Tenecteplase

Question 1

Indications - TNKase (tenecteplase)

Answer 1

❑ ST elevation (threshold values: J-point elevation of 2 mm in leads V2 and V3 and 1 mm in all other leads) or new presumably new LBBB; in context of signs and symptoms of AMI and time of onset of signs and symptoms <12 hrs

Question 2

Dosage - TNKase (tenecteplase)

Answer 2

Weight based dosage with single bolus delivered over 5 seconds. Not compatible with dextrose solutions

.< 60kg = 30mg (6mL) - 60 to 69kg = 35mg (7mL) - 70 to 79kg = 40mg (8mL) - 80 to 89kg = 45mg (9mL) - >90kg = 50mg (10mL)

Standard management of AMI should be implemented concurrently with and following the single bolus of tenecteplase

Question 3

Contraindications - TNKase (tenecteplase)

Answer 3

❑ Any prior intracranial hemorrhage
❑ Known structural cerebral vascular lesion (e.g., AVM)
❑ Known malignant intracranial neoplasm (primary or metastatic)
❑ Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours
❑ Suspected aortic dissection
❑ Active bleeding or bleeding diathesis (excluding menses)
❑ Significant closed head trauma or facial trauma within 3 months

Question 4

Setup for TNKase (tenecteplase)

Answer 4

1. Remove the shield assembly from the supplied B-D™ 10ccc Syringe with TwinPak™ Dual Cannula Device and aseptically withdraw 10 mL of Sterile Water for Injection (SWFI), USP from the supplied diluent vial using the red hub cannula syringe filling device. Do not use Bacteriostatic Water for Injection, USP. Note: Do not discard the shield assembly.
2. Inject the entire contents of the syringe (10 mL) into the TNKase™ vial directing the diluent stream down the side of the vial. Slight foaming upon reconstitution is not unusual; any large bubbles will dissipate if the product is allowed to stand undisturbed for several minutes.
3. Gently swirl until contents are completely dissolved. DO NOT SHAKE. The reconstituted preparation results in a colorless to pale yellow transparent solution containing TNKase™ at 5mg/mL at a pH of approximately 7.3. The osmolality of this solution is approximately 290 mOsm/kg.
4. Determine the appropriate dose of TNKase™ (see Dose Information Table) and withdraw this volume (in milliliters) from the reconstituted vial with the syringe. Any unused solution should be discarded.
5. Once the appropriate dose of TNKase™ is drawn into the syringe, stand the shield vertically on a flat surface (with green side down) and passively recap the red hub cannula.
6. Remove the entire shield assembly, including the red hub cannula, by twisting counter0-clockwise. Note: The shield assembly also contains the clear-ended blunt plastic cannula; retain for split septum IV access.

Question 5

Split septum IV system

Answer 5

• Remove the green cap
• Attach the clear-ended blunt plastic cannula to the syringe.
• Remove the shield and use the blunt plastic cannula to access the split septum injection port.
• Because the blunt plastic cannula has two side ports, air or fluid expelled through the cannula will exit in two sideways directions; direct away from face or mucous membranes.

Question 6

Luer-Lok® system

Answer 6

Connect syringe directly to IV port