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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 surgery
4- Severe uncontrolled hypertension.
Side Effect:
1- Bleeding.
2-Allergic reaction.
3-Sever kidney disease.
4-Dameg to the blood vessels
and 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:

Aminocaproic
acid.
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/def
ault.aspx?tn=&gn=Streptokinase&mc=&an=&regn
o=&sf=&sd=&PageIndex=1&sm=human

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