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CPR Exam 1 > Clotting Cascade > Flashcards

Clotting Cascade Flashcards

1
Q

Thrombin function

A

Recruit even more platelets and cause fibrins to form a mesh work over the platelet aggregation

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2
Q

CASE 1 68yo male on warfarin therapy for 5 mos for many past strokes, he has fallen and fractured his hip. Warfarin is discontinued 48hrs before surgery for what reason

A

48hrs is the time required for full expression of the Factor 2,7,9,10 genes

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3
Q

Reason warfarin should be discontinued 48hrs prior to surgery

A

Warfarin DECREASES VIT K

VIT K is needed for gamma-glutamylcarboxylase since it inhibits epoxied hydrolase

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4
Q

What does Gamma-glutamylacarboxylase do

A

Catalysts many Ca bonding proteins (FACTORS 2, 7, 9, 10 + PROTEIN C and PROTEIN S) = coagulation
(Synthesis of these take 48hrs, and breakdown of them also takes 48hrs by warfarin)

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5
Q

Factor 2 half-life

A

60hrs

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6
Q

Factor 9 half-life

A

24hrs

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7
Q

Factor 10 half-life

A

40-60hrs

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8
Q

What activated the extrinsic pathway

+ which important factor

A

External Trauma when blood escapes the vascular system
FASTER
*FACTOR 7

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9
Q

What activates the intrinsic pathway + which important factor

A

Trauma inside vascular system
(Platelets, exposed endothelium, chemicals, collagen —> activate)
SLOWER
*Factor 8, 9, 11, 12

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10
Q

INTRINSIC PATHWAY STEPS

A
  1. Kallikrein activates F12 (hageman factor)
  2. F12a activates F11
  3. F11a activates F9*
  4. Thrombin activates F8*
  5. F10 is added *
    =TENASE COMPLEX
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11
Q

Thrombin is what factor

A

Factor 2

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12
Q

Intrinsic TENASE complex includes

A

F8a
F9a
F10

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13
Q

EXTRINSIC PATHWAY steps

A
  1. Tissue injury activates Thromboplastin
  2. Thromboplastin activates F7*
  3. Tissue Factor is added
  4. F10 is added
    = TENASE COMPLEX
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14
Q

Extrinsic TENEASE complex

A

F7a
F10
Tissue Factor

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15
Q

COMMON PATHWAY steps

A
  1. Factor 10 on TENASE complex is activated by CA+2
  2. F10a uses Ca+2 + F5a to activate Prothrombin (F2) to Thrombin (F2a)
  3. F2a activates F5
  4. F2a uses Ca+2 to activate F8 + make FIBRIN *
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16
Q

Primary Hemostasis

A 
Platelets aggregate to form platelet plug (block hole)
WEAK
-vascular contraction 
-glycoproteins R on platelets
- collagen +fibrinogen
17
Q

Secondary Hemostasis

A

Fibrin Mesh forms of the platelet plug by coagulation cascade

  • STRONG
  • fibrin
  • subendothelial collagen
  • Thromboplastin
  • coagulation factors
  • fibrinogen
18
Q

MAJOR ROLE OF THROMBIN *

A
  1. Fibrinogen to Fibrin

2. F13 to F13a

19
Q

How is the Fibrin cross linked

A

F13a and Ca+2 cause the fibrin to cross link

20
Q

3 other roles of thrombin

A
  1. F5a
  2. F8a
  3. Activation of platelets
21
Q

2 anticoagulants and what there major effect is

A
  1. Hydroxycoumarins
  2. Indanediones
    * INHIBIT VIT K
22
Q

Hydroxycoumarins example

A

Warfarin

23
Q

Activation of VIT K steps (2 steps)

A
  1. 2,3-epoxied reductase + NADH : 2,3-epoxide—> QUINONE
  2. Quinone reductase : quinone —> QUINOL * in liver
    * LIVER : quinone —> quinol (active)
24
Q

What does the VIT K (QUINOL) do

A

Uses gamma-glutamyl carboxylase* to ACTIVATE Factors 2, 7, 9, 10, Protein C and Protein S

25
Q

How does Warfarin inhibit coagulation

A

It INHIBITS the 2,3-Epoxide Reductase which blocks the conversion of VIT K cycle to convert GLUTAMATAE RESIDUES ——> gamma-carboxyglutamate residues (Factors 2,7,9,10, proteins C +S)* + PROTHROMBIN*

26
Q

For patient with elevated PT or mucosal bleeding what shouldI give them

A

400mg VIT K or daily 50mg-100mg

27
Q

Peak plasma warfarin happens when

A

3hrs after Ingested

28
Q

S-Warfarin

A

Binds to albumin tighter

*5x more potent

29
Q

R-warfarin

A

Highly binds to proteins

Not as potent

30
Q

Which types of drugs will inhibit or increase the ability of warfarin to work

A

Drugs that compete to bind to albumin or drugs that inhibit warfarin metabolism

31
Q

Protein C and Protein S function

A

ANTICOAGULATION
——I F5a + F8a
= LOWER THROMBIN FORMATION*

32
Q

Low Protein C cases

A

Significant risk for venous thrombosis

33
Q

With Patient taking Warfarin what should you look our for

A

Any bleeding
Diet should have VIT K (green leafy veggies)
Carry ID card

34
Q

Hemophilia A

A

X F8 most severe + more common

* cant form Fibrin clot (Hemostasis) + no TENASE COMPLEX

35
Q

Hemophilia B

A

X F9

Also called Christmas Disease

CPR Exam 1 (20 decks)

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