Anticoagulants -
Anticoagulants such as heparin Vitamin K antagonists and drugs that alter platelet function
( such as acetylsalicylic acid, dipyridamole and GP IIb and IIIa inhibitors) may increase the risk
of bleeding if administered prior to , during or after tenecteplase therapy

Drug/Lab test Interaction-
during tenecteplase therapy, results of coagulation tests and/or measures of fibronolytic
activity may be unreliable unless specific precautions are taken to prevent in vitro artifacts

Acute myocardial Infarction AMI

Allergic reactions-    anaphylaxis, angioedema, laryngeal edema, rash, urticaria, <1% reported

Hematologic-   most frequent - bleeding. serious bleeding may occur. Death or permanent
                          disability can occur in patients in patients who experience stroke or serious
                          bleeding episodes.

Miscellaneous-       cardiogenic shock, arrhythmias, atrioventricular block, pulmonary edema,
                                  heart failure, cardiac arrest, recurrent myocardial ischemia,
                                  myocardial reinfarction, myocardial rupture, cadiac tamponade, percarditis
                                  pericardial effusion, mitrial regurgitation, thrombosis. embolism and
                                  electromechanical disassociation

                                  Nausea, vomiting, hypotension and fever have been reported

Contraindicated in patients with acute myocardial infarction

Special Precaution-
Bleeding- should serious bleeding occur any concomittant heparin or anticoagulant should be
discontinued immediately

High risk patients- each patient should be carefully evaluated and anticipated benefits weighed
against potential risks associated with therapy.

Cholesterol embolization - has been reported rarely.This serious condition which can be lethal ,
is also associated with invasive vascular procedures eg cardiac catherization, angiography,
vascular surgery.

Arrhythmias- it is recommended that antiarrhythmic therapy for bradycadia and/or vascular
irritability be available when tenecteplase is adminstered

Pregnancy- tenecteplase should be given to pregnant women only if potential benefit outweigh
the potential risk to the fetus.

Lactation- excercise caution when tenecteplase is adminstered to a breast-feeding woman

Children-  the safety and efficacy of tenecteplase in children have not been established

Elderly- the benefits of tenecteplase on mortality should be carefully weighed against the increased
risks of advere events, including bleeding 
 

Indication-
Acute myocardial Infarction AMI

Dosage-
Teneceplase is  for intervenous administration  only
Recomended daily dose should not exceed 50mg and is based on patients weight.

A single bolus dose should be administered over 5 seconds based on patients weight .
The treatment should be initiated as soon as possible after the onset of AMI symptoms

Pharmacology-
Tenecteplase is a modified form of human tissue plasminogen activator tPA  that binds fibrin
and converts plasminogen to plasmin . In the presence of fibrin, in vitro studies demonstrates
that tenecteplase conversion of plasmonogen to plasmin is incresed relative to its conversion
in the absence of fibrin.

Pregnancy-
Tenecteplase should be given to pregnant women only if potential benefit outweigh
the potential risk to the fetus.

Lactation-
Excercise caution when tenecteplase is adminstered to a breast-feeding woman

Children- 
The safety and efficay of tenecteplase in children have not been established

Elderly-
The benefits of tenecteplae on mortality should be carefully weighed against the increased
risks of advere events. including bleeding