1/95
Victorian Drug Usage Advisory Committee

 TGA

(10)  ACC Acute Myocardial Infarction Guidelines 1996, revision 1999

(11)  Micromedex

Cardiac Clinical Pharmacy Service, F.M.C. Wendy Siebert: IV-Tenecteplase 2002

3 December, 2007