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Coagulation > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is the goal of primary hemostasis

A

the formation of a platelet plug

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2
Q

List out the steps of primary hemostasis

A
  • vascular damage occurs
  • vasoconstriction
  • platelets activate
  • platelets adhere to injury
  • platelets secrete granule content
  • platelets aggregate
  • platelet plug is formed
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3
Q

What is the goal of secondary hemostasis

A

to form a stable fibrin clot

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4
Q

List out the steps of how secondary hemostasis occurs

A
  • proteins are in blood as inactive zymogens
  • a complex forms that activates the zymogens
  • coagulation cascade occurs
  • thrombin is produced
  • thrombin converts fibrinogen into fibrin
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5
Q

What is the final stage of hemostasis?

A

fibrinolysis- the digestion and removal of fibrin clot

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6
Q

How do endothelial cells that line the inner surface of blood vessels influence in coagulation?

A

They can secrete anticoagulant and procoagulant molecules that move the coagulation cascade along

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7
Q

What are the anticoagulant properties of intact vascular intima

A

prevents thrombosis by:
inhibiting platelet aggregation
preventing coag activation and propagation
enhancing fibrinolysis

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8
Q

What procoagulants can endothelial cells secrete

A 
VWF
P-selectin
exposure of collagen
PAI-1
TAF1
ADAMTS13
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9
Q

What anticoagulants can endothelial cells secrete

A 
nitrous oxide
PGI2
heparan
TFPI
Thrombomodulin
EPCR
TPA
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10
Q

What does prostacyclin do

A

inhibits platelets and is a vasodilator

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11
Q

What does nitric oxide do?

A

inhibits platelet activation, promotes angiogenesis

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12
Q

What does TFPI stand for and what does it do?

A

Tissue factor pathway inhibitor

controls activation of extrinsic pathaway

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13
Q

What does thrombomodulin do?

A

EPCR binds protein C–> thrombomodulin catalyzes activation of protein C pathway
Ends in thrombin inhibition

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14
Q

What does heparan sulfate do?

A

enhances activity of antithrombin

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15
Q

What is VWF? What does it do

A

it is secreted by endothelial cells, activated by thrombin,

the carpet on which platelets assemble

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16
Q

What do ICAMs, PECAMs and P selectin do?

A

they are adhesion molecules that promote platelet and leukocyte binding

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17
Q

What causes the coagulation system to activate? Extrinsic pathway

A

the exposure of Tissue factor which is right on the outside of the inner vessel lining.
TF needs to have contact with F VII

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18
Q

What do endothelial cells secrete to promote fibrinolysis?

A

TPA- tissue plasminogen activator
PAI-1- plasminogen activator inhibitor
TAFI-thrombin activatable fibrinolysis inhibitor

all preventing excessive plasmin generation

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19
Q

What molecule allows platelets to adhere

A

VWF- links platelets to collagen

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20
Q

What molecule allows platelets to aggregate

A

GP llb/lla receptors on platelets that are activated and allow fibrinogen, VWF and fibronectin to bind to platelets. Fibrinogen is the key player

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21
Q

What do platelets secrete out of their granules

A

procoagulants- V, VWF, VIII and fibrinogen

control proteins-Ca, ADP

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22
Q

What is the main ingredient for enzyme-cofactor- substrate complex to form

A

the platelet membrane must be activated, this is the foundation for secondary hemostasis

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23
Q

Where do coagulation factors come from? How many are there?

A

the liver, 16

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24
Q

What is a zymogen?

A

an inactive enzyme

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25
Q

What are cofactors and what is their role

A

coagulation factors the help bind, stabilize and enhance activity of enzymes

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26
Q

What is the primary enzyme of the coagulation system

A

thrombin,

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27
Q

What is the substrate for the primary enzyme of the coag system

A

fibrinogen

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28
Q

What coagulation factor has the shortest half life? What is it?

A

VII- 6hr half life

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29
Q

What coagulation factor has the highest molecular weight

A

VWF-its really big

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30
Q

What coagulation factor if most concentrated in the blood?

A

I- fibrinogen

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31
Q

What coagulation factor if most concentrated in the blood?

A

I- fibrinogen

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32
Q 
What is are the nicknames for coagulation factors 
I 
II 
III
IV
A

I-fibrinogen
II-prothrombin
III-Tissue factor
IV- ionic Ca

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33
Q

What are the nicknames for coagulation factors
V
VII
VIII

A

V- five
VII- seven
VII- antihemophilic factor

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34
Q 
What are the nicknames for coagulation factors
IX
X
XI
XII
A

IX-Christmas factor
X-Stuart Prower factor
XI-eleven
XII-Hageman factor

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35
Q 
What are the nicknames for coagulation factors
pre-k
HMWK
XIII
PF3
A

pre-K fletcher factor-prekallikrein
HMWK- Fitzgerald factor-high molecular weight kininogen
XIII-fibrin stabilizing factor
PF3- platelet factor 3

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36
Q

Which coagulation factors are serine proteases

A 
II-prothrombin
VII-seven
IX-Christmas
X-Stuart
XI-11
XII-Hageman
pre-k- pre kallikrein-fletcher
2+7=9, 10, 11, 12 prek
37
Q

Which coagulation factor carries factor VIII and allows for platelet adhesion

A

VWF

38
Q

What coagulation factors function as cofactors

A 
III-TF
V-5
VIII- antihemophilic factor
HMWK- kininogen- Fitzgerald
3+5=8 HMWK
39
Q

Which coagulation factor functions as a mineral

A

IV- ionic Ca

40
Q

Which coagulation factor is a thrombin substrate, and polymerizes to create fibrin

A

fibrinogen

41
Q

Which coagulation factor functions as transglutaminase and transamidase? enzymes

A

XIII- fibrin stabilizing factor

42
Q

Which coagulation factor functions as an assembly molecule?

A

platelet factor 3

43
Q

What do serine proteases do?

A

they are enzymes that act on a substrate by digesting the primary backbone,
state as inactive zymogens

44
Q

Which coagulation factors are vitamin K dependent?

A

II, VII, IX, X

2+7=9, 10

45
Q

Where is vitamin K found in a person’s diet

A

green leafy vegetables

quinone, also produced by some bacteria

46
Q

What is the function of vitamin K

A

catalyzes a change in the prothrombin group proteins

47
Q

What is the prothrombin group

A

the group of vitamin K dependent coag factors

48
Q

What regulatory proteins act on each of the members of the prothrombin group

A

II-C
VII-S
IX-Z
X- none

49
Q

How does vitamin K activate the factors in the prothrombin group

A

adds a carboxyl group
enabling the factor to bind to ionic Ca (IV)
The bound Ca allows vitamin K to add charged phospholipids to the coag factor
coag complexes help continue coagulation cascade

50
Q

What are the 3 coagulation complexes

A

Extrinsic
intrinsic
prothromninase

51
Q

What are the components of the extrinsic tenase complex, what does it activate

A

TF, Ca, VIIa, phospholipid

IX and X

52
Q

What are the components of the intrinsic tenase complex, what does it activate?

A

IXa, VIIIa, phospholipid, Ca

X

53
Q

What are the components of prothrombinase, what do they activate?

A

Xa, Va, phospholipid, Ca

prothrombin

54
Q

What does BK stand for

A

bradykinin

55
Q

What lab test detects the absence of any of the factors in the intrinsic pathway

A

aPTT or PTT

56
Q

What lab test measures the extrinsic pathway function?

A

PT

57
Q

What are the procoagulants involved in the coag cascade

A

V-
VWF
VIII
Fribrinogen

58
Q

What are the two phases of coagulation? how much thrombin do each of them produce

A

initiation- TF expressing cells- 3-5% of total thrombin- extrinsic
propagation- on platelets, produces 95% or more of thrombin-intrinsic

59
Q

What is the principal enzyme of fibrinolysis

A

plasmin- hydrolysis off fibrin

60
Q

How is plasminogen converted to plasmin

A

TPA Tissue plasminogen activator TPA

UPA- urokinase plasminogen activator - less effective

61
Q

Where does TPA come from? and UPA?

A

TPA-secreted by endothelium

UPA-kidney cells

62
Q

How is plasminogen inhibited?

A

PAI-1- inhibits TPA and UPA-plasminogen never turns to plasmin
alpha 2- antiplasmin- inhibits free plasmin
TAFI- thrombin activatable fibrinolysis inhibitor- blocks TPA and plasminogen from binding

63
Q

What do fibrin fragments do

A

XYDE

inhibit hemostasis, products of fibrin digestion

64
Q

What are contact factors?

A

factors that are activated by contact with a negative charge to become activated

65
Q

What are the contact factors

A

XIIa, HMWK, prek- activates factor XII

66
Q

How does thrombin activate fibrinogen

A

thrombin cleaves fibrinopeptides, and A and B from alpha and beta chains

67
Q

Which procoagulant is the most concentrated

A

fibrinogen

68
Q

What are the pediatric developmental stages

A

neonatal- first 4 weeks
infancy first year
childhood 1 to puberty

69
Q

How are infants categorized by weight

A

large more than 4000
small 2500 or less
very low 1500 or less
extremely low 1000 or less

70
Q

Who are more at risk of thrombosis

A

babies- No
elderly - yes
pregnancy -yes very

71
Q

Difference between white clot and red

A

White-platelets and VWF

Red- after coag- stabilized clot

72
Q

What triggers the eicosanoid synthesis pathway

A

G proteins

73
Q

What is the purpose of the eicosanoid synthesis process

A

To activate platelets

74
Q

The ___ Camp you have the __ platelet activation

A

less camp

more platelet activation

75
Q

where does arachadonic acid come from

A

phospholipids

76
Q

Why is arachadonic acid important

A

inflammation and vasodialation

77
Q

What affects the zone of inhibition and susceptibility breakpoints

A

the thickness of agar
too thick-falsely small zones (false resistance)
too thin-falsely large zones (false susceptibility)

78
Q

What is the purpose of placing plates with KB upside down

A

to avoid condensation interfering with results

79
Q

What is the maximum of antibiotic disks per mueller hinton plate

A

12 for every 150 mm plate

80
Q

What temperature can Kirby Bauer Disks be stored and for how long

A

2-8C for 1 week

needs to be at room temp before use

81
Q

What does the MecA gene cause resistance for

A

codes for penicillinases- penicillin binding protein PBP2a

causes resistance to penicillin, methicillin, nafcillin, cloxacillin, dicloxacillin

82
Q

What are MRSA and what are the resistant to

A

oxacillin resistant Staph aureus

83
Q

What special properties do oxacillin disks have

A

modified mueller hinton plate with oxacillin with McFarland suspension

84
Q

What resistance does the erm gene cause

A

encodes for methylation 23S RNA
causes resistance to erythromycin
induces clindamycin

85
Q

What resistance does the msrA gene cause?

A

encodes for efflux mechanism that gives resistance to erythromycin
susceptible to clindamycin

86
Q

What is the D test for

A

to see if there is resistance to both erythromycin and clindamycin

87
Q

What does it mean if the clindamycin zone is flattened in a D test

A

erm gene present

resistance to clindamycin

88
Q

What does it mean if a D test is not flattened and there is resistance in the erythromycin only

A

msrA gene present

not resistant to clindamycin

89
Q

What is the MHT modified Hodge Test for?

A

looks for carbapenemase enzyme in enterobacteriaceae
gives them ability to neutralize beta lactam carbapenems
if test is positive, resistant to all carbapenems
clover shape

Coagulation (7 decks)

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