Thrombolytic agents Flashcards
How long is it from the formation of the blood clot before the fibrinolysis (degradation of fibrin mesh) gradually breaks down the blood clot?
1 - 12 hours
2 - 24 hours
3 - 48 hours
4 - 72 hours
3 - 48 hours
Following healing the body will decide to break down any blood clots that are no longer needed, called fibrinolysis. This normally begins within 48 hours of blood clot formation. Which protein produced by the liver is crucial for starting fibrinolysis?
1 - factor III (3)
2 - plasminogen
3 - tissue plasminogen activator
4 - plasmin
2 - plasminogen
Plasminogen, produced by the liver is crucial for starting fibrinolysis in the fibrinolysis pathway. Endothelial cells produce what that is able to convert plasminogen into its active form plasmin?
1 - factor III (3)
2 - protein S
3 - tissue plasminogen activator (tPa)
4 - protein C
3 - tissue plasminogen activator (tPa)
- used clinically as a clot buster to dissolve pathological blood clots
During secondary haemostasis endothelial cells are exposed to coagulation factors (factor Xa and thrombin) and the production of tissue plasminogen activator (tPa) is increased. What 2 other molecules do endothelial cell produce that is able to inhibit tPa and plasmin, ensuring we are able to clot and stop bleeding?
1 - protein S
2 - plasminogen activator inhibitor 1
3 - protein C
4 - antiplasmin
2 - plasminogen activator inhibitor 1
4 - antiplasmin
Once plasmin is activated how does it degrade clots?
1 - acts as a protease acting on fibrin
2 - acts as a reductase
3 - induced apoptosis in platelets
4 - initiates shedding of endothelium cells
1 - acts as a protease acting on fibrin
Tissue plasminogen activator (tPa) is responsible for converting plasminogen into plasmin. What other proteins / factors are able to activate plasmin in addition to tPa?
1 - factor IXa (9a)
2 - XIIa (12a)
3 - protein C
4 - all of the above
4 - all of the above
Which of the 2 core thrombolytic agents that we need to know?
1 - Streptokinase
2 - Tinzaparin
3 - Alteplase
4 - Tenecteplase
3 - Alteplase
4 - Tenecteplase
- both end in teplase
The 2 drugs are core thrombolytic agents are - Alteplase and Tenecteplase. What is the mechanism of action of these 2 drugs?
1 - increases plasminogen 2 - inhibits antiplasmin
3 - inhibits plasminogen activator inhibitor 1
4 - binds to fibrin proteins and activates plasminogen, allowing plasmin to break down clot
4 - binds to fibrin proteins and activates plasminogen, allowing plasmin to break down clot
The thrombolytic agent Alteplase is indicated to be administered IV in patients with acute ischaemic strokes. However, to have these beneficial effects they have to be administered in what time frame?
1 - <4.5 hours
2 - <10 hours
3 - <24 hours
4 - <48 hours
1 - <4.5 hours
- mechanical thrombectomy can also be given
Although percutaneous coronary interventions are now the main treatment for patients with ST-elevation ACS, thrombolytic agent can also be given and will improve outcomes if given in what time period?
1 - <4.5 hours
2 - <12 hours
3 - <24 hours
4 - <48 hours
2 - <12 hours
Although percutaneous coronary interventions are now the main treatment for patients with ST-elevation ACS, thrombolytic agent can also be given and will improve outcomes if given within 12 hours. They do however, need to be given with which 2 other drug classes?
1 - ACE inhibitors
2 - loop diuretics
3 - anti-platelets
4 - anti-coagulants
3 - anti-platelets
4 - anti-coagulants
- the combination of these 3 classes of drugs does increase the risk of haemorrhage
Which of the following are thrombolytic agents given in, reducing the size of the blood clot?
1 - bells palsy
2 - increased jugular venous pressure
3 - CKD
4 - PE
4 - PE
Which of the following are common adverse events from thrombolytic agents?
1 - hypotension
2 - nausea
3 - vomiting
4 - all of the above
4 - all of the above
In which of the following should thrombolytic agents be stopped?
1 - serious bleeding
2 - allergic reaction
3 - cardiogenic shock
4 -cardiac arrest
5 - all of the above
5 - all of the above
What 2 of the following are contraindications for the use of thrombolytic agents?
1 - PE
2 - ACS
3 - bleeding
4 - intracranial haemorrhage
3 - bleeding
4 - intracranial haemorrhage
- needs to be ruled out using a CT or MRI
Which drug has been shown to increase the risk of an anaphylactoid reaction when combined with thrombolytic agents?
1 - anti-platelets
2 - ACE inhibitors
3 - anticoagulants
4 - antidepressants
2 - ACE inhibitors
Which 2 of the following is how thrombolytic agents are typically administered?
1 - orally
2 - IV
3 - injection IV
4 - suppository
2 - IV
3 - injection IV
Administration of thrombolytic agents should only be used in high dependency areas with experts in its use. Once administered how often must the patient be monitored?
1 - every 15 minutes
2 - every 30 minutes
3 - every hour
4 - every 2 hours
1 - every 15 minutes
- must be performed for the 1st 2 hours
