Page 48 - RxExam's Naplex Theory Review Part-1

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Thrombolytic Agents:
Dose Special Notes

Streptokinase 1. Myocardial infarction 1). Streptokinase (Streptase) acts with plasminogen to
(Injection) produce an "activator complex" that converts plasminogen
a. Intravenous infusion: to the proteolytic enzyme plasmin. Plasmin degrades fibrin
1,500,000 IU within 60 min. clots as well as fibrinogen and other plasma proteins.

OR 2). Streptokinase (Streptase) is indicated for:
a. Acute Evolving Transmural Myocardial Infarction
b. Intracoronary infusion: b. Pulmonary Embolism (PE)
20,000 IU by bolus followed c. Deep Vein Thrombosis (DVT)
by 2,000 IU/min. for 60 min. d. Arterial Thrombosis or Embolism (AT or AE)
Not to exceed total dose e. Occlusion of Arteriovenous Cannulae
140,000 IU.
3). Administer Streptokinase as soon as possible after
onset of symptoms. The greatest benefit in mortality
2. PE, DVT, AT or AE reduction was observed when Streptokinase was
administered within four hours, but statistically significant
Loading Dose: 250,000 IU/30
benefit has been reported up to 24 hours.
minutes
4). Because of the increased likelihood of resistance due to
Maintenance dose: 100,000
antistreptokinase antibody, Streptase, Streptokinase, may
IU/hr for 24 to 72 hours.
not be effective if administered between five days and
twelve months of prior Streptokinase or Anistreplase
administration, or streptococcal infections, such as
streptococcal pharyngitis, acute rheumatic fever, or acute
glomerulonephritis secondary to a streptococcal infection.

Urokinase Loading dose: 4400 IU/Kg at 1). Urokinase (Kinlytic) is an enzyme (protein) produced by
(Injection) a rate of 90 ml/hr over a the kidney, and found in the urine. There are two forms of
period of 10 minutes followed urokinase which differ in molecular weight but have
with continuous infusion similar clinical effects. Kinlytic is the low molecular weight
4400 IU/Kg/hr at a rate of 15 form. It acts on the endogenous fibrinolytic system. It
ml for 12 hours. converts plasminogen to the enzyme plasmin. Plasmin
degrades fibrin clots as well as fibrinogen and some other
plasma proteins.

2). Urokinase (Kinlytic) is indicated for the treatment of
pulmonary embolism.

Alteplase 1. Myocardial Infarction 1). Alteplase (Activase) is an enzyme (serine protease)
(Injection) a). For patients weighing > 67 which has the property of fibrin-enhanced conversion of
kg, the recommended dose is plasminogen to plasmin. It produces limited conversion of
a 15 mg IV bolus, followed by plasminogen in the absence of fibrin. It is indicated for the
50 mg infused over the next treatment of acute myocardial infarction, acute ischemic
30 minutes, and then 35 mg stroke and pulmonary embolism (PE).
infused over the next 60 min.
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