Thrombolytics; L4 (9-24-15) Flashcards
1
Q
**Streptokinase
A
- MOA: fibrinolytic (SK combines with plasminogen -> SK-plasmin and SK-plasminogen complexes convert free plasminogen to plasmin); (non-fibrin-selective lytic)
- ROA: IV
- Indications: thrombolysis, stroke, MI, PE
- Side-effects: bleeding; (can have allergic rxn with repeated administration)
2
Q
Urokinase
A
- MOA: fibrinolytic (non-fibrin-selective lytic; occurs naturally in urine)
- ROA: IV
- Indications: thrombolysis, stroke, MI, PE
- Side-effects: bleeding
3
Q
**Tissue plasminogen activator (tPA) (alteplase, reteplase, tenecteplase)
A
- MOA: fibrinolytic (recombinant human tissue plasminogen activator–converts plasminogen into plasmin -> cleaves fibrin clots, fibrinogen and plasminogen)
- ROA: IV
- Indications: thrombolysis, stroke, (acute ST-elevation) MI (STEMI); (pulmonary emboli with hemodynamic compromise, large DVTs, and arterial thrombosis; acute nonhemorrhagic CVA in selected pts only)
- Side-effects: **bleeding
4
Q
**Epsilon aminocaproic acid (AMICAR)
A
- MOA: ANTI-fibrinolytic (BLOCKS fibrin from binding to plasminogen)
- ROA: IV
- Indications: REVERSAL of bleeding/hemorrhage (*can be used to neutralize bleeding complications from OD of streptokinase!) (or especially in post-op pts with hemophilia)
- Side-effects: hypotension; (thrombi formed during tx with AMCAR do not lyse)
5
Q
Aprotonin (Trasylol) (*note: lost FDA approval)
A
- MOA: ANTI-fibrinolytic (binds to free plasmin like a2-antiplasmin)
- ROA: IV
- Indications: REVERSAL of bleeding (was used to decrease post-op bleeding, but was withdrawn after excessive thrombotic end-organ dysfunction)
- Side-effects: graft thrombosis
6
Q
~Ancrod (*note: not used in US anymore; used in Europe still)
A
- MOA: fibrinolytic (comes from snake venom!)
- ROA: IV
- Indications: stroke
- Side-effects: allergic reaction
7
Q
~Tranexamic acid (AMCHA)
A
- MOA: ANTI-fibrinolytic
- ROA: IV
- Indications: REVERSAL of bleeding
- Side-effects: retinopathy
