Thrombolytics

Question 1

How does Plasmin break down fibrin?

Answer 1

Converted from Plasminogen by cleaving a single bond allowing exposure of Kringles lysine binding sites that can cleave fibrin.

Question 2

What is recombinant tissue plasminogen activator drug called?

Answer 2

Alteplase. Reduces the size of blood clots by cleaving fibrin.

Question 3

What are indications for giving Altepase?

Answer 3

Acute MI - STEMI
Acute ischemic stroke - less than 3 hours.
Acute large PE

Question 4

What are adverse effects of Altepase and what can affect them?

Answer 4

High incident of hemorrhaging after administering, being on ASA or Heparin increases risk.

Question 5

What are some contraindications to giving Altepase?

Answer 5

Active bleeding, hx of ICH, recent trauma, cerebral aneurysm, uncontrolled HTN, pregnancy, prior stroke less than 3 months.

Question 6

How do you reverse excessive fibrinolysis?

Answer 6

Aminocaproic Acid - Lysine analog that binds in the active site of Plasmin preventing function and further breakdown.

Question 7

What is another use of Aminocaproic Acid?

Answer 7

Can be used after surgery to stop hemorrhaging, high concentration in urine, so can stop GU bleeding.