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Pharm BMED 575


Plasmin is the activated form of? plasminogen
Plasmin acts on what and produces what? Acts on fibrin to degrade it
What is the action of thrombolytic agents? Converts plasminogen to plasmin
Fibrinolytics can be used to treat severe pulmonary embolism TRUE
DVT cannot be treated with fibrinolytics FALSE
Arterial thrombosis are resistant to treatment by fibrinolystics FALSE
There are no cautions when treated strokes with fibrinolytics FALSE
Fibrinolytics can be used for AMI TRUE
Historically, what was used to treat coronary occlusion? Thrombolytics
What is PCI percutneous coronary intervention (the placement of drug eluting stents)
If thrombolytic agents are used, percent reduction in mortality is seen? 20%
What time frame must thrombolytics be administered? within 6 hours
What ECG waveforms are not as treated with thrombolytics? non-Q wave
What ECG patterns are most benefited by thrombolytic therapy? ST-segment elevation or bundle branch block
What adjunct treatments are used to treat MI with thrombolytics? aspirin, beta blockers and ACE inhibitors
Does heparin improve or make worse the response to t-PA? improve
Name four thrombolytic agents tissue plasminogen activator, streptokinase, urokinase, and anistreplase
What is the MOA of thrombolytics? They all work to activate the fibrinolytic enzyme plasminogen
Where is endogenous t-PA produced? The endothelial cells
What are rt-PA, Alteplase, Activase? commercially produced recombinant t-PA
How are the artificial t-PAs given? As an IV infusion or bolus
Which of the thrombolytics is able to activate "clot-bound" plasminogen? ie, get to plasminogen that is hidden by existing fibrin rt-PA, Alteplase, Activase
rt-PA, Alteplase, Activase have a higher risk of stroke, but what action are they most effective at? establishing coronary re-perfusion
Which thrombolytic is thousands of dollars per treatment? rt-PA, Alteplase, Activase
What are some of the side effects of Streptokinase? Allergic response, anaphylaxis, and pyrexia
Where does Streptkinase work? complexes with proactivator and activates plasminogen
Which thrombolytic is more systematic, rt-PA or streptokinase Streptokinase. It is not as fibrin specific as rt-PA but acts more systematically
If used with aspirin, which thrombolytic is as effective as other fibrinolytics? Streptokinase
What thrombolytic loses efficacy after the first treatment due to antibody formation? streptokinase
Where is endogenous urokinase produced? the kidney
What is the MOA of urokinase? Urokinase directly activates plasminogen to plasmin
How is urokinase dosed? IV loading dose followed by 12 hour infusion
What is APSAC? anisoylated plasminogen streptokinase activator complex
What are the constituents of anistreplase (Eminase) an inert mixture of plasminogen and streptokinase
What does anistreplase (Eminase) do once injected? The acly group hydrolyzed once in the blood and it becomes fibrinolytic
Which of the thrombolytics has a long duration of action? anistreplase (Eminase)
Which now discontinued thrombolytic is more clot selective than streptokinase but not as expensive as rt-PA? anistreplase (Eminase)
What was some of the reasons anistreplase was pulled from the market? caused considerable fibrinogenolysis and is antigenic
What is the MOA of aminocaproic acid (Amicar)? it inhibits fibrinolysis and reversed the action of other fibrinolytic drugs
What fibronlytic compound does aminocaproic acid (Amicar) act on? it completely inhibits the formation of plasminogen
What two patients groups would Amicar be used on? hemophiliacs and those suffering from fibrinolytic therapy overdose
How is Amicar used as a prophylactic? To prevent re-bleeding in intracranial aneurysms.
What chemical is aminocaproic acid (Amicar) similar to? Lysine
What is the MOA of transexamic acid (Cyklokapron)? it inhibits the activation of plasminogen
What inhibitor of fibrinolysis is useful is upper GI bleeds? transexamic acid (Cyklokapron)
What two inhibitors of fibrinolysis can cause intravascular thrombosis? aminocaproic acid and transexamic acid
Hypotension and myopathy are two adverse side effects of the inhibitors of fibrinolysis. TRUE
GI discomfort and nasal stuffiness are not an issue with aminocaproic acid and transexamic acid because they don't effect the parasympathetic nervous system FALSE
What is the MOA of aprotinin (Trasylol) it is serine protease inhibitor
While aminocaproic acid inhibits the formation of plasminogen and transexamic acid inhibits the activation of plasminogen, how does aprotinin (Trayslol) work? It inhibits fibronolysis by free plasmin
What is a side effect of aprotinin (Trasylol)? may cause anaphylaxis
Created by: lisamccunesSS