Streptokinase

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.   Available forms:

The only available form is powder.

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 half life is approximately 23 . 

Indications & usage: 

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

function, and reduction of mortality associated with acute MI; reduction of infarct size and CHF associated with acute MI.

2-Pulmonary Embolism .

 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 ASAP 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 Monitor Coagulation profile.

2-checking ECG & Vital signs 3-Be aware if patient has had either recent streptococcal infection

or recent treatment with streptokinase, higher loading dose may be necessary.

4-Check hypersensitivity reactions, give 100 unit intradermal, as ordered; wheal & flare response within 20 minutes means patient is probably allergic.

5-Notify doctor immediately if hypersensitivity occur.6-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 vessels and others.

Notify the doctor immediately if the patient complain of any of the following:1-Blurred Vision.2-Dizziness.3-Fever.4-Sweating.

Antidote of Streptokinase:

Aminocaproic acid.

Thank you