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Basic Principles > 2 - Coagulation and Blood > Flashcards

2 - Coagulation and Blood Flashcards

1
Q

What is the end factor of the plasma clotting factor cascade?

A

Fibrin

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2
Q

Describe Platelet Adherence in Veins

A

endothelial lining is damaged

Platelets adhere to exposed collagen via surface integrin receptors GPIa/IIa and GP VI receptors

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3
Q

Describe platelet adherence in Arteries

A

Endothelial lining is disrupted, and in addition to collagen adherence,

vWF from endothelial cells and pre-existing clot adhere to integrin Ib/IX

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4
Q

What is the role of ADP in primary hemostasis?

A

Platelet Activation

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5
Q

What is the role of COX and cyclooxygenase in primary hemostasis?

A

Platelet Activation

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6
Q

What is the role of the GP IIb/IIIa receptor in primary hemostasis?

A

Platelet Stabilization

“Inside-Out” signaling

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7
Q

How are platelets naturally inhibited in their endothelial environment?

A

Endothelial cells secrete Prostaglandin i2

they also secrete NO which inhibits TxA2 receptor (platelet activation)

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8
Q

What drugs counteract platelet adherence?

A

None!

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9
Q

Which drug is an ADP antagonist?

What part of primary hemostasis does it inhibit?

A

Clopidogrel

Platelet Activation

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10
Q

Abciximab, Eptifibatide, and Tirofiban act at which receptor?

Which part of primary hemostasis do they inhibit?

A

GP IIb/IIIa

Formation and Stabilization of the platelet plug

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11
Q

Are the extrinsic and intrinsic pathways part of primary or secondary hemostasis?

A

Secondary

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12
Q

What is secondary hemostasis?

A

The cascade of enzymes that creates fibrin to stabilize the preliminary platelet clot

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13
Q

Activation of _______ initiates secondary hemostasis.

A

Thrombin

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14
Q

What is the extrinsic pathway?

Why is it called extrinsic?

A

Initiated when endothelial damage exposes tissue factor (TF) on underlying cell membranes

The TF comes from the cell membrane, which is not part of (extrinsic) the circulation

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15
Q

What is the end product of the extrinsic pathway?

A

Thrombin (IIa)

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16
Q

What happens after the extrinsic pathway?

A

Thrombin acts on fibrinogen to form fibrin

Thrombin cleaves factor XI to XIa, which triggers the intrinsic pathway

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17
Q

What is the purpose of the intrinsic pathway?

A

Produces more Xa

Xa transforms Prothrombin to Thrombin

Thrombin transforms fibrinogen to fibrin

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18
Q

All of the clotting factors are primarily produced in the liver except ________

A

VIII (8)

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19
Q

Which factors are Vitamin K dependent?

A

2

7

9

10

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20
Q

What are the three natural clotting inhibitors?

A

TF Pathway Inhibitor

Anti-thromibn III

Protein C and S

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21
Q

What is tPA?

A

tissue plasminogen activator

Secreted in the body by endothelial cells to activate plasminogen to plasmin, which breaks down fibrin

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22
Q

What two drugs inhibit fibrinolysis?

How?

A

Epsilon-Aminocaproic acid (EACA) and TXA

block the binding sites of plasminogen, so it can’t act on fibrin

23
Q

What is a normal platelet count?

A

150-400

24
Q

What is the primary role of vWF?

A

cross-linking activated platelets to form the plug

25
Q

What lab evaluates primary hemostasis?

A

Your platelet count

26
Q

What labs evaluate secondary hemostasis?

A

PT/PTT

INR

27
Q

What is viscoelastic testing

A

ROTEM

Looks at whole blood clotting and fibrinolysis

28
Q

What is factor V Leiden?

A

FVL

most common hypercoaguable mutation

29
Q

What lab would show how effective apixaban or rivaroxaban are?

A

AntiXa

30
Q

Why do DTIs end in “-rudin”?

A

Because they’re derived from hirudin in LEECHES!!!!

31
Q

What O2ER is associated with tissue hypoxia?

A

> 50%

32
Q

What MixedVO2 and CentralVO2 would indicate tissue hypoxia?

A

50, 60

33
Q

What is Cryo?

When is it useful?

A

Cryo is thawed FFP that has been centrifuged to remove everything but fibrinogen, fibronectin, vWF, F8, and F13

Cryo contains more fibrinogen by volume

Useful when fibrinogen is depleted: DIC, massive hemorrhage

34
Q

What are the two primary treatment options for patients with vWD?

A

DDAVP

Factor concentrates

35
Q

Why does DDAVP help stop bleeding in vWD patients?

A

Promotes cleavage of F8 into vWF

36
Q

Is vWD a disease of primary or secondary hemostasis?

A

Primary

37
Q

What is the most common form of hemophilia?

A

Hemophilia A (85%)

38
Q

How is hemophilia treated?

A

DDAVP (increases factor 8)

recombinant F8 (but often develop antibodies to it)

Plasma transfusion

39
Q

PT/PTT are ______ in a patient with Vit K deficiency?

A

Prolonged

40
Q

Are PT/PTT accurate measures of bleeding risk in liver disease patients?

A

No. Often overestimate bleeding risk.

The hemostatic balance is usually (fragilely) maintained by compensation during liver disease

41
Q

DIC is always associated with _________

A

a comorbid condition:

infection

inflammation

malignancy

42
Q

Does DIC result from an abnormality of the intrinsic or extrinsic pathway?

A

Extrinsic

TF sparks unregulated thrombin production and fibrin development

43
Q

Which disorders are most associated with DIC?

A

Sepsis

Malignancy

Obstetric Complications

44
Q

Name 2 cyclooxygenase inhibitors.

How do they cause anticoagulation?

A

Aspirin and NSAIDS

Inhibit platelet aggregation

45
Q

Can aspirin be reversed?

A

No. Non-competitive inhibitor.

46
Q

Why are Phosphodiesterase Inhibitors used for stroke prophylaxis?

A

cAMP is an active inhibitor of platelet aggregation

47
Q

Name 2 ADP antagonists.

How do they cause anticoagulation?

A

Clopidogrel, Ticagrelor

Inhibit platelet aggregation

48
Q

Name 3 GP IIb/IIIa Receptor Antagonists.

How do they cause anticoagulation?

A

Abciximab, Eptifibatide, Tirofibin

inhibit cross-linkage of fibrinogen (platelet aggregation)

49
Q

Name 1 Vit K Antagonist.

How does it cause anticoagulation?

A

Warfarin

Competes with Vit K for carboxylation binding sites

Inhibits synthesis of VitK dependent factors (2, 7, 9, 10, fctrs C and S)

50
Q

Does heparin inhibit FXa directly or indirectly?

A

Indirectly by binding to AT-III

51
Q

Name 2 Parenteral Direct Thrombin Inhibitors

A

Argatroban and Bivalirudin

52
Q

Which drug is used to reverse heparin?

How does it work?

A

Protamine

Derived from fish sperm!

Binds to heparin and forms a stable salt

53
Q

Name 2 lysine analogues.

A

TXA and EACA

54
Q

What is the average blood volume of a male?

Female?

A

70ml/kg

65ml/kg

Basic Principles (15 decks)

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