Elaxim

Indications

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Acute bronchospasm
• Respiratory distress

Dosage

Children: Refer to specific drug guidelines in the BNF for Children for accurate dosing information.

Adults: Refer to specific drug guidelines in the BNF for accurate dosing information.

Mechanism of action

The mechanism of action varies depending on the specific drug being actuated, but generally involves the rapid dispersal of drug particles into the airways. For inhaled bronchodilators, they typically work by binding to adrenergic receptors in the bronchial smooth muscle leading to relaxation and dilation of the airways.

Pharmacodynamics

Pharmacodynamics of actuation primarily involves the drug's effects on the respiratory system, with the intention of relieving bronchoconstriction and improving airflow. The duration of action and peak effect can vary widely based on the specific medication used and the delivery technique.

Pharmacokinetics

Pharmacokinetics of inhaled medications generally indicates a rapid onset of action due to the direct delivery to the lungs, with peak plasma concentrations occurring within minutes. The distribution is localized, and the elimination half-life will depend on the specific pharmacological properties of the drug being actuated.

Pregnancy

Limited data on the safety of actuation during pregnancy. Consult a healthcare provider for individualized assessment.

Breast-feeding

Consult a healthcare provider as the effects on breastfed infants are not well-studied.

Storage

Store in a cool, dry place, away from light and moisture.

Indications

• Acute myocardial infarction
• Acute coronary syndromes

Dosage

Adults: 30–50 mg (maximum per dose 50 mg), administered intravenously over 10 seconds, initiated within 6 hours of symptom onset.

Mechanism of action

Tenecteplase is a genetically engineered variant of tissue plasminogen activator (tPA) that binds to fibrin in a thrombus (blood clot) and activates plasminogen, converting it to plasmin. This process leads to the degradation of fibrin, thus facilitating the dissolution of the clot and restoration of normal blood flow.

Pharmacodynamics

The pharmacodynamic effects of tenecteplase include rapid thrombolysis in patients with acute myocardial infarction. The drug's fibrin specificity and longer half-life compared to alteplase contribute to its efficiency in dissolving clots. It enhances the body's ability to recanalize occluded coronary arteries, resulting in improved myocardial perfusion.

Pharmacokinetics

Tenecteplase is administered intravenously, with a bioavailability approaching 100%. The drug has a half-life of approximately 20 to 25 minutes, allowing for rapid action. Its clearance is primarily through the liver, and plasma levels can be affected by factors such as age, weight, and renal function. Monitoring is essential to ensure effective dosing and minimize the risk of bleeding complications.

Contra-indications

• Aortic stenosis
• Cardiac tamponade
• Head trauma
• Toxic pulmonary oedema
• Recent history of myocardial infarction
• Susceptibility to angle-closure glaucoma
• Ventilation and perfusion abnormalities

Adverse effects

• Drowsiness
• Hemiparesis
• Venous thrombosis
• Arrhythmias
• Asthenia
• Cerebral ischaemia
• Dizziness
• Flushing
• Headache
• Hypotension
• Nausea
• Vomiting
• Circulatory collapse
• Diarrhoea
• Skin reactions

Interactions

• Nitrates may develop tolerance leading to reduced therapeutic effects
• Care should be taken when used with other anticoagulants or antiplatelet agents

Precautions

• Caution in elderly patients due to potential for postural hypotension and falls
• Patients on long-acting nitrates should have doses adjusted to avoid tolerance
• Monitor for signs of bleeding

Pregnancy

Manufacturer advises caution, as risk cannot be ruled out.

Breast-feeding

Manufacturer advises avoiding breastfeeding for 24 hours after dose; express and discard milk during this time.

Storage

Store in a cool, dry place. Protect from light. Store vials in the original package until use.

Formulations

• Powder for solution for infusion