Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (385 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTtenecteplase (TNK-tPA)(Rx)
(ten-ek′ta-place)
TNKase
Func. class.:
Thrombolytic
Chem. class.:
Tissue plasminogen activator
Activates conversion of plasminogen to plasmin (fibrinolysin): plasmin breaks down clots (fibrin), fibrinogen, factors V, VII; occlusion of venous access lines
Acute myocardial infarction, coronary artery thrombosis
Hypersensitivity, 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 (C), breastfeeding, children, geriatric patients, arterial emboli from left side of heart, hypocoagulation, subacute bacterial endocarditis, rheumatic valvular disease, cerebral embolism/thrombosis/hemorrhage, intraarterial diagnostic procedure or surgery (10 days), recent major surgery, dysrhythmias, hypertension
Calculator
• 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, give over 5 sec
• Adult ≥90 kg:
IV BOL
50 mg, give over 5 sec, max 50 mg total dose
Available forms:
Powder for inj, lyophilized 50 mg
•
As soon as thrombi identified; not useful for thrombi >1 wk old
•
Cryoprecipitate or fresh frozen plasma if bleeding occurs
•
Heparin after fibrinogen level >100 mg/dl; heparin inf to increase PTT to 1.5-2× baseline for 3-7 days; IV heparin with loading dose is recommended
•
Aseptically withdraw 10 ml of sterile water for inj from diluent vial, use red cannula syringe-filling device, inject all contents of syringe into product vial, direct into powder, swirl, withdraw correct dose, discard any unused sol; stand shield with dose vertically on flat surface and passively recap red cannula, remove entire shield assembly by twisting counter-clockwise, give by IV BOL
•
IV therapy: use upper-extremity vessel that is accessible to manual compression
•
If product not used immediately, refrigerate, use within 8 hr; not compatible with dextrose; flush dextrose-containing lines with saline before and after administration
CV:
Dysrhythmias, hypotension, pulmonary edema,
pulmonary embolism, cardiogenic shock, cardiac arrest, heart failure, myocardial reinfarction, myocardial rupture, tamponade, pericarditis, pericardial effusion, thrombosis, CVA
HEMA:
Decreased Hct,
bleeding
INTEG:
Rash, urticaria, phlebitis at IV inf site, itching, flushing
SYST:
GI, GU, intracranial, retroperitoneal bleeding, surface bleeding, anaphylaxis
IV:
Onset immediate, half-life 20-24 min, metabolized by liver
Increase:
bleeding—aspirin, indomethacin, phenylbutazone, anticoagulants, antithrombolytics, glycoprotein IIb/IIIa inhibitors, dipyridamole, clopidogrel, ticlopidine, NSAIDs, cefamandole, cefoperazone, cefoTEtan, SSRIs, SNRIs
Increase:
risk of bleeding—feverfew, garlic, ginger, ginkgo, green tea, horse chestnut
Increase:
INR, PT, PTT
•
Allergy:
fever, rash, itching, chills; mild reaction may be treated with antihistamines
•
Cholesterol embolism, blue-toe syndrome, renal failure, MI, cerebral/spinal cord/bowel/retinal infarction, hypertension; can be fatal
Bleeding
during 1st hr of treatment; hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; may require tranfusion (rare), continue to assess for bleeding for 24 hr
•
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 treatment
•
Hypersensitive reactions: fever, rash, dyspnea; product should be discontinued
•
VS, B/P, pulse, respirations, neurologic signs, temp at least q4hr; temp >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
Retroperitoneal bleeding: back pain, leg weakness, diminished pulses
•
Bed rest during entire course of treatment
•
Avoidance of venous or arterial puncture, inj, rectal temp, any invasive treatment
•
Treatment of fever with acetaminophen or aspirin
•
Pressure for 30 sec to minor bleeding sites; inform prescriber if this does not attain hemostasis; apply pressure dressing
•
Therapeutic response: resolution of MI
•
About proper dental care to avoid bleeding
•
To notify prescriber immediately of sudden, severe headache
•
To notify prescriber of bleeding; hypersensitivity; fast, slow, or uneven heart rate; feeling of faintness; blood in urine, stools; nose bleeds
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert