Streptokinase and Urokinase are contraindicated in:
Streptokinase and Urokinase are both thrombolytic agents used to dissolve blood clots. Common contraindications for thrombolytics include recent surgery, bleeding disorders, active peptic ulcers, and intracranial hemorrhage. But wait, Streptokinase is an antigenic agent, so it can cause allergic reactions, which might be a contraindication in patients with a history of hypersensitivity. Urokinase is less antigenic.
Wait, another point: Streptokinase is a bacterial protein, so prior exposure (like in strep infections) might lead to immunity, making it ineffective. But that's more about efficacy than contraindication. The main contraindications are related to bleeding risk. So the most likely correct answer is active bleeding or recent trauma/surgery. But without the options, it's tricky. Let me check standard contraindications for these drugs.
In the absence of options, I'll proceed by assuming the standard contraindications. Let's say the options include active internal bleeding, recent stroke, or allergy. The correct answer would be active internal bleeding. Let me structure the explanation accordingly.
**Core Concept**
Streptokinase and Urokinase are thrombolytic agents that activate plasminogen to form plasmin, which degrades fibrin clots. Their use is contraindicated in conditions where the risk of hemorrhage outweighs clot lysis benefits. Key contraindications include active bleeding, recent intracranial surgery, and severe coagulopathy.
**Why the Correct Answer is Right**
**Active internal bleeding** is a contraindication because thrombolytics amplify fibrinolysis, increasing the risk of life-threatening hemorrhage. For example, in peptic ulcers or hemoptysis, clot disruption could lead to uncontrolled bleeding. This aligns with guidelines from the AHA/ACC, which list active bleeding as an absolute contraindication for thrombolytic therapy.
**Why Each Wrong Option is Incorrect**
**Option A:** *Renal impairment* (if listed) is not an absolute contraindication; dose adjustments may be required, but it is not a prohibitive factor.
**Option B:** *Hypertension* (if listed) is a relative contraindication if BP is >180/110 mmHg, but not an absolute one.
**Option C:** *Diabetes* (if listed) is unrelated to thrombolytic safety unless there are concurrent bleeding risks (e.g., retinopathy).
**Option D:** *Previous MI* (if listed) is not a contraindication; thrombolytics are often used for acute MI.
**Clinical Pearl / High-Yield Fact**
Always screen for **absolute contraindications** (e.g., active bleeding, recent stroke) before administering