Fibrinolytic drugs

Question 1

Fibrinolytic drugs 1 group and 3 drugs

Answer 1

Recombinant tissue plasminogen activators (t-PA)
Urokinase
Streptokinase
Anistreplase

Question 2

Fibrinolytic drugs - indications

Answer 2

Degrade thrombus in MI, thrombotic stroke, pulmonary embolism.

Question 3

t-PAs - 3 drugs

Answer 3

Alteplase
Reteplase
Tenecteplase

Question 4

Fibrinolytic drugs - MOA

Answer 4

Convert plasminogen to plasmin.

Question 5

Fibrinolytic drugs - adverse effects

Answer 5

Bleeding, but less with t-PAs.
Arrhythmias (tachy and brady) –> from free radicals after reperfusion of coronary arteries after thrombolysis.
Streptokinase - hypersensitivity (anaphylactic shock), should not be used repeatedly in same pt.

Question 6

Treatment of fibrinolytic drug-associated hemorrhage

Answer 6

Aminocaproic acid - inhibits fibrinolysis.

Question 7

Aminocaproic acid - indications

Answer 7

Hemorrhage by fibrinolytic drugs.
After GI or prostate surgery.
Cancer pts during radiation/chemo.

Question 8

Aminocaproic acid - amd

Answer 8

Orally or intravenously

Question 9

Aminocaproic acid - adverse effects

Answer 9

Thrombosis, hypotension, arrhythmias.

Question 10

Tranexamic acid - what is it, and MOA.

Answer 10

Antifibrinolytic drug. Occupies the lysine binding sites of plasmin for fibrin.

Question 11

Tranexamic acid - indications

Answer 11

Heavy menstrual bleedings.

Question 12

Tansexamic acid - adverse effects

Answer 12

Thrombotic events (esp if pts are on hormonal contraceptives, are obese or smoking).

Question 13

Fibrinolytic drugs that may be given by infusion

Answer 13

Streptokinase, alteplase

Question 14

Fibrinolytic drugs that may be given in bolus

Answer 14

Reteplase

Tenecteplase

Question 15

Systemic fibrinogen depletion of fibrinolytic drugs

Answer 15

Streptokinase: marked
Reteplase: moderate
Alteplase: mild
Tenecteplase: minimal.

Question 16

Contraindications to thrombolysis

Answer 16

Contraindications to fibrinolytic therapy for deep venous thrombosis or acute pulmonary embolism

Absolute contraindications
Prior intracranial hemorrhage
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within three months (excluding stroke within three hours*)
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed-head trauma or facial trauma within three months

Relative contraindications
History of chronic, severe, poorly controlled hypertension
Severe uncontrolled hypertension on presentation (SBP >180 mmHg or DBP >110 mmHg)
History of ischemic stroke more than three months prior
Traumatic or prolonged (>10 minute) CPR or major surgery less than three weeks
Recent (within two to four weeks) internal bleeding
Noncompressible vascular punctures
Recent invasive procedure
For streptokinase/anistreplase - Prior exposure (more than five days ago) or prior allergic reaction to these agents
Pregnancy
Active peptic ulcer
Pericarditis or pericardial fluid
Current use of anticoagulant (eg, warfarin sodium) that has produced an elevated international normalized ratio (INR) >1.7 or prothrombin time (PT) >15 seconds
Age >75 years
Diabetic retinopathy