Streptokinase

Marwah M.Ibrahim Instructor: Mr.Samuel K.Sarfo

Objectives:

At the end of this presentation you know the following:-Generic / tread name.-Therapeutic / pharmacologic classification.-Pregnancy category.Available form and action-

-Therapeutic uses/indication and dosage administration.Pharmacokinetics.-

Contraindication.-

-Nursing consideration.

Streptokinase:

Is a protein secreted by several streptococci, it can bind & activate human

plasminogen to convert to plasmin.

Generic name: Streptokinase.

Brand (trade) name:Kabikinase, Streptas ( names registered medication in Saudi Arabia according to FDA).

Therapeutic class: Thrombolytic enzyme.

Pharmacologic class: Tissue Plasminogen Activator.

Pharmacology:Converts plasminogen to the enzyme plasmin, which aids in dissolution of blood clots.

Pregnancy category: C

Available forms:The only available form is powder for solution for solution.

Administration:1-IV ( intravenous route ).

2-IC ( intracoronary route ).

Action:Dissolve clot that have formed in blood vessels.

Storage/Stability:Store unopened vials at controlled room temperature (59° to 86°F). Use reconstituted solution immediately or within 8 h if stored at 36°to 46°F. Discard any unused solution.

Pharmacokinetics

Metabolism:No metabolites identified.

Elimination:Streptokinase is cleared by the liver. The t ½ is approximately 23 min (for activator complex).

Indications & usage:

1- AMI. lysis of intracoronary thrombi → improvement of ventricular

function, and reduction of mortality associated with acute MI (IV or intracoronary route); reduction of infarct size and CHF associated with acute MI (IV).

2-Pulmonary Embolism. (involving obstruction of blood flow to a lobe or multiple segments, with or without unstable hemodynamics).

3-DVT.acute, extensive thrombi of the deep veins (eg, those involving the

popliteal vessels); lysis of acute arterial thrombi and emboli; alternative to surgical revision for clearing totally or partially occluded arteriovenous cannula when acceptable flow cannot be achieved.

Dosage and Administration

Acute MI (Adults): IV infusion Administer ASA after symptom onset (greatest benefit when administered within 4 h, but benefit has been reported up to 24 h). Infuse a total dose of 1,500,000 units within 60 min. Intracoronary infusion Administer 20,000 units by bolus followed by 2000 units/min for 60 min (total dose, 140,000 units).

PE , DVT, Arterial Thrombosis, or Embolism (Adults):IV infusion Administer ASAP after onset of thrombotic event, preferably within 7 days. A loading dose of 250,000 units infused into a peripheral vein over 30 minutes has been found appropriate in over 90% of patients.

Nursing consideration:

1-Bedor therapy draw blood for PT, APTT ( Rate of IV infusion depend on thrombin time ).2-Monitor drug's effectiveness by carefully checking ECG & V/S. Be prepared to treat reperfusion arrhythmias. 3-Institute bleeding precaution.4-Be aware if patient has had either recent streptococcal infection or recent treatment with streptokinase, higher loading dose may be necessary. treatment with streptokinase .5-Check hypersensitivity reactions, give 100 unit intradermal, as ordered; wheal & flare response within 20 minutes means patient is probably allergic.6-Notify doctor immediately if hypersensitivity occur.7-Keep corticosteroids and aminocaproic acid available to treat allergic reaction and bleeding.

Contraindications:1-Active internal bleeding.2- Recent cerebrovascular accident (within 2 months).3- Intracranial or intraspinal surgery4- Severe uncontrolled hypertension.

Side Effect:

1- Bleeding.2-Allergic reaction.3-Sever kidney disease.4-Dameg to the blood vesselsand others.

Check with the doctor immediately if the patient complain of any of the following:

1-Blurred Vision.2-Dizziness.3-Fever.4-Sweating.

Antidote of Streptokinase:

Aminocaproicacid.

Any question ?

References;

Judith A.Schilling et.Al ( 3ed edition ) Illustrated Manual of Nursing practice. 2002 Lippincott Williams & Wilkins.

http://www.sfda.gov.sa/ar/drug/search/Pages/default.aspx?tn=&gn=Streptokinase&mc=&an=&regno=&sf=&sd=&PageIndex=1&sm=human

http://www.rxlist.com/streptase-drug/side-effects-interactions.htm