Fibrinolytic drugs (thrombolytics) are critical agents that dissolve intravascular clots by converting plasminogen into plasmin. B.Pharm students should grasp mechanisms of action, fibrin specificity, pharmacokinetics, major agents (streptokinase, urokinase, alteplase/tPA, reteplase, tenecteplase), clinical indications (acute MI, pulmonary embolism, ischemic stroke), contraindications, adverse effects like bleeding and antigenicity, monitoring parameters (fibrinogen, D‑dimer), and reversal strategies (aminocaproic acid, tranexamic acid). This focused overview emphasizes therapeutic principles, laboratory monitoring, drug interactions, and clinical decision points to help pharmacists optimize thrombolytic therapy and manage complications. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary pharmacologic action of fibrinolytic drugs?
- Inhibition of platelet aggregation
- Activation of plasminogen to plasmin
- Prevention of thrombin formation
- Stabilization of fibrin clots
Correct Answer: Activation of plasminogen to plasmin
Q2. Which fibrinolytic agent is derived from streptococcal bacteria and is highly antigenic?
- Alteplase (tPA)
- Urokinase
- Streptokinase
- Tenecteplase
Correct Answer: Streptokinase
Q3. Which drug is a recombinant tissue plasminogen activator commonly used for acute ischemic stroke?
- Reteplase
- Alteplase (tPA)
- Urokinase
- Streptokinase
Correct Answer: Alteplase (tPA)
Q4. Which fibrinolytic has the longest plasma half-life, allowing single‑bolus administration?
- Alteplase
- Reteplase
- Urokinase
- Tenecteplase
Correct Answer: Tenecteplase
Q5. Which of the following is an absolute contraindication to fibrinolytic therapy?
- Recent minor surgery >6 weeks ago
- Active internal bleeding
- Stable angina
- Controlled hypertension
Correct Answer: Active internal bleeding
Q6. What is the most common clinically significant adverse effect of fibrinolytic drugs?
- Nephrotoxicity
- Hypersensitivity rash only
- Bleeding
- Hepatotoxicity
Correct Answer: Bleeding
Q7. Which plasma protein is the primary physiologic inhibitor of plasmin?
- Alpha1‑antitrypsin
- Alpha2‑antiplasmin
- Antithrombin III
- Protein C
Correct Answer: Alpha2‑antiplasmin
Q8. Which agent is an antifibrinolytic used to reverse excessive fibrinolysis?
- tPA
- Tranexamic acid
- Urokinase
- Heparin
Correct Answer: Tranexamic acid
Q9. A marked decrease in which laboratory parameter suggests excessive systemic fibrinolysis during therapy?
- Platelet count
- Fibrinogen level
- Serum creatinine
- Serum bilirubin
Correct Answer: Fibrinogen level
Q10. Which engineered thrombolytic has point mutations that increase resistance to plasminogen activator inhibitor‑1 (PAI‑1)?
- Alteplase
- Reteplase
- Tenecteplase
- Streptokinase
Correct Answer: Tenecteplase
Q11. In acute ischemic stroke within the therapeutic window, which fibrinolytic is standardly administered intravenously?
- Streptokinase
- Urokinase
- Alteplase (tPA)
- Tenecteplase only intra‑arterial
Correct Answer: Alteplase (tPA)
Q12. Which characteristic best describes streptokinase compared with tPA?
- Fibrin‑specific and non‑antigenic
- Non‑fibrin‑specific and antigenic
- Longer half‑life than tenecteplase
- Does not activate plasminogen
Correct Answer: Non‑fibrin‑specific and antigenic
Q13. Systemic activation of plasmin by fibrinolytics can lead directly to degradation of which hemostatic proteins?
- Albumin and transferrin
- Coagulation factors V and VIII and fibrinogen
- Immunoglobulins only
- Lipoproteins
Correct Answer: Coagulation factors V and VIII and fibrinogen
Q14. Which thrombolytic is commonly given as a single intravenous bolus for ST‑elevation myocardial infarction?
- Alteplase infusion only
- Tenecteplase
- Streptokinase continuous infusion
- Urokinase oral tablet
Correct Answer: Tenecteplase
Q15. Which laboratory marker increases as a result of fibrin clot breakdown after fibrinolytic therapy?
- Decreased C‑reactive protein
- Elevated D‑dimer
- Lowered lactate dehydrogenase
- Reduced erythrocyte sedimentation rate
Correct Answer: Elevated D‑dimer
Q16. Plasminogen activator inhibitor‑1 (PAI‑1) primarily inhibits which of the following?
- Alpha2‑antiplasmin
- Plasmin directly
- Tissue plasminogen activator (tPA) and urokinase
- Fibrinogen synthesis
Correct Answer: Tissue plasminogen activator (tPA) and urokinase
Q17. Prior exposure to streptococcal antigens can affect streptokinase therapy by causing:
- Increased renal clearance only
- Formation of neutralizing antibodies reducing efficacy
- Enhanced fibrin specificity
- Complete resistance to bleeding
Correct Answer: Formation of neutralizing antibodies reducing efficacy
Q18. Which fibrinolytic was originally isolated as a human enzyme from renal cells?
- Alteplase
- Streptokinase
- Urokinase
- Tenecteplase
Correct Answer: Urokinase
Q19. Which fibrinolytic has the shortest elimination half‑life, often requiring continuous infusion?
- Tenecteplase
- Reteplase
- Alteplase
- Streptokinase with single bolus
Correct Answer: Alteplase
Q20. Fibrin‑specific thrombolytics reduce systemic plasmin generation because they preferentially:
- Bind antithrombin III
- Activate plasminogen when bound to fibrin
- Inhibit platelet aggregation
- Increase fibrinogen synthesis
Correct Answer: Activate plasminogen when bound to fibrin
Q21. Which antifibrinolytic drug is commonly used intravenously to control severe bleeding after thrombolysis?
- Aminocaproic acid (EACA)
- Heparin
- Alteplase
- Streptokinase
Correct Answer: Aminocaproic acid (EACA)
Q22. Tranexamic acid reduces fibrinolysis by:
- Activating plasminogen
- Blocking lysine binding sites on plasminogen
- Increasing PAI‑1 synthesis
- Enhancing thrombin generation
Correct Answer: Blocking lysine binding sites on plasminogen
Q23. Which clinical history would generally preclude use of systemic fibrinolysis?
- Remote minor laceration 2 months ago
- History of intracranial hemorrhage
- Well‑controlled diabetes mellitus
- Hyperlipidemia only
Correct Answer: History of intracranial hemorrhage
Q24. Plasmin directly degrades which structural component of a thrombus?
- Collagen matrix only
- Fibrin meshwork
- Platelet granules
- Endothelial basement membrane
Correct Answer: Fibrin meshwork
Q25. For dental procedures in a patient who recently received fibrinolytics, which local measure is recommended to reduce bleeding?
- Oral tranexamic acid mouthwash
- Systemic streptokinase
- High‑dose aspirin preprocedure
- Intravenous heparin
Correct Answer: Oral tranexamic acid mouthwash
Q26. Which laboratory test is least useful for routine monitoring of fibrinolytic therapy effectiveness?
- Fibrinogen concentration
- D‑dimer level
- aPTT
- Fibrin degradation products (FDPs)
Correct Answer: aPTT
Q27. Which adverse reaction is particularly associated with streptokinase compared to recombinant tPA?
- Severe renal failure
- Allergic reactions due to antigenicity
- Direct hepatotoxicity
- Increased HDL levels
Correct Answer: Allergic reactions due to antigenicity
Q28. Which factor increases the risk of hemorrhagic transformation when administering fibrinolytics for ischemic stroke?
- Uncontrolled severe hypertension
- Young age under 40
- Use of statins prior to stroke
- Low blood glucose
Correct Answer: Uncontrolled severe hypertension
Q29. Concomitant use of which class of drugs most increases bleeding risk with fibrinolytics?
- Proton pump inhibitors
- Anticoagulants such as heparin or warfarin
- Beta‑blockers
- Thiazide diuretics
Correct Answer: Anticoagulants such as heparin or warfarin
Q30. Which is an important clinical advantage of tenecteplase compared with alteplase?
- Shorter half‑life requiring continuous infusion
- Oral administration available
- Longer half‑life allowing single bolus administration
- No bleeding risk
Correct Answer: Longer half‑life allowing single bolus administration
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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