Sketchy Pharm: Thrombolytics

Question 1

How can you remember the recombinant forms of tPA?

Answer 1

Most have t-p-a in the suffix (which Sketchy symbolizes with the Toy PlAy set): aletplase, tenecteplase, and reteplase.

The one that doesn’t is streptokinase (think of the strepto-connector toys).

Question 2

tPA (and its recombinant forms) activates ________________.

Answer 2

plasminogen to plasmin, which then starts degrading fibrin

Question 3

What are clinical indications for fibrinolytic therapy?

Answer 3

Stroke (the kid painting with a stroke of black paint on her hat)
PE (the thrombotic bird’s nest)
MI (the kid playing the broken banjo)

Question 4

What timeline distinguishes between PCI and fibrinolytic therapy?

Answer 4

Percutaneous intervention (PCI = stenting) is superior if performed within two hours of STEMI initiation –just like the outfielder signaling for two more players needd behind the bat-wielding jock – and fibrinolytic therapy is best after then but before 6 hours.

Question 5

Asymmetrical pupils can be a sign of what vascular concern?

Answer 5

Cerebral hemorrhage

Question 6

What are some contraindications to tPA use?

Answer 6

All things that can increase risk of bleeding: recent intracranial surgery; recent head trauma; recent surgery of any kind; signs of hemorrhage on CT; and sustained hypertension.

Question 7

Which form of recombinant tPA can be antigenic?

Answer 7

Streptokinase (because it is derived from Streptococcal bacteria) –think of the boy with the red face next to the Strepto-Connector box

Question 8

There are two antidotes to fibrinolytic overdose. What are they and what is their mechanism?

Answer 8

Aminocaproic acid (like the MeaN teacher putting a CAP on the tubes of red paint being squirted in the playground)

Tranexamic acid (just like the exams she would be grading if it weren’t for those trouble makers)

Both work by competitively inhibiting tPA.