(THER) Thrombolytics Flashcards
What is the main endogenous activator of plasminogen and what is the end result?
t-PA I- single chain tissue plasminogen activator
Ultimately converts plasminogen into plasmin, allowing for dissolution of clots.
Physiologic Inhibitors of Plasminogen activation (main 2)
- PAI-1 (rapid acting plasminogen activator inhibitor)
- a2-antiplasmin
Plasminogen
Aka pro-fibrinolysin
It is the zymogenic form of the active enzyme plasmin
What does plasmin degrade?
Both fibrinogen and fibrin
What is the product of plasmin’s action on fibrin?
D-dimers
Fibrin is formed by the action of __________ on ___________.
Thrombin on fibrinogen
Formed fibrin strands are stabilized by the action of ___________.
Factor XIIIa aka Transamidase
What are the main (2) factors which promote Fibrinolysis?
- Plasminogen incroporation into thrombus via fibrin binding
- Binding of t-PA to fibrin
Factors which limit Fibrinolysis
- Fibrin crosslinking by Factor XIIIa
- Binding oof 2-antiplasmin to fibrin
What are the (2) main clinically approved thrombolytic agents?
- Tissue plasminogen activators (both human t-Pa and the recombinants)
- Streptokinase
How is thrombolytic therapy monitored?
There is no true monitoring of the effect on the clot. You must look at plasminogen/fibrinogen levels.
Main clinical uses of thrombolytic agents (6)
- Acute MI
- Periheral Arterial Occlusion
- DVT
- PE
- Thrombotic Stroke
- Catheter clearance
Pharmacologic antagonists for thrombolytic agents (2)
- EACA (Epsilon-amino caproic acid)
- Tranexmic Acid
Snake venom and thrombi
A number of venoms contain enzymes which can digest fibrinogen. Some are used therapeutically.
What is the first line anticoagulant during angioplasty?
Heparin
Streptokinase/Urokinase MOA and Route
Fibrinolytic
IV
Streptokinase/Urokinase Indications and Side Effects
Ind: Thrombolysis, stroke, MI, PE
SE: Bleeding
Tissue Plasminogen Activator MOA and Route
Fibrinolytic
IV
Tissue plasminogen activator Indications and Side Effects
Ind: Thrombolysis, stroke, MI
SE: Bleeding
Epsilon amino caproic acid (AMICAR) MOA and route
Anti-fibrinolytic
IV
Epsilon amino caproic acid (AMICAR) Indications and Side Effects
Ind: Reversal of bleeding
SE: Hypotension
Aprotinin (Trasylol) MOA and Route
Anti-fibrinolytic
IV
Aprotinin (Trasylol) Indications and Side Effects
Ind: Reversal of bleeding
SE: graft thrombosis
Ancrod MOA and Route
Fibrinolytic (derived from snake venom)
IV
Ancrod Indications and Side Effects
Ind: Stroke
SE: Allergic reaction
Tranexamic Acid (AMCHA) MOA and Route
Anti-fibrinolytic
IV
Tranexamic Acid (AMCHA) Indications and Side Effects
Ind: Reversal of bleeding
SE: Retinopathy
