Streptokinase

Question 1

Drug class?

Answer 1

Thrombolytics

Question 2

How does it work?

Answer 2

The activation of the endogenous fibrinolytic system is initiated by the formation of a streptokinase-plasminogen complex. This complex possesses activator properties and converts plasminogen into the proteolytic and fibrinolytic active, plasmin. The more plasminogen that is bound within this activator complex, the less plasminogen is left to be converted into its enzymatically active form. Therefore, high doses of streptokinase are associated with a lower bleeding risk and vice versa.

After intravenous administration and neutralisation of the individual antistreptokinase-antibody titer, streptokinase is immediately available systemically for activation of the fibrinolytic system

Question 3

Indications?

Answer 3

Treatment of acute myocardial infarction within 12 hours of onset, with persistent ST-segment elevation or recent left bundle-branch block.

Question 4

Contra-indications?

Answer 4

Basically situations where a haemorrhage would be fucking bad.

Question 5

Side effects?

Answer 5

Blood and lymphatic system disorders - Haemorrhage at the injection site, ecchymoses. Gastrointestinal bleeding, genitourinary bleeding, epistaxis.

Immune system disorders - Development of antistreptokinase antibodies. Allergic anaphylactic reactions, e.g. rash, flushing, itching, urticaria, angioneurotic oedema, dyspnoea, bronchospasm, hypotension.

Cardiovascular disorders - At commencement of therapy, hypotension, tachycardia, bradycardia. In the setting of fibrinolytic therapy with Streptase in patients with myocardial infarction the following events have been reported as complications of myocardial infarction and/or symptoms of reperfusion:
• Very common: hypotension, heart rate and rhythm disorders, angina pectoris.
• Common: recurrent ischaemia, heart failure, reinfarction, cardiogenic shock, pericarditis, pulmonary oedema.

Gastrointestinal disorders - Nausea, diarrhoea, epigastric pain, vomiting.

General disorders and administration site conditions - Headache, back pain, muscle pain, chills, fever, asthenia, malaise.

Investigations - Transient elevations of serum transaminases and bilirubin.

Question 6

Possible interactions?

Answer 6

There is an increased risk of haemorrhage in patients who are receiving or who have recently been treated with anticoagulants e.g. heparin or drugs which inhibit platelet formation or function e.g. platelet aggregation inhibitors, dextrans.