Thrombolysis amboss

Question 1

Fibrinolytic therapy. FIBRIN SPECIFIC AGENTS mechanism?

Answer 1

Promote the degradation of fibrin but not of fibrinogen.

Question 2

Fibrinolytic therapy. FIBRIN SPECIFIC AGENTS?

Answer 2

Tissue plasminogen activator (tPA)
Recombinant plasminogen activators (rtPA): tPAs that are produced by recombinant biotechnology techniques: Alteplase; Reteplase (rPA); Tenecteplase (TNK-tPA)

Question 3

Fibrinolytic therapy. Non-FIBRIN SPECIFIC AGENTS Mechanism?

Answer 3

Lead to degradation of fibrin and fibrinogen.

Question 4

Fibrinolytic therapy. Non-FIBRIN SPECIFIC AGENTS?

Answer 4

Streptokinase and urokinase

Question 5

Fibrinolytic therapy. Mechanism?

Answer 5

Fibrinolytics promote the degradation of thrombi by activating plasminogen to plasmin

Question 6

How is produced streptokinase?

Answer 6

Enzyme produced by group A streptococci; catalyzes the conversion of plasminogen to plasmin

Question 7

How is produced urokinase?

Answer 7

Serine protease found in plasma, urine, and various types of tissue that is also used in fibrinolytic therapy

Question 8

How acts direct fibrinolytics?

Answer 8

Direct fibrinolytics (e.g., plasmin) are enzymes that cleave fibrin without intermediate steps.

Question 9

How acts indirect fibrinolytics?

Answer 9

Indirect fibrinolytics do not act on the thrombus themselves but convert plasminogen to plasmin, which then degrades the thrombus.

Question 10

General mechanism of fibrinolytics?

Answer 10

directly or indirectly increase the concentration of plasmin → cleavage of thrombin and fibrin

Question 11

Lab findings in fibrinolytics?

Answer 11

Prolonged PT, PTT;

Normal platelet count

Question 12

Adverse of fibrinolytics?

Answer 12

Bleeding (e.g., intracranial hemorrhage)
Hypersensitivity reactions (esp. to streptokinase)

Question 13

Indication of fibrinolytics?

Answer 13

Early STEMI (< 12 hours)
Early ischemic stroke (< 3 hours)
Massive pulmonary embolism

Question 14

Contraindications to fibrinolytic therapy? 5

Answer 14

Active bleeding
Prior intracranial hemorrhage
Recent surgery
Severe hypertension
Known bleeding diathesis

Question 15

What is the main agent for Ischemic stroke, STEMI and PE?

Answer 15

ALTEPLASE (synthetic tissue plasminogen activator that converts plasminogen to plasmin).

Question 16

Antifibrinolytics. What agents?

Answer 16

Tranexamic acid;

Aminocaproic acid

Question 17

Antifibrinolytics. mechanism?

Answer 17

Group of drugs that impair fibrinolysis, typically by interfering with plasmin formation

Question 18

Tranexamic acid. What inhibit and what kind of derivate it is?

Answer 18

Synthetic lysine analog and inhibitor of plasminogen with antifibrinolytic action

Question 19

Aminocaproic acid. What inhibit and what kind of derivate it is?

Answer 19

Lysine derivative and inhibitor of plasminogen activators and plasmin with antifibrinolytic action

Question 20

What agents used for reversal of fibrinolytics?

Answer 20

Antifibrinolytics (tranexamic acid and aminocaproic acid);

FFP, PCC, or cryoprecipitate (Cryoprecipitate is obtained from frozen blood plasma via centrifuge and contains more factor VIII and fibrinogen than FFP.)

Platelet transfusions (if necessary)

Question 21

What is cryoprecipitate?

Answer 21

Cryoprecipitate is obtained from frozen blood plasma via centrifuge and contains more factor VIII and fibrinogen than FFP

Question 22

What contains more VII and fibrinogen: cryoprecipitate or FFP?

Answer 22

cryoprecipitate