streptokinase (redirected from Streptase)

streptokinase /strep·to·ki·nase/ (-ki´nas) a protein produced by ß, which produces fibrinolysis by binding to plasminogen and causing its conversion to plasmin; used as a thrombolytic agent.

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streptokinase-streptodornase  (SKSD) a mixture of enzymes elaborated by hemolytic streptococci; used as a proteolytic and fibrinolytic agent.

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strep·to·kin·ase (strpt-kns, -z, -kns, -nz)

n. Abbr. SK

A proteolytic enzyme produced by hemolytic streptococci, capable of dissolving fibrin and used medically to dissolve blood clots.

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streptokinase (strep´tōkī´nās´),

n a fibrinolytic activator that enhances the conversion of plasminogen to the fibrinolytic enzyme plasmin. It is used in the treatment of certain cases of pulmonary and coronary embolism.

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streptokinase

an enzyme produced by streptococci that catalyzes the conversion of plasminogen to plasmin; abbreviated SK. Streptokinase, when administered as a thrombolytic, requires detailed and skilled control to avoid hemorrhage. It also is capable of producing severe antigenic reactions upon readministration. See also anticoagulant (2).

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streptokinase-streptodornase

a mixture of enzymes elaborated by hemolytic streptococci; used as a proteolytic and fibrinolytic agent.

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streptokinase Warning - High-alert drug!

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

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

Route	Onset	Peak	Duration
I.V.	Immediate	1 hr	4 hr
Intracoronary	Unknown	Unknown	Unknown

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.
☞ 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 patient why he's receiving drug.
☞ 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.