coagulation

Question 1

ability of the blood stop bleeding

Answer 1

hemostasis

Question 2

wall defect in endothelial causes what to factors to be exposed

Answer 2

collagen
von willebrand factor

Question 3

formation of a clot term

Answer 3

thrombogenesis

Question 4

red thrombus

Answer 4

veins

RBC
long fibrin tail
detach -> PE/DVT

Question 5

white thrombus

Answer 5

arterial flow

platelets and fibrin cross-linking

Question 6

glycoproteins on platelet cell surfaces

name and what they bind to

Answer 6

collegen binds to glycoprotein 1a receptor

vWF binds to glycoprotein 1b receptor

Question 7

3 soluble mediators in platelet activation

Answer 7

adenosine (ADP)
thromboxane A2
serotonin (5HT)

Question 8

what do NSAIDS inhibit

Answer 8

prostaglandin synthesis

• pro-clot
• black box for CV events

Question 9

what does aspirin target

Answer 9

inhibits thromboxane A2

Question 10

what do endothelial cells normally produce

Answer 10

prostaglandin I2 (prostacyclin)

inhibits platelet aggregation

Question 11

extrinsic pathway activation

Answer 11

outside tissue damage exposes tissue factor

Question 12

intrinsic pathway activation

Answer 12

inside the vessel

platelets interact with damaged endothelium

Question 13

DVT Virchow’s Triad

Answer 13

1. stasis
2. hyper coagulability
3. endothelial injury

Question 14

inherited DVT risk factors

Answer 14

antithrombin III deficiency (normally inhibits thrombin from forming)

Protein C and S deficiency (inhibit factor 8)

sickle cell anemia (RBC become trapped and damage endothelium)

activated protein C resistance (normal amount of protein C but factors produced are resistant)

Question 15

acquired DVT risk factors

Answer 15

bedbound, surgery, trauma, obesity, estrogen malignancies, chronic venous insufficiency.

Question 16

DIC

what is it

Answer 16

disseminated intervascular coagulation

• using up all clotting factors and platelets

Question 17

what causes DIC

Answer 17

• gram (-) bacteria b/c of endotoxins it releases
• massive tissue injury
• malignancy
• abruptio placentae

Question 18

protease inhibitors

what they do?
list 4 of them

Answer 18

inactivate the coagulation proteins

alpha 1 antiprotease
alpha 2 macroglobulin
alpha 2 antiplasmin
antithrombin

Question 19

what breaks down the clot after its formed?

Answer 19

inactive plasminogen -> plasmin

activated by tissue plasminogen activator (tPA)

• plasmin breaks down the fibrin

Question 20

intrinsic pathway numbers

Answer 20

12, 11, 9, 10

Question 21

extrinsic pathway numbers

Answer 21

7, 10

Question 22

common pathway

Answer 22

prothrombin -> thrombin
fibrinogen -> fibrin

Question 23

what factors does thrombin activate? (5)

Answer 23

factor 13
factor 5
factor 8
factor 11
protein C

Question 24

hemophilia type A is what clotting factor

Answer 24

8

Question 25

3 activators of plasminogen -> plasmin fibrinolytics

Answer 25

- pro-bleeding - catalyze formation of serine protease plasmin - tissue plasminogen activator (tPA) - Urokinase - Streptokinase

Question 26

what makes up anistreplase

Answer 26

pro-activator + streptokinase = activator

Question 27

2 drugs protect clots from lysis inhibit plasminogen -> plasmin

Answer 27

aminocaproic acid TXA

Question 28

HIT what is it? treatment?

Answer 28

antibodies target thrombocytes (decrease platelets) stop drug platlets, FFP 7-10 days post initiation

Question 29

aptt

Answer 29

activated partial thromboplastin time 35-45 seconds intrinsic and common pathway phospholipid added to induce intrinsic pathway

Question 30

PT

Answer 30

prothrombin time extrinsic and common pathway addition of tissue factor 3 time to clot compared to control (INR)

Question 31

INR

Answer 31

warfarin 2-3

Question 32

3 indirect thrombin inhibitors

Answer 32

enhances antithrombin HMWH: antithrombin 3 (Xa and thrombin) LMWH: factor Xa Fondaparinux: antithrombin

Question 33

heparin reversal how does it work?

Answer 33

protamine (+) binds to heparin (-)

Question 34

what complex do indirect thrombin inhibitors have?

Answer 34

pantasaccharide HMWH, LMWH, fondaparinux

Question 35

direct thrombin inhibitors (3)

Answer 35

argatroban dabigatran Hirudin (lab version)

Question 36

warfarin MOA

Answer 36

blocks gamma carboxylation of several glutamate resides (clotting factors 2,7,9,10) thrombin - vit K dependent - oxidation and reduction reaction - high protein binding

Question 37

warfarin reversal

Answer 37

stop drug vit K FFP factor 9

Question 38

heparin toxicity (3)

Answer 38

hemorrhagic disorder of fetus birth defects cutaneous necrosis

Question 39

factor 10a inhibitors (2)

Answer 39

rivaroxaban apixaban

Question 40

streptokinase

Answer 40

fibrinolytic plasminogen -> plasmin streptococci bacteria

Question 41

urokinase

Answer 41

fibrinolytic plasminogen -> plasmin synthesized by kidney and synthetic version

Question 42

t-PA

Answer 42

tissue plasminogen activator fibrinolytic alteplase activates plasminogen that it bound to fibrin -> plasmin

Question 43

aspirin

Answer 43

cox 1 inhibits TXA2 synthesis

Question 44

plavix

Answer 44

irreversibly inhibit ADP receptors on platelets

Question 45

abciximab

Answer 45

2B and 3A glycoreceptors blockers antiplatelet monoclonial antibody

Question 46

vit K

Answer 46

green leafy vegetables activity on prothrombin, factors 7,9,10

Question 47

desmopressin

Answer 47

increase factor 8 tx: von willebrand, hemophilliaA

Question 48

aminocaproic acid

Answer 48

competitively inhibits plasminogen activation

Question 49

tranexamic acid

Answer 49

TXA antifibrinolytic inhibits plasminogen TX: severe bleeding

Question 50

what does fibrin bind to on the platelets

Answer 50

glycoprotein 2b and 3a