Tenecteplase

INTRODUCTION

Indications

Reduction of mortality associated with acute myocardial infarction.

Action

Converts plasminogen to plasmin, which is then able to degrade fibrin present in clots. Directly activates plasminogen. Therapeutic Effects: Lysis of thrombi in coronary arteries, with preservation of myocardium and resultant decrease in mortality.

Adverse Reactions/Side Effects

Adverse reactions are frequently sequelae of underlying disease

CV: ARRTHYTHMIAS, CARDIOGENIC SHOCK, CARDIAC TAMPONADE, EMBOLISM, HEART FAILURE, MYOCARDIAL INFARCTION, MYOCARDIAL RUPTURE, PERICARDITIS, PERICARDIAL EFFUSION, PULMONARY EDEMA, RECURRENT MYOCARDIAL ISCHEMIA, THROMBOSIS, hypotension. GI: nausea, vomiting. Hemat: BLEEDING. Misc: allergic reactions, including anaphylaxis, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, coughing up blood, black/tarry stools, hematuria, or a fall in hematocrit or blood pressure. Be especially alert for signs of intracranial bleeds, including sudden severe headache, confusion, nausea, vomiting, paralysis, numbness, speech problems, and visual disturbances. Notify physician or nursing staff immediately if these signs occur.

• Be alert for signs of recurrent cardiac ischemia and MI (chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety) or recurrent peripheral arterial thrombosis (pain, cramping, coldness, cyanosis in the affected limb). Notify physician or nursing staff immediately if these signs occur.

• Assess signs of heart failure and pulmonary edema, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician or nursing staff immediately.

• Assess heart rate, ECG, and heart sounds, especially for the first few days after infusion (See Appendices G, H). Report immediately any rhythm disturbances, or symptoms of increased arrhythmias (palpitations, chest discomfort, shortness of breath, fainting, fatigue/weakness).

• Assess blood pressure, especially for the first few days after infusion. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess injection site during and after IV administration, and report signs of bleeding or phlebitis (local pain, swelling, inflammation).

Interventions

• Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

• Use extreme caution during aerobic exercise in patients with recent MI. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, ...