Blood Flashcards by Christine Parascandola

“Hemo” is defined as related to _______ ( Hematology, hemoglobin, hemophilia, hemocytometer)

BLOOD

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Hemostasis is a process to ____ and stop _____ (hemorrhage)

prevent, bleeding

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Thrombosis is the formation or presence of a _______ ______ in a blood vessel
▪ Vein thrombosis (_____ thrombi: ___ embedded in fibrin) —> __________
▪ Coronary (artery) thrombosis (______ thrombi: ______ embedded in fibrin) –> ________

blood clot, red, RBC, Anticoagulants, white, platelets, Antiplatelets

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Drugs Affect Hemostasis and Thrombosis
by acting at:

❖Blood ________ ( ______ formation)
❖ ________ function
❖ ________ removal (_________)

coagulation, fibrin, Platelet, Fibrin, fibrinolysis

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Red Blood Cells (__________) transport _______.

Erythrocytes, oxygen

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White Blood Cells (_________) fight _____ and __________ by attacking infected cells

Leukocytes, germs, infections

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Platelets (___________) help to ____ bleeding by forming a blood ____

Thrombocytes, stop, clot

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Red Blood Cells (RBCs) or Erythrocytes
Structure:
▪_______-shaped
▪ _______ surface area
▪ Has no _______
▪ Contains _______ which picks oxygen
Function:
▪ Transport _______ from the lungs to the body and __________ _______ from the body back to the lungs

Disk, Large, nucleus, hemoglobin, oxygen, carbon dioxide

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Platelets (Thrombocytes)
Structure:
▪ __________, _____-shaped
▪ ______ surface area (2 μm in diameter)
▪ Has no _______
▪ Fragments of cytoplasm from cells of the ?

Colorless, lens, Small, nucleus, bone marrow

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Platelets
Found:
▪ Platelets are found in ______
▪ In birds and amphibians they are presented as?

mammals, intact mononuclear cells

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Platelets - Function:
▪ Prevent excessive ______ or _______ bleeding after an injury by forming a ?

internal, external, blood clot

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What can be seen here?

Platelets

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Types of White Blood Cells

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Function of WBC

Function: each type has a specific function, and they work together to fight illness or disease
▪ Infections
▪ Inflammation
▪ Allergic reactions
▪ Stress
▪ Use if certain medications

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The Phases of Hemostasis

The basic process of Hemostasis:
▪ Vascular
▪ Platelet
▪ Coagulation
▪ Fibrinolysis

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Coagulation (clotting) is the process by which blood changes from a ______ to a ___,
forming a blood clot. It is mediated by ?

liquid, gel, cellular components and coagulation factors.

Activation
Adhesion
Aggregation of platelets
Deposition
and maturation of fibrin

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Describe the phases of hemostasis

Vascular spasm
- Damaged blood vessel. Body releases clotting factors.
- Prothrombin becomes thrombin IIa.
Plug formation
- Thrombin IIa is important for activation of fibrinogen which becomes fibrin. Collagen plays a role here.
Fibrin then polymerizes and forms clot during Coagulation.

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Describe the platelet pathway

Procoagulation and anticogulation: which phase go first depends on what is activated first.
ADP, NO, and PG1 tissue factor, collagen all participate in aggregation of platelets.

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Describe the clotting cascade

Tissue factor is important for factor 7A.
zymogens - once activated, coagulation factors numbered I-13, Xa = activated,
Factor 5A is necessary for stopping the cascade.

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Name the common name and drug inhibitor of Coagulation Factor I

Fibrinogen

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Name the common name and dug inhibitor of Coagulation Factor II

Prothrombin, Heparin

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Name the common name and dug inhibitor of Coagulation Factor III

Tissue thromboplastin

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Name the common name and dug inhibitor of Coagulation Factor IV

Calcium (Ca++), Calcium chelators

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Name the common name and dug inhibitor of Coagulation Factor V

Proaccelerin

Name the common name and dug inhibitor of Coagulation Factor VI

Activated accelerin (Va)

Name the common name and dug inhibitor of Coagulation Factor VII

Proconvertin: serum prothrombin conversion accelerator

Name the common name and dug inhibitor of Coagulation Factor VIII

Antihemophillic factor, none

Name the common name and dug inhibitor of Coagulation Factor IX

Plasma thromboplastin component: christmas factor, Warfarin

Name the common name and dug inhibitor of Coagulation Factor X

Stuart-prower factor, Heparin Rivaroxaban

Name the common name and dug inhibitor of Coagulation Factor XI

Plasma: thromboplastin antecedent

Name the common name and dug inhibitor of Coagulation Factor XII

Hageman factor

Name the common name and dug inhibitor of Coagulation Factor XIII

Fibrin stabilizing factor, none

Clotting takes place in three major steps: 1. Activation of _________ activators 2. Conversion of ________ into ________ 3. Conversion of __________ into _____ fibers

prothrombin, prothrombin, thrombin, fibrinogen, fibrin

Factors: zymogens (inactive) proteolytic enzymes Become active “a”. Ca++ is important for activation process 12 Factors work together

Pro-coagulants promote coagulation: ?

XIIa; XIa; Xa, IXa and thrombin (IIa)

Anti-coagulants inhibit coagulation:

antithrombin III (AT); fibrinolysis

Heparin - potentiates _________ inhibition

antithrombin; it helps antithrombin to do its job

Conditions that Require Anticoagulants and Antiplatelets Cardiovascular disorders: 1. Thrombosis in both ______ and ______ (may be due to high ________, _____ disease, ________, _________) 2. Stroke (dogs with high rate of _____ disease, _____, _____ ____ in horses) 3. ________ thrombosis (a venous thrombosis) 4. ______ heart disease 5. Acute _________ syndrome 6. Thromboembolic disease in ? 7. _______ fibrillation 8. ____________ prophylaxis

arteries, veins, cholesterol, kidney, diabetes, pancreatic, heart, cats, heat, stroke, Pulmonary, Ischemic, coronary, immune-mediated hemolytic anemia, Arterial, Antithrombotic

Coagulation Bleeding need what types of drug?

❑ Anticoagulants - blood thinner ❑ Antiplatelet drugs - blood thinner ❑ Fibrinolytic drugs ❑ Drugs for treatment of bleeding (Antifibrinolytic drugs)

Hematopoietic system ❑ Drugs for treatment of anemia ❑ Hematopoietic growth agents

Blood volume

❑ Drugs for treatment of Hypovolemia

Anticoagulants are drugs are used to modify the cascade either when there is a _____ in coagulation or when there is ________ coagulation

defect, unwanted

❑ Heparin and Low-molecular weight heparin (LMWH) 1. List two examples of LMWHs. ❑ Warfarin and Coumarin Derivatives 2. List three examples of Coumarin derivatives. 3. List a form of synthetic vitamin K ❑ Thrombin Inhibitors ❑ Factor Xa Inhibitors

1. ❖ Dalteparin , ❖ Enoxaparin 2. Dicumarol, Acenocoumarol, Warfarin 3. Menadione

Anti-coagulants inhibit coagulation: Fibrinolysis, antithrombin III (AT) AT III, is an _________ anticoagulant (______ co-factor). Upon binding to, it inactivates factors: ? Heparin potentiates ________ action ~ 1000 times.

endogenous, Heparin, IXa Xa*, XIa, XIIa, Thrombin (IIa)*, antithrombin

MOA: Heparin binds to ____ and causes ________ changes, which significantly enhances its ______ effects on various activated ______ factors (~ _____-fold)

AT, conformational, inhibitory, coagulation, 1,000

Which factors does Heparin inactivate?

IIa IXa Xa XIa XIIa

▪ Heparin is a _______ occurring ______ _______ found in _____ cells

naturally, anticoagulant, proteoglycan, mast

▪ Heparin is prepared from _____ ____ tissue or _____ ____ mucosa ▪ White _____, soluble in ____ ▪ The dose is in ____ units rather than m

bovine, lung, porcine, intestinal, powder, water, USP

Heparin Uses: Used for: _______ clotting or increase risk of ___ formation (applicable to which species? ) List example diseases in which heparin is used.

excessive, clot, cats, dogs, horses BLEPTTVD ❖ Thromboembolic disease ❖ Thromboembolic problems following vascular surgery ❖ Venous thrombosis ❖ Disseminated intravascular coagulopathy (DIC) ❖ Pulmonary thromboembolism ❖ Laminitis (horses) ❖ Endotoxic shock ❖ Burns USP: united stats pharmacopenia units?

Heparin Routes of administration: ? IM may cause ________ Not absorbed when given ____

SC, IV, hematoma, orally

❖ Unfractionated heparin (UFH): inactivates which coagulation factors?

Thrombin (Factor IIa) and Factor Xa UFH = standard heparin

❖ Low-molecular weight heparin (LMWH) inactivates which coagulation Factor?

Heparin MOA: bind to and activate _________ (?) which in turns _______ factors

antithrombin (AT), inactivates

Heparin is NOT a drug for which ONE DOSE FITS ALL ▪ Patients with ____ AT may not respond as well as those with ______ AT levels ▪ Variable ___ among animals and protein binding ▪ Dose adjustments should be tailored to individual patients by monitoring ______ ___ ▪ The _________ _________ __________ time (aPTT) test is available to veterinarians ▪ The ideal range for ____-__ activity in dogs, cats, and horses is not established

low, adequate, PK, clotting, times, anti-Xa

Heparin - Adverse Effects: 1. ________ problems 2. Heparin-induced _________ (in _____, not in animals)

1. Bleeding 2. thrombocytopenia, people

Heparin Overdose causes excessive __________ and _______

anticoagulation, bleeding

Heparin Reversal for overdose: __________ _________ administration * This is found in the _____ of certain fish * Strongly ____ and combines with _____ heparin to form _____, ____ salt that ______ further anticoagulant activity of heparin

Protamine Sulfate, sperm, basic, acidic, stable inactive, prevents

1. Name two examples of Low-Molecular Weight Heparins ( LMWHs) 2. LMWH advantages vs UFH: ▪ Greater _____ and ____ profile ▪ Favorable and predictable ___ 3. Activity: anti-factor ___ / anti-factor ____ratio ( for UFH ratio is __:__) ✓ More complete and predictable _____ ✓ ______ duration ✓ ____ frequent administration ✓ Reduced risk of ______ ✓ More ______ anticoagulant response

1. ❖ Dalteparin (Fragmin ), ❖ Enoxaparin (Lovenox ) 2. activity, safety, PK 3. Xa, IIa , 1:1, absorption, Longer, Less, bleeding, predictable

Dalteparin is a ______, MW ~ _____ (compare to UFH, ~______) - _____ is different than for UFH

LMWH, 5000, 15,000, PK

Dalteparin MOA: binding to ____ and _________ antithrombin- mediated inhibition of synthesis and activity of coagulation factor ___

AT, increasing, Xa

Dalteparin Activity ratio: ___ : ___ Half-life: In dogs: __ hr In cats: ____ hr In horses: ____ is similar do humans

2.7, 1, 2, 1.5, PK

Dalteparin Adverse effects:? * ________ * If IM administration – _________ * If renal disease – the elimination will be __________ * ____-_____ interaction

* Bleeding * If IM administration – hematoma * If renal disease – the elimination will be prolonged * Drug-drug interaction

Enoxaparin is a _______, MW ~ ____(compare to ____, ~15,000) ___ is different than UFH

LMWH, 5000 , UFH, PK

Enoxaparin MOA: binding to ___ and ______ antithrombin- mediated inhibition of synthesis and activity of coagulation factor ___

AT, increasing, Xa

Enoxaparin Activity ratio: ___ : ___ and ___ : ___ Half-life: In dogs: __ hr In cats: ___ hr In horses: PK is similar to _____ (24 hr)

3.3, 1, 5.3, 1, 5, 1.9, humans

Enoxaparin Adverse effects: * ________ * If IM administration – ____________ * If renal disease – the elimination will be _________ * Drug-drug _________

Bleeding, hematoma, prolonged, interaction

❑ Warfarin and Coumarin Derivatives ❖ Dicumarol ❖ Acenocoumarol

Vitamin K Vitamin K is a ____-soluble vitamin essential for the _______ synthesis of the _______ group of coagulation factors (factors ?) Vitamin K: K1 --- from _______ K2 produced by bacteria in the ___ K3 is ___________: ____ soluble and ____ soluble

fat, hepatic, prothrombin, II, VII, IX, and X, plants, gut, synthetic, lipid, water

Clover contains __-____ ___________ --> responsible for hemorrhagic disease in cattle. If consume _____ clover ---> disease

4-OH-coumarin, excess

Coumarin Synthetic Derivatives: Vitamin K-antagonists MOA: reduce the _______/________ of Vit K-dependent factors that promote clotting (factors ?) by inhibiting the regeneration of vitamin K (_________ _______) resulting in its depletion.

production, activation, II, VII, IX, and X, epoxide reductase

Some cinnamon have _________. Cinnamon with ________ causes uncontrolled bleeding.

coumarin, warfarin

Coumarin Synthetic Derivatives: Vitamin K-antagonists Uses: ▪ To decrease the tendency for _______ (thromboprophylaxis in ____) ▪ To treat or prevent blood ____ in veins or arteries ▪ To reduce the risk of _____ or ________ _______

thrombosis, dogs, clots, stroke, heart attack

Coumarin Synthetic Derivatives: Vitamin K-antagonists Reversal: ? Adverse effects: ▪ ____-____ interaction (______, _______, and others)

Vitamin K, Drug-drug, aspirin, clopidogrel

❖ Warfarin ❖ Dicumarol ❖ Acenocoumarol These are all examples of? They are _______ soluble, _____ sensitive ____

Coumarin synthetic derivatives and Vitamin K antagonists Water, Light, tablets

Coumarin Synthetic Derivatives: Vitamin K-antagonists - Synthetic coumarin derivatives, anticoagulants : reduce the formation of ?

blood clots

Vitamin K deficiency Vitamin K deficiency causes _______ bleeding due to failure of normal ____ clot formation ❖ Accidental poisoning by warfarin in dogs and cats: ▪ Over-the-counter anticoagulant _______ ▪ Clinical signs: ________ at 2-3 days after consumption. Toxic dose in both dogs and cats: __-___ mg/kg Cumulative toxic doses: 1-5 mg/kg for 5-15 days in dogs 1 mg/kg for 7 days in cats ❖ Intestinal ___________ ❖ Medication containing ______ __________ (synthetic Vitamin K)

excessive, fibrin, rodenticide, hemorrhage, 5-50, malabsorption, warfarin, Menadione

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