streptokinase

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streptokinase

[strep″to-ki´nās] an enzyme produced by streptococci that catalyzes the conversion of plasminogen to plasmin. It is administered intravenously as a thrombolytic agent in the treatment of acute coronary arterial thrombosis, acute pulmonary embolism, deep venous thrombosis, and acute arterial thromboembolism or thrombosis. It is also used to clear obstructed arteriovenous cannulae. Detailed and skilled control is required in its use in order to avoid hemorrhage. It also can produce severe antigenic reactions upon readministration. See also anticoagulant.streptokinase-streptodornase a mixture of enzymes elaborated by hemolytic streptococci; used as a proteolytic and fibrinolytic agent.

streptokinase

Streptase

Pharmacologic class: Group C beta-hemolytic streptococcal nonenzymatic protein

Therapeutic class: Thrombolytic

Pregnancy risk category C

Action

Converts plasminogen to plasmin, an enzyme that degrades fibrin clots and lyses thrombi and emboli

Availability

Powder for injection: 250,000, 750,000, and 1.5 million international units/vial

Indications and dosages

➣ Acute evolving transmural myocardial infarction

Adults: 1.5 million international units by I.V. infusion over 1 hour as soon as possible after symptom onset. For intracoronary infusion, 20,000 international units by I.V. bolus via coronary catheter, followed by infusion of 2,000 international units/minute over 1 hour (total of 140,000 international units).

➣ Deep-vein thrombosis (DVT)

Adults: Loading dose of 250,000 international units by I.V. infusion over 30 minutes, followed by 100,000 international units/hour I.V. for 72 hours. Begin therapy as soon as possible after thrombotic symptoms begin (preferably within 7 days).

➣ Pulmonary emboli

Adults: Loading dose of 250,000 international units by I.V. infusion over 30 minutes, then 100,000 international units/hour I.V. for 24 hours (or 72 hours if concurrent DVT is suspected). Begin therapy as soon as possible after thrombotic symptoms begin (preferably within 7 days).

➣ Arterial thrombosis or emboli

Adults: Loading dose of 250,000 international units by I.V. infusion over 30 minutes, then 100,000 international units/hour I.V. for 24 to 72 hours. Begin therapy as soon as possible after thrombotic symptoms begin (preferably within 7 days).

Contraindications

• Hypersensitivity to drug or anistreplase

• Cerebrovascular accident, intracranial or intraspinal surgery within past 2 months

• Active internal bleeding

• Intracranial neoplasm

• Severe, uncontrolled hypertension

Precautions

Use cautiously in:

• severe hepatic or renal disease, recent major surgery or trauma, obstetric delivery, acute pericarditis, infectious endocarditis, atrioventricular malformation or aneurysm, suspected thrombus in left side of heart, septic thrombophlebitis or occluded arteriovenous cannula at seriously infected site

• conditions in which bleeding may be hard to manage (such as organ biopsy, peptic ulcer, previous puncture of noncompressible blood vessel)

• history of cerebrovascular disease

• use of drug within past 2 years

• concurrent anticoagulant use

• elderly patients

• pregnant or breastfeeding patients.

Administration

See Before giving, make sure hydrocortisone is available to treat allergic reaction and aminocaproic acid is available to treat excessive bleeding.

See As ordered, give test dose of 100 international units intradermally to check for hypersensitivity. Wheal-and-flare response within 20 minutes indicates probable allergy.

• To reconstitute, add 5 ml of normal saline solution or dextrose 5% in water to each vial, then dilute again to 45 ml. Roll vial gently between hands; don't shake.

• If necessary, dilute further to 50 ml in plastic container or to 500 ml in glass bottle.

• Don't mix with other drugs or give other drugs through same I.V. line.

Adverse reactions

CNS: headache, intracranial hemorrhage

CV: hypotension, arrhythmias

EENT: periorbital swelling

GI: nausea, vomiting, GI hemorrhage

GU: hematuria

Hematologic: anemia, bleeding tendency

Musculoskeletal: musculoskeletal pain

Respiratory: minor breathing difficulties, bronchospasm, apnea

Skin: urticaria, itching, flushing

Other: bleeding at puncture sites, delayed hypersensitivity reaction

Interactions

Drug-drug. Anticoagulants, aspirin, dipyridamole, indomethacin, phenylbutazone: increased risk of bleeding

Drug-diagnostic tests. Hemoglobin: decreased value

International Normalized Ratio, transaminases: increased values

Partial thromboplastin time (PTT), prothrombin time (PT): prolonged

Patient monitoring

• Monitor vital signs and neurologic status carefully after giving test dose and throughout therapy.

See Watch for signs and symptoms of hypersensitivity reaction. Stop drug if these occur.

• Check for bleeding every 15 minutes for first hour, every 30 minutes for next 7 hours, then every 4 hours.

See Stop therapy and contact prescriber immediately if excessive bleeding occurs.

• Assess neurologic status closely. Watch for indications of intracranial bleeding.

• Handle patient gently and sparingly. If necessary, pad bed rails to prevent injury.

• Monitor pulse rate every hour. Also monitor distal circulation.

• Monitor PTT, PT, plasma thrombin time, hemoglobin, hematocrit, and platelet count.

• Avoid giving I.M. injections during therapy.

Patient teaching

• Tell patient why he's receiving drug.

See Teach patient to recognize and immediately report signs or symptoms of hypersensitivity reaction or excessive bleeding.

• Instruct patient to report unusual bruising or bleeding. Teach him safety measures to avoid bruising and bleeding.

• Advise patient that he'll undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

strep·to·ki·nase (SK),

(strep'tō-kī'nās), an extracellular protein produced by certain streptococci that binds to plasminogen and activates its conversion to plasmin; it has no enzyme activity of its own. Synonym(s): plasminokinase, streptococcal fibrinolysin

streptokinase

(strĕp′tō-kĭn′ās, -āz, -kī′nās, -nāz)n. A protein, produced by hemolytic streptococci, that converts plasminogen to plasmin and is used as a drug to dissolve blood clots.

streptokinase

Kabikinase^®, Streptase^® Cardiology A fibrinolytic enzyme that converts plasminogen to plasmin, and used as a thrombolytic for reperfusing acutely occluded coronary arteries. See Thrombolytic therapy. Cf APSAC, tPA.

strep·to·ki·nase

(SK) (strep'tō-kī'nās) An extracellular metalloenzyme from hemolytic streptococci that cleaves plasminogen, producing plasmin, which causes the liquefaction of fibrin; usually used in conjunction with streptodornase in the removal of clots.

streptokinase

A protein-splitting ENZYME used as a drug to dissolve blood clot in a coronary artery so as to minimize the degree of MYOCARDIAL INFARCTION during a heart attack. It is also used to treat PULMONARY EMBOLISM. The drug is on the WHO official list. Brand names are Kabikinase and Streptase.

strep·to·ki·nase

(strep'tō-kī'nās) Extracellular protein produced by some streptococci that binds to plasminogen and activates its conversion to plasmin; no enzyme activity of its own.

streptokinase

strep·to·kin·ase

streptokinase

strep•to•ki•nase

streptokinase

streptokinase

streptokinase

streptokinase

streptokinase

Action

Availability

Indications and dosages

Contraindications

Precautions

Administration

Adverse reactions

Interactions

Patient monitoring

Patient teaching

strep·to·ki·nase (SK),

streptokinase

streptokinase

strep·to·ki·nase

streptokinase

strep·to·ki·nase

streptokinase

Words related to streptokinase

noun an enzyme produced by some strains of streptococcus that can liquefy blood clots by converting plasminogen to plasmin

Related Words