Drug Interaction:
Thrombolytic enzmes include- Alteplase, Anistreptase, Streptokinas, Urokinase
Refer - Streptokinase -
Aspirin,dipyridamole and such drugs which affect platelet function,heparin and other anticoagulants, can increase the risk of haemorrhage.
Indication:
Acute myocardial infaction Management of AMI in adults, for lysis of thrombi obstructing coronary arteries
Adverse Reaction:
Haemorrhage,Anaphylactic shock. Fever and haemorrhage.Cerebral,peripheral and pulmonary embolisms have occured.Allergic reactions,liver enzyme abnormalities,hypotension.
Topical use: Fever and allergic reactions(can be minimised by frequent removal of exudate).
Thrombolytic enzymes-
Bleeding- two types-
Minor- ( superficial or surface bleeding) and
Major -( internal, severe bleeding Incidence ) 0% to 16% .
The overal incidence of major bleeding with high IV dose infusion is 1.2 %
Allergic reactions-
Urokinase-
Is a protein origin , there is no evidence of induced antibody formation.
relatively mild reactions (eg. bronchospasm, and skin rash ) are reported rarely and usally respond to conventional therapy
Streptokinase-
Minor breathing difficulty , bronchospasm, periorbital swelling, angioneurotic edema, urticaria,itching,flushing, nausea, headache, musculoskeletal pain, and delayed hypersenstivity reactions, (eg. vasculitis, and interstilial nephritis)
Fever -
Urokinase ( 2% to 3% ) a cause and effect relationship has not been established
streptokinase ( 0% to 28% ) ocurs in patients treated intravenously with streptokinase
Symptomatic treatment is usually sufficient Use acetoaminophen rather than aspirin
Guillian -Barre syndrome-
Although a cause and effect relationship has not been established several reports suggests that streptokinase induces immunological response that may initiate this syndrome
Contra-Indications:
Hypersens,bleeding diasthesis,trauma.
Special precautions:
Severe hypertension,peptic ulcer,stroke,streptikinase treatment within last 12 months.
Dosages/ Overdosage Etc:
Acute myocardial infaction Management of AMI in adults, for lysis of thrombi obstructing coronary arteries
Dosage-
Adult- 1.5mu as a single dose infused over a period over 1 hour immediately after the onset of symptoms
Patient Information:
1. Allergy- Tell your doctor if you had ay unusual reactions to streptokinase, food substances, presrvatives, dyestuffs etc.
2. Pregnancy- Tell your doctor if you are pregnant or if you have recently delivered a baby. Studies in pregnant women ( for strptokinase) and studies in animals ( for urokinase) have not shown that these medicines cause either miscarriage or harm to the fetus. (including birth defects)
3. Breast feeding- Not known whether thrombolytic agents pass into breast milk. Mothers who are taking any of these medcines and who wish to breast feed should discuss this with their doctor.
4. Children- Have been tested in children and in effective doses. Have not been shown to cause differet side effects than they do in adults.
5. Older adults- Need for treatment with thrombolytic agent may be increased in elderly patients with clots. However chance of bleeding may be increased. Discuss this with your doctor.
6. Other medicines- It is important for your doctorto know if you are taking-
Anticoagulants or
Aspirin or
Cefamandone or
Cefoperazone or
Cefotetan or
Divalproex or
Enoxaparin or
Heparin or
Indomethicin or
Phenylbutazone or
Plicamycin or
Sulfinpyrazone or
Ticlopidine or
Valpricacid - chance of bleeding may be increased
7. Other Medical problems- Your doctor should know if are having other medical problems especially-
Blood disease ,bleeding problems or
Brain disease or tumor or
Colitis orstomach ulcer or
Heart or blood vessel disease or
Liver disease or
Stroke or
Tuberculosis -- chance of serius bleding may be increased
Streptococcal infection- antistreptase or streptokinase may not work properly after a sterptokinase infections, your doctor may decide to use a different thrombolytic agent.
Also tell your doctor if youhad any of the following conditions-
Falls or blows to the body or head or any other injury or
Injections into a blood vessel or
Placements ofany tube into the body.
Surgery including dental surgery -chance of bleeding may be increased
If you have recently delivered a baby use of these agents may cause serious bleeding.
9. Dosing- Follow doctors instructions
10. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.
11. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.
12. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.
Pharmacology/ Pharmacokinetics:
Pharmacology-
Streptokinase acts with plasmogen to produce -activator complex - that converts plasmsmogen to proteolytic enzyme plasmin.Plasmin degrades fibrin clots as well as fibronogen and other plasma proteins. Plasmin is inactivated by circulating inhibitors such as alpha -2-macroglbulin . These inhibitors are rapidly consumed at high doses of strptokinase
Pharmcokinetics-
The T1/2 of streptokinase activator complex is about 23 minutes, the complex is inactivated in part, by antistrptococcal antibodies. The mechanism of elimination is unknown, no metabolites of streptokinase have been identified.
