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Streptokinase

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Kabikinase, Streptase

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

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Blood formers, Coagulators, and anticoagulants; thrombolytic enzyme

Pharmacologic class: Group C beta-hemolytic streptococcal nonenzymatic protein
Therapeutic class: Thrombolytic

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A beta-hemolytic streptococci derivative. Activates the conversion of plasminogen to plasmin, an enzyme that degrades fibrin, fibrinogen, and other procoagulant proteins into soluble fragments, promoting thrombolysis. Reduces blood and plasma viscosity as well as erythrocyte aggregation, increasing collateral blood vessel perfusion.

Therapeutic effect:
Thrombolysis is aided by this substance. Streptokinase's fibrinolytic action is effective both outside and within the formed thrombus/embolus.

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Acute evolving transmural myocardial infarction

Deep-vein thrombosis

Pulmonary emboli

Arterial thrombosis or emboli

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Ticlopidine

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Ticlid

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Tablets: 250mg

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Pharmacologic class: Platelet aggregation inhibitor
Therapeutic class: Antiplatelet agent

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Platelet aggregation inhibitor that interferes with platelet membrane functioning and therefore platelet interactions.

Therapeutic effect:
Prevents release of platelet constituents and prolongs bleeding time.

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To reduce risk of thrombotic cerebrovascular accident when aspirin is ineffective or intolerable.

Adjunctive therapy to prevent sub-acute stent thrombosis in patients with implanted coronary stents.

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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

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Hypersensitivity to drug

Hematopoietic disease

Pathologic bleeding

Severe liver impairment

History of thrombotic thrombocytopenia purpura (TTP) or aplastic anemia

Precautions (use cautiously in):

Renal or hepatic impairment

High risk for bleeding

Elderly patients

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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

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CNS: dizziness, headache, weakness, intracerebral bleeding
EENT: conjunctival hemorrhage, tinnitus, epistaxis
GI: nausea, vomiting, diarrhea, full sensation, GI pain, dyspepsia, flatulence, anorexia, GI bleeding
GU: hematuria
Hematologic: ecchymosis, eosinophilia, purpura, TTP, thrombocytosis, neutropenia, agranulocytosis, bone marrow depression
Skin: rashes, bruising, pruritus, urticaria
Other: pain, post-traumatic or peri-operative bleeding

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Patient monitoring:

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

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. 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 the patient why he’s receiving the drug.

Teach the 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 the 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.

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Patient monitoring:

Closely monitor coagulation studies and CBC with white cell differential. Watch for evidence of bleeding.

Report promptly laboratory values indicative of neutropenia, thrombocytopenia, or agranulocytosis

Assess neurologic status carefully. Stay alert for signs and symptoms of intracranial bleeding.

Monitor liver function tests.

Patient teaching:

Tell the patient why he’s receiving the drug.

Tell patient to take with meals, but not within 2 hours of antacid.

Instruct the patient to immediately report easy bruising or bleeding.

Advice patient to stop taking drug 10 or 14 days before elective drug.

Inform the patient that aspirin-containing products and many herbs increase risk of bleeding. Urge to consult prescriber before taking OTC drugs or herbs.

Caution patient to avoid activities that can cause injury. Tell them to use soft-toothbrush and electric razor to avoid gum and skin injury.

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

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Patricia Schull. (2013). McGraw-Hill Nurses Drug Handbook, Seventh Edition.

Wilson, B.A., Shannon, M.T. & Stang, C.L. (2007). Prentice Hall Nurse’s Drug Guide. STREPTOKINASE. Retrieved on September 17, 2021, from http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=S033.html

Wilson, B.A., Shannon, M.T. & Stang, C.L. (2007). Prentice Hall Nurse’s Drug Guide. TICLOPIDINE. Retrieved on September 17, 2021, from http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/T040.html

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