Coagulation

Question 1

Inhibit platelet adhesion

Answer 1

PGI2

Question 2

Released in response to endothelial damage

Answer 2

vWF
collagen exposed
PGI2 redcued

Question 3

Mechanism of platelet aggregation

Answer 3

GP1a bind collagen and GP1b binds vWF –> bound platelets replease ADP, thromboxane A2 (TXA2) and serotonin (5-HT) –> those things recruit and activate more platelets - promote GPIIb/IIIa receptor to bind fibrinogen (crosslinks platelets) –> TXA2 and HR-2 cause vasoconstriction

Question 4

Fibrin formation

Answer 4

TF + VII –> VIIa-TF (w/ IX and XIII) cleave X to Xa –> Xa (and V) cleaves prothrombin –> thrombin –> thrombin cleaves fibrinogen to fibrin

Question 5

TFPI

Answer 5

inhibits activity of TF/VIIa

Question 6

Protein C

Answer 6

w/ cofactor (protein S), destroys factors V and VIII

Question 7

Thrombomodulin

Answer 7

on endothelial cells, allows activation of protein C by thrombin

Question 8

Antithrombin III (AT III)

Answer 8

plasma protease inhibitor that inactivates clotting factors

Question 9

alpha1-antiprotease and a2-macroglobulin

Answer 9

like AT III, inactivate clotting factors

Question 10

Disseminated intravascular coagulation (DIC)

Answer 10

inhibitors overwhelmed by injury, sepsis, etc. leading to clots everywhere

Question 11

Fibrinolysis

Answer 11

removing fibrin clots via PLASMIN (digests fibrin and clotting factors)

Question 12

Converts plasminogen to plasmin

Answer 12

tissue plasminogen activator (t-PA)

Question 13

Antidote for Heparin

Answer 13

protamine sulfate

Question 14

Use of heparin

Answer 14

anticoag: surgery, IV cath

Prophylaxis of DVT, PE

Question 15

LMH drugs

Answer 15

enoxaprin

fondaparinux

Question 16

Direct thrombin inhibitor drugs

Answer 16

Bivalirudin (IV)
Argatroban (IV)
Dabigatran (O)

Question 17

Heparin is dependent on

Answer 17

AT III- protease of fibrin

Question 18

Use of bivalirudin and argatroban

Answer 18

Alternate in HIT

Question 19

Caution of bavalirudin and argatroban

Answer 19

liver patients

Question 20

Dabigatrans use

Answer 20

prevent stroke in non-valvular a. fib

Question 21

Metabolism of dabigatran

Answer 21

Kidney

argatroban and bivalrudin are liver

Question 22

Contra for dabigatran

Answer 22

mech heart valves

avoid abrupt discontinuation: thrombotic events

Question 23

Antidote for dabigatran

Answer 23

Idarucizumab

Question 24

DTI

Answer 24

bivalirudin
argatroban
dabigatran

Question 25

Direct Factor X inhibitors

Answer 25

Rivaroxaban
Apixiban
Betrixaban
Edoxaban

Question 26

Warfarin MOA

Answer 26

inhibits Vit K epoxide reductase (vit K needed for clotting factors)

Question 27

Factors effected by warfarin

Answer 27

II, VII, IX, X, protein C & S

Question 28

SE of warfarin

Answer 28

hemorrhage

Dec. Protein C: cutaneous necrosis and infart

Question 29

Contra of warfarin

Answer 29

pregnancy

drug interactions

Question 30

Drug interactions of warfarin

Answer 30

vit K - abx (absorption)
clotting factors - estrogen
platelet aggregation/function - ASA
dipslace from binding site on albumin
inhibit/induce liver microsomal enzymes

Question 31

t-PA

Answer 31

tissue plasminogen activator – plasminogen is converted to plasmin which digests fibrin and clotting factors (fibrinolysis)

Question 32

t-PA released from

Answer 32

endothelium

Question 33

PAI

Answer 33

binds free t-PA to prevent fibrinolysis; if not bound, t-PA cleaves plasminogen to plasmin and degrades clots

Question 34

DOC for patients undergoing placement of coronary stents

Answer 34

Clopidigrel (ticlopidine, prasugrel)