Module 9 thrombolytics and reversal agents

Question 1

Thrombolytic drug classes

Answer 1

tissue plasminogen activator (TPA)
streptokinase
urokinase

Question 2

TPA drugs

Answer 2

alteplase
tenecteplase
reteplase

Question 3

Thrombolytic MOA

Answer 3

cause lysis of existing clots

- plasminogen activators: plasmin degrades crosslinked fibrin which is required for formation of clot

Question 4

thrombolytic uses

Answer 4

lysis of existing clots
restore patency of obstructed tissue -> prevention of distal tissue necrosis 
- acute MI
- acute ischemic stroke
- Massive PE
- Central IV line occlusion

Question 5

thrombolytic AE

Answer 5

dissolution of pathologic thrombi
dissolution of physiologically appropriate fibrin clots in response to vascular injury
-> hemorrhage

Question 6

reversal agent drugs

Answer 6

NovoSeven
Kcentra
FEIBA
praxbind

Question 7

Novoseven (rFVIIA)

Answer 7

recombinant factor VIIa
- contains mammalian proteins
reversal in 10-20 minutes
short duration: 1-2 hours

Question 8

Kcentra (4-PCC)

Answer 8

Warfarin reversal 
contains vitamin K dependent factors
- II, VII, IX, X, protein S and C 
FFP in a syringe: equivalent to 8-16 units 
DO NOT: use with HITT 
reversal within 30 minutes

Question 9

FEIBA (anti-inhibitor coag complex)

Answer 9

activated prothrombin complex from human plasma

- combo of active FVII and inactive II, IX, X

Question 10

Praxbind (idarucizumab)

Answer 10

humanized monoclonal antibody fragment
- binds directly to dabigatran 
- irreversibly binds to benzamide
- Reverses aPTT, PT, TT
rapid onset: immediate reversal 
duration: single bolus at least 24 hours