Thrombolytic Agents

Question 1

Thrombolytic Agents

Answer 1

• Alteplase - t-PA/rt-PA -(Activase)
• Reteplase - r-PA - (Retavase)
• Streptokinase - SK - (Streptase)
• Tenecteplase - TNK - (TNKase)
• Urokinase - (Abbokinase)

Question 2

MOA

Answer 2

• Tissue specific activation of plasminogen

- Directly activates plasminogen to form plasmin which leads to clot lysis

Question 3

Agents that are tissue specific:

Agents that are non-tissue specific

Answer 3

• Specific: alteplase, retaplase, tenecteplase

- Non-specific: streptokinase

Question 4

Indications

Answer 4

• Acute MI: use w/in 6 mo
• Coronary artery thrombosis
• Ischemic stroke: use within 3 mo
• PE
• DVT

=> Not commonly use due to serious ADE: bleeding

Question 5

Precautions

Answer 5

• Hypersensitivity
• *BP > 185/110 mm Hg
• Recent or active *bleeding
• Hx of intracerebral hemorrhage
• *Pt on PO anticoagualtion/heparin use w/in 48H of stroke onset
• Recent head trauma
• *SK use w/in the last 3-6 mo or strep infection w/in the last 6 months

Question 6

ADEs

Answer 6

• Bleeding
• HypoTN
• Fever

Question 7

Alteplase

• Clinical comments

Answer 7

• Recombinant DNA product
• Do not use ASA w/in 24H
• Hepatic CL w/ > 50% removed in 5 min
• Do not use bacteriostatic water for adm
• Incompatible w/ dobutamine, dopamin, heparin, NTG
• Must be reconstituted and use w/in 8H

Question 8

Reteplase

• Dose
• Clinical comments

Answer 8

• Recombinant DNA product produced in E. Coli
• Must be reconstituted w/ sterile water for injection to 1mg/mL [ ]
• Sol’n must be used w/in 4H of reconstitution
• Dose: Acute MI: 10U IV over 2 min followed by a 2nd dose 30 min later

Question 9

Streptokinase

• Dose
• Clinical comments

Answer 9

• Dose:
• AMI: 1.5 MU IV over 60 min
• PE: 3 MU IV over 24H
• Clinical comments:
• Antigenic
• Skin test for antibodies: 1000U => wait 10-20 min
• Do not repeat if used SK w/n the last yr or had strep infection recently
• Must be reconstituted and used w/in 8H
• Do not shake vial

Question 10

Streptokinase & MI

Answer 10

Stroptokinase is the 1st throbolytic protein of bacterial origan
- is antigenic and pts who reinfarct w/in 12mo are unable to receive 2nd dose due to the formation of antibodies