Haemostasis and Thrombosis

Question 1

2 initial stages of thrombin production

Answer 1

TF bearing cells activate factors V and X to form prothrombinase complex

Prothrombinase complex activates factor II to IIa (prothrombin to thrombin)

Question 2

endogenous antithrombus mechanism?

Answer 2

AT-III which inactivates fica and fXa

Question 3

4 pharmacological targets for anticoagulants?

Answer 3

1) inhibition of fIIa
2) inhibition of fXa
3) up regulation of ATIII
4) reduce levels of vit K

Question 4

factor IIa inhibitor?

Answer 4

Dabigatran

Question 5

What is dabigatran

Answer 5

factor IIa inhibitor

Question 6

factor Xa inhibitor?

Answer 6

Rivaroxaban

Question 7

What is Rivaroxaban

Answer 7

factor Xa inhibitor

Question 8

What is heparin

Answer 8

ATIII activator

Question 9

An ATIII activator?

Answer 9

Heparin

Question 10

What does warfarin do?

Answer 10

Reduce vit K levels

Question 11

What is vit K necessary for?

Answer 11

Generation of factors II, VII, IX and X

Question 12

What is needed for. Generation of factors II, VII, IX and X

Answer 12

Vit k

Question 13

What can reduce vit K levels

Answer 13

Warfarin

Question 14

Why is dabigatran rarely used.

Answer 14

Dabigatran can cause bad GI bleeding

Question 15

Treatment for DVT, pre and post full diagnosis?

Answer 15

Dalteparin pre, and warfarin and rivaroxaban post

Question 16

what is dalteparin an example of

Answer 16

LMW heparin

Question 17

Treatment for a pulmonary embolism?

Answer 17

Dalterparin/heparin and rivoroxaban and warfarin

Question 18

example of LMW heparin

Answer 18

Dalteparin

Question 19

3 risk factors for DVT

Answer 19

rate of blood flow, consistency (constituents) of blood, blood vessel wall integrity

Question 20

What is given as anti-platelet therapy

Answer 20

Aspirin and clopidogrel

Question 21

thrombus in veins colour?

Answer 21

Red

Question 22

Thrombus in artery colour? and why?

Answer 22

White because of foam cells

Question 23

What is always offered in NSTEMIs

Answer 23

Warfarin and clopidogrel, Antiplatelets

Question 24

What is used to treat NSTEMIs

Answer 24

Antiplatelets

Question 25

What is used to treat STEMIs

Answer 25

Antiplatelets and thrombolytics

Question 26

Difference between STEMI and NSTEMI

Answer 26

STEMI is a fully occluded coronary artery, NSTEMI is a partially occluded coronary artery

Question 27

What factor activates platelets

Answer 27

IIa

Question 28

Explain platelet activation molecular level (7/8)

Answer 28

thrombin binds to protease activated receptor PAR. this causes rise in intracellular Ca. this causes exocytosis of ADP from dense granules. ADP activates P2Y12 receptors which activates and aggregates platelets. PAR also liberates arachidonic acid (AA). Cyclooxygenase generates thromboxane A2 from AA. TXA2 activation causes expression of GPIIb/IIIa receptor on platelet surface which is involved in platelet aggregation

Question 29

What does PAR stand for and do

Answer 29

Protease activates receptor Causes rise in intracellular Ca. this causes exocytosis of ADP from dense granules. PAR also liberates arachidonic acid (AA). Cyclooxygenase generates thromboxane A2 from AA.

Question 30

What does clopidogrel do

Answer 30

Platelet inhibitor, P2Y receptor antagonist and so prevents activation and aggregation of platelets.

Question 31

What does aspirin do

Answer 31

COX1 inhibitor so prevents AA from becoming TXA2

Question 32

What does abciximab do

Answer 32

Binds to GpIIb/IIIa prevents aggregation

Question 33

What drug Binds to GpIIb/IIIa prevents aggregation

Answer 33

Abciximab

Question 34

What drug is a COX1 inhibitor so prevents AA from becoming TXA2

Answer 34

aspirin

Question 35

What drug us a P2Y receptor antagonist and so prevents activation and aggregation of platelets.

Answer 35

Clopidogrel

Question 36

How is fibrin generated

Answer 36

Large scale thrombin production, this binds to fibrinogen and makes fibrin strands

Question 37

What do thrombolytics to

Answer 37

Convert plasminogen to plasmin which is a protease that degrades fibrin

Question 38

Example of thrombolytic?

Answer 38

Alteplase

Question 39

Alteplase is a?

Answer 39

thrombolytic

Question 40

3 main antiplatelet drug categories?

Answer 40

COX inhibitors, P2Y receptor antagonists, and GpIIb/IIIa antagonists