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Perf Tech 1 > Coag > Flashcards

Coag Flashcards

0
Q

2 examples of anticoagulant factors:

A

Prostacyclin

Vascular Plasminogen Activator

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1
Q

Anticoagulant Factors are released from _______.

A

Endothelial cells.

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2
Q

2 Procoagulant Factors:

A

Platelets

Plasma proteins

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3
Q

The inactive state is called ______.

A

Zymogen

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4
Q

A membrane-bound protein is called the ______.

A

Tissue Factor

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5
Q

_______ tend to be released when the lining of the vascular vessel gets disrupted.

A

Procoagulant Factors

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6
Q

3 phases of Cell-Based Coagulation

A

Initiation
Amplification
Propagation

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7
Q

The activity of the ______ complex is the most significant event to initiate coagulation.

A

FVIIa/TF

7a/Tissue Factor

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8
Q

In the initiation phase of cell base coagulation, the _____ is both a receptor and cofactor for FVII (F7).

A

Tissue factor

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9
Q

When the zymogen FVII (F7) binds to the tissue factor it becomes _____ and forms the _____ complex.

A

7a

F7a/TF

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10
Q

In the initiation phase, the F7a/TF complex activates what zymogens?

A

F9 and F10

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11
Q

TF-bearing cells appear to bind Factor 7a and low levels of Factors 9a and 10a even ______ but are separated from the Phase II: Amplification compounded by the normally intact blood vessel wall.

A

In the absence of injury

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12
Q

In the initiation phase of Cell Based Coagulation factor ___ formed on the TF-bearing cell interacts with cofactor ____ to form a prothrombinase complex.

A

10a

5a

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13
Q

The thrombin generated on the TF-bearing cell serves as the “signal” for Phase ______ to begin.

A

Phase 2: Amplification

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14
Q

The prothrombinase complex generates a _______ on the surface of TF-bearing cells.

A

Small amount of “priming” thrombin.

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15
Q

Fibroblasts and monocytes are examples of _____.

A

Tissue factor bearing cells

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16
Q

If tissue injury has occurred and activated platelets are around, Factor ___ will diffuse to those platelets, bind to their surface, and (in conjunction with Cofactor ___) activate zymogen Factor ___ to Factor ___.

A

9a
8a
10
10a

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17
Q

_______ are released by endothelial cells.

A

Anticoagulant Factors

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18
Q

TF-bearing cells appear to bind Factor ___ and low levels of Factors ___ and ___ even in the absence of injury but are separated from the Phase II: Amplification compounded by the normally intact blood vessel wall.

A

7a

9a and 10a

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19
Q

The _____ generated on the TF-bearing cell serves as the “signal” for Phase 2: Amplification to begin.

A

Thrombin

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20
Q

In the initiation phase of Cell Based Coagulation factors ____ remain on the TF-bearing cell, while factor ____ diffuses away.

A

10a and 5a

9a

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21
Q

In the initiation phase of Cell Based Coagulation Factor 10a formed on the TF-bearing cell interacts with Cofactor 5a to form a _____ complex.

A

Prothrombinase

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22
Q

The activity of the FVIIa/TF complex is the most significant event to _______.

A

Initiate coagulation

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23
Q

In phase 2 of Cell Based Coagulation, when sufficient _____ is generated on or adjacent to TF-bearing cells, ____ are activated.

A

Thrombin (F2a)

Platelets

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24
Q

The small amount of TF-bearing cell-generated thrombin does what 4 things during Phase 2?

A

Activates platelets
Activates F5a from F5
Activates F8a and dissociates it from von Willebrand Factor (vWF)
Activates F11a from F11

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25
Q

Rate of thrombin generation takes leading role in ____ circulation.

A

Venous

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26
Q

When vascular injury occurs, platelets leave the blood vessel, bind to _______ and are activated by a combination of those factors and the _______.

This occurs during Phase _____.

A

Collagen, vWF, blood vessel wall receptors

“Priming” dose of thrombin

3

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27
Q

The adherence of platelets to the damaged tissue is the first step in the formation of the platelet “plug” necessary for ______.

A

Primary hemostasis

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28
Q

In phase 3, the newly activated platelets bind Factors _____ and the Factor ____ freshly liberated by the Factor 7a/TF complex.

A

5a
8a
9a

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29
Q

In phase 3, the freshly-generated Factor ___ binds to the freshly activated platelet.

A

11a

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30
Q

In phase 3, the freshly-generated Factor 11a binds to the _____, effectively bypassing the need for Factor ____.

A

Freshly activated platelet

12a

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31
Q

in Phase 3, membrane-bound Factor ____ keeps on activating Factor 9 to Factor 9a.

A

11a

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32
Q

in Phase 3, membrane-bound Factor 11a keeps on activating Factor ___ Factor ___.

A

9

9a

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33
Q

Factor 8a and co-factor 9a form what is called the _____.

A

Platelet tenase complex (PTC)

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34
Q

The production of vast amounts of thrombin on the surface of activated platelets is the first step in _____.

A

Phase 3: Propagation

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35
Q

_____ agents are used to prevent DVT.

A

Anti-thrombin

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36
Q

The Platelet Tenase Complex is formed by:

A

F8a and co-factor 9a

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37
Q

The PTC activates even more Factor ___ to Factor ___.

A

10

10a

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38
Q

Factor ___ combines with Factor ___ to form the prothrombinase complex.

A

10a

5a

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39
Q

Platelets take leading role followed by fibrin formation in ____ circulation.

A

Arterial

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40
Q

Factor 10a combines with Factor 5a to form the _____ complex.

A

Prothrombinase

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41
Q

The prothrombinase complex causes the:

A

Explosive burst of thrombin that helps produce a stable fibrin clot

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42
Q

Most of the thrombin produced is generated ____ the initial fibrin clot is formed.

A

After

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43
Q

______ is most prominent following severe crushing type injuries.

A

Vascular constriction

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44
Q

____ is considered in vitro.

A

CPB circuit

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45
Q

____ is considered in vivo.

A

Patient

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46
Q

Patients that lack Factor ___ have no problem clotting.

A

12

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47
Q

____ circulation requires rapid response system to seal off any bleeding sites.

A

Arterial

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48
Q

_____ + _____ = activation of the platelet.

A

Transmembrane signaling

High shear stress

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49
Q

_____ agents are used to prevent arterial thrombosis.

A

Anti platelet

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50
Q

What 7 things occur when an arterial blood vessel is damaged?

A

Vascular constriction
Platelet adhesion
Platelet activation (formation of platelet plug)
Activation of cell-based coagulation cascade (formation of fibrin clot)
Clot retraction
Activation of fibrinolytic cascade
Vessel repair/regeneration

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51
Q

Vascular constriction involves _____ and is most prominent following ______.

A

Smooth muscle

Severe crushing injuries

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52
Q

In arterial circulation, ____ take leading role followed by ____.

A

Platelets

Fibrin formation

53
Q

Sub-endothelial collagen also binds with platelet receptor GP4 which causes _____.

A

Activation of the platelet

54
Q

____ circulation has an acceptable slower response.

A

Venous

55
Q

In venous circulation rate of ____ takes leading role.

A

Thrombin

56
Q

Smooth muscle layers of arteries

A

Outer longitudinal

Inner circular

57
Q

Capture that occurs in platelet adhesion depends on: (2)

A

Sub-endothelial molecules of von Willebrand’s Factor (vWF) and collagen

Platelet surface receptor Glycoprotein Ib

58
Q

GPIb binds easily with vWF, but it has a ____ affinity interaction, which slows but does not stop the platelet.

A

Low

59
Q

Cyclooxygenase activity irreversibility inhibited by Aspirin because there is no _____ formation.

A

Thromboxane

60
Q

Interaction between platelet GPIb and the vWF molecule causes ______.

A

Transmembrane signaling

61
Q

Which platelet agonists have vasoconstricting effects?

A 
Thromboxane A2 (TXA2)
Serotonin
62
Q

Transmembrane signaling coupled with high shear stress results in activation of ____.

A

Platelet

63
Q

_____ binds with platelet receptor GP1a/2a.

A

Sub-endothelial collagen

64
Q

During platelet activation, the platelet loses its normal ____ shape.

A

Discoid

65
Q

Platelet receptor _____ undergoes conformation change.

A

GP2b/3a

66
Q

After the platelet receptor GP2b/3a undergoes conformational change it is able to bind to ____.

A

vWF

67
Q

GP2b/3a and vWF have a ____ affinity bond that secures the activated platelet to the ____.

A

High

Sub-endothelium

68
Q

Sub-endothelial collagen binds with platelet receptor ____. At medium shear stress strong enough to bind platelet to sub-endothelium.

A

Gp1a/2a

69
Q

5 goals of platelet activation:

A

Recruitment of additional platelets
Vasoconstriction of smaller arteries
Local release of ligands needed for stable platelet-platelet matrix
Localization and acceleration of platelet-associated fibrin formation
Protection of clot from fibrinolysis

70
Q

Activated platelets release _____, which recruit additional platelets.

A

Platelet agonists

71
Q

3 platelet agonists

A

Thromboxane A2
Serotonin
ADP

72
Q

_____ inactivate F5a and F8a cofactors.

A

Proteins C and S

73
Q

Thromboxane is an important _____ and _____.

A

Platelet agonist

Vasoconstrictor

74
Q

_____ is formed in cytosol following cyclooxygenase cleavage of arachidonic acid.

A

Thromboxane A2

75
Q

____ anchors the platelet.

A

GP2b/3a

76
Q

ASA paralyzes the production of ____.

A

thromboxane A2

77
Q

Why should platelet gel should never be applied directly to new bypass graphs?

A

Vasoconstriction effects

78
Q

Serotonin is released from platelet granules. It is a _____ and _____.

A

Platelet agonists

Vasoconstrictor

79
Q

____ is released from platelet granules and is a platelet agonists with no known vasoactive roles.

A

ADP

80
Q

Cyclooygenase activity irreversibility inhibited by ____ because there is no thromboxane formation.

A

Aspirin

81
Q

Sub-endothelial collagen also binds with platelet receptor _____ which causes activation of the platelet.

A

GP4

82
Q

____ is the site of action of newer anti-platelet agents.

A

GP2b/3a

84
Q

The formation of the platelet plug begins with the surface receptor GP2b/3a undergoing a _____ dependent conformational change making it able to bind with _______.

A

Calcium

Fibrinogen or vWF

85
Q

The production of _____ signals the Fibrinolytic phase of coagulation.

A

Plasmin

86
Q

Fibrinogen and vWF are stored in ____ within the platelet that are released ____.

A

Alpha-granules

Following activation

88
Q

Fibrinogen and vWF bonds form between _____ binding them together in a _____.

A

Platelet

Tight matrix

89
Q

_____ is released by endothelial cells and activated by thrombin and venous occlusion.

A

tPA

90
Q

More than _____ GP2b/3a receptors present on platelet surface, with additional receptor molecules available within ____.

A

50,000

Cytoplasm

91
Q

Even as the fibrin clot is being formed, the ____ system is being initiated to disrupt the clotting process and the clot itself.

A

Termination

93
Q

_____ are measured to help determine the amount of fibrinolysis occurring.

A

FDPs

94
Q

Four autologous anticoagulants help control the spread of coagulation activation:

A 
Tissue Factor Pathway Inhibitor (TFPI)
Protein C (PC)
Protein S (PS)
Antithrombin III (AT or AT-III)
95
Q

____ forms a quarternary complex called the TF/F7a/10a/TFPI which I activates various factors and limits coagulation.

A

TFPI

96
Q

What does the quarternary complex called the TF/F7a/F10a/TFPI formed by TFPI?

A

Inactivates various factors and limits coagulation

97
Q

______ are regulated by Plasminogen Activator Inhibitors 1&2.

A

uPA and tPA

98
Q

Endothelial cells have a negative charge that repels _____.

A

Platelets (positive charge)

99
Q

Endothelial release of ADPase inactivates platelet released ADP limiting ability ______.

A

Recruit other platelets

101
Q

TFPI forms a quarternary complex called the ____ which inactivates various factors and limits coagulation.

A

TF/F7a/F10a/TFPI

103
Q

____ is a vitamin K-dependent plasma glycoprotein which helps break down F10a and F8a.

A

Protein C

104
Q

Proteins C and S inactivate ____ and ____ cofactors.

A

F5a

F8a

106
Q

Protein C is activated by ____ and its activity is increased by ____.

A

Thrombin

Protein S

107
Q

Protein C and Protein S are _____ dependent plasma glycoproteins.

A

Vitamin K

108
Q

_____ inhibits thrombin and the “serine protrudes”.

A

Anti-thrombin

109
Q

_____ is produced from the zymogen plasminogen by the action of urokinase-type plasminogen activator (uPA) and tissue-type plasminogen activator (tPA).

A

Plasmin

110
Q

Serine Proteases include Factors _____ (4).

A

4a
10a
11a
12a

111
Q

tPA is released by _____ and activated by _____ and _____.

A

Endothelial cells

Thrombin and venous occlusion

112
Q

tPA and plasminogen bind to the growing fibrin polymer as _____ is converted to _____.

A

Fibrinogen (F1)

Fibrin (F1a)

113
Q

____ and ____ bind to the growing fibrin polymer as fibrinogen (F1) is converted to fibrin (F1a).

A

tPA

Plasminogen

114
Q

In the last step of fibrinolysis, _____ is activated to _____ which cleaves fibrin strands.

A

Plasminogen

Plasmin

115
Q

In the last step or fibrinolysis, plasminogen is activated to Plasmin which cleaves _____ strands.

A

Fibrin

116
Q

FDPs are measured to help determine the amount of _____ occurring.

A

Fibrinolysis

117
Q

_____ anticoagulants prevent clotting and require intact endothelial cell barrier.

A

Endogenous

118
Q

Endothelial release of ____ and ____ inhibit platelet adhesion and aggregation.

A

Nitric oxide

Prostacyclin (PGI2)

119
Q

4 effects that coagulation has on cardiac surgery and cardiopulmonary bypass

A

Bleeding
Circuit integrity
Inflammation
Disease state of patient

120
Q

____ foreign surface stimulates coagulation cascade.

A

Large

121
Q

Coagulation cascade will stimulate ____ activities.

A

Inflammation

122
Q

5 effects of bypass/surgery on coagulation:

A 
Activates intrinsic and extrinsic coagulation pathways
Activates neutrophils and monocytes 
Exposes sub-endothelium
Activates platelets
Vascular endothelial cell activation.
123
Q

Large negatively charged surface activates ____ pathway, which also activates _____ which activates _____.

A

Intrinsic
Fibrinolysis
Complement

124
Q

Endothelial release of ____ inactivates platelet released ADP limiting ability to recruit other platelets.

A

ADPase

125
Q

Activation of complement cascade results in ____ activation.

A

Leukocyte

126
Q

Exposed sub-endothelium stimulates ______.

A

Coagulation

127
Q

Platelet activation during bypass can occur due to ____ and activates _____.

A

Contact with foreign surface of circuit

Intrinsic and extrinsic pathways

128
Q

Endothelial cells have a ____ charge.

A

Negative

129
Q

Cleaved fibrin strand produces _____.

A

Fibrin Degradation Products

FDPs or Fibrin Split Products

130
Q

Plasmin is produced from the zymogen plasminogen by the action of _____ and _____.

A

uPA and tPA

131
Q

uPA and tPA are regulated by _______.

A

Plasminogen Activator Inhibitors 1&2 (PAI-1 & PAI-2)

132
Q

Coronary suction introduces _____ from damaged cells which activates the ____ pathway.

A

Tissue factor

Extrinsic

134
Q

The production of plasmin signals the ____ phase of coagulation.

A

Fibrinolytic

139
Q

Endothelial release of nitric oxide and prostacyclin inhibit ________ (2).

A

Platelet adhesion and aggregation

152
Q

Plasmin is produced from the zymogen _____ by the action of urokinase-type plasminogen activator (uPA) and tissue-type plasminogen activator (tPA).

A

Plasminogen

153
Q

More than 50,000 _____ receptors present on platelet surface, with additional receptor molecules available within cytoplasm.

A

GP2b/3a

Perf Tech 1 (2 decks)

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