2 English reference stress (sk)
3 instructions for streptokinase 3. 1 drug name streptokinase
3.2 English name Rebinant Streptokinase
3.3 alias streptokinase; Thrombolytic enzyme; Recombinant streptokinase; Herbeck suppository
3.4 classification of drugs in circulatory system >: antithrombotic drugs > thrombolytic agents
3.5 Formula of lyophilized powder for injection: 654.38+ 10,000 units/bottle; 500,000 units/bottle; 1.5 million units/bottle.
3.6 The pharmacological action of streptokinase 1 mol ratio is combined into a complex, and then fibrinolytic enzyme is activated into fibrinolytic enzyme, which catalyzes the hydrolysis of fibrin, the main matrix of thrombus, thus dissolving thrombus and then dredging blood vessels; At the same time, the existence of fibrin enhances the thrombolytic effect of streptokinase, so streptokinase can effectively and specifically dissolve thrombus or blood clot and treat diseases with thrombosis as the main lesion.
3.7 Pharmacokinetics of streptokinase After intravenous administration, streptokinase was rapidly distributed all over the body, and distributed in liver (34%), kidney (12%) and gastrointestinal tract (7.3%) after 15min, and the plasma concentration decreased exponentially. There are two stages of elimination from plasma, fast and slow, and the half-lives are 5 ~ 30 minutes and 83 minutes respectively. It is mainly excreted from the liver through the biliary tract and still retains its biological activity.
3.8 indications of streptokinase are used for thrombotic diseases, such as acute myocardial infarction. Can be used for preventing and treating acute myocardial infarction, cerebral infarction, deep vein thrombosis and pulmonary embolism; It is also suitable for preventing and treating arterial embolism, hemodialysis (dissolving blood clots), shunt obstruction and pleural adhesion; It can maintain normal cardiopulmonary function, and the sequelae of nervous system disappear completely or mostly.
3.9 the taboo of streptokinase 1. Patients with bleeding, surgery, history of trauma, cardiopulmonary resuscitation or vascular puncture who can't stop bleeding within two weeks are prohibited.
2. Patients with a history of ulcer bleeding, esophageal varices, ulcerative colitis or hemorrhagic retinopathy in the past two weeks are prohibited.
3. Patients with uncontrolled hypertension, blood pressure >180mmhg/10mmhg or aortic dissection aneurysm cannot be excluded.
4. Patients with coagulation disorders and hemorrhagic diseases are prohibited.
5. Severe hepatic and renal insufficiency is prohibited.
6. Patients with mitral stenosis with atrial fibrillation, left atrial thrombosis (cerebral embolism may occur after thrombolysis) and infective endocarditis are prohibited.
7. Pregnant women and lactating women are prohibited.
8. People who are allergic to streptokinase are prohibited.
3. 10 Precautions 1. Use with caution in elderly patients and children.
2. Streptokinase should be strictly used under the guidance of clinicians.
3. Thrombolytic therapy for acute myocardial infarction should be started as soon as possible, and treatment should be started within 12h after onset.
4. Dissolve with 5% glucose solution before use, and the solution should be used up within 4 ~ 6h.
5. Streptokinase cannot be used for 5 days to 12 months after it is used.
6. After using streptokinase to treat vascular recanalization, reinfarction occurs, and other thrombolytic drugs can be used.
7. overdose is easy to bleed. If the amount of bleeding is too large, 6- aminocaproic acid can be used to stop bleeding, and fresh plasma or whole blood can be transfused.
Store at 8.2 ~ 8℃.
3. Adverse reactions of11streptokinase The incidence of adverse reactions of streptokinase is low. Common adverse reactions are as follows.
1. Fever, chills, nausea and vomiting, shoulder pain, allergic skin rash; Hypotension occurs when streptokinase is injected intravenously. If blood pressure drops, the rate of decline should be slowed down. Anaphylactic shock is rare.
2. Bleeding, bleeding at puncture site, ecchymosis of skin, gastrointestinal tract, urinary tract or respiratory tract bleeding; When streptokinase is used in thrombolytic therapy for acute myocardial infarction, the incidence of stroke is 0. 1% ~ 0.3%.
3. Other reactions: when streptokinase is used in thrombolytic therapy for acute myocardial infarction, reperfusion arrhythmia may occur, and occasionally slow arrhythmia, accelerated ventricular spontaneous rhythm, ventricular premature beats or ventricular fibrillation may occur; Occasionally cause hemolytic anemia, jaundice and alanine aminotransferase (ALT). After thrombolysis, secondary embolism may occur, such as pulmonary embolism, cerebral embolism or cholesterol embolism.
3. Usage and dosage of12 streptokinase It is generally recommended that10.5 million units of streptokinase be dissolved in 5% glucose solution for l00ml, and intravenous drip1h.. Thrombolytic therapy for acute myocardial infarction should be started as soon as possible, and treatment should be started within 12h after onset. For special patients (such as underweight or obviously overweight), the doctor can appropriately increase or decrease the dose (according to 20000 units /kg body weight) according to the specific situation.
3. 13 drug interaction The simultaneous use of streptokinase and aspirin has a good effect on acute myocardial infarction. At the same time, the use of anticoagulant or dextran in advance will increase the risk of bleeding.
4 streptokinase poisoning [1]
4. 1 The main clinical manifestations are bleeding, including venipuncture site, wound, nosebleeds, hematuria, sometimes skin or mucous membrane bleeding, and severe visceral bleeding, especially intracranial bleeding, which can be life-threatening. There may be allergic reactions, such as fever, headache, nausea, vomiting, facial flushing, eyelid edema, urticaria, etc. In severe cases, anaphylactic shock may occur. Arrhythmia may occur during coronary artery perfusion, such as accelerated ventricular spontaneous rhythm and frequent ventricular premature beats.
4.2 Laboratory examination showed that coagulation time, prothrombin time and bleeding time were prolonged.
4.3 Diagnostic point 1. Medical history, a clear history of medication.
2. There are clinical manifestations of poisoning such as bleeding.
3. Laboratory inspection support.
4.4 treatment points 1. If there is bleeding reaction, stop taking the medicine immediately.
2. Local bleeding can be stopped by local compression.
3. Severe systemic bleeding can be treated with antifibrinolytic drugs, such as 6- aminocaproic acid or aminobenzoic acid.
4. When necessary, input fresh plasma, cold precipitate, fibrinogen and new blood.
5. Anti-allergic treatment.