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PHARMACOLOGY 2 - HEMATOLOGIC LESSON 1 > Hematologic Lesson 1 > Flashcards

Hematologic Lesson 1 Flashcards

1
Q

Maintaining fluidity of the blood, repairing vascular injury, and
limiting blood loss

A

HEMOSTASIS

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2
Q

Breakdown of the hemostatic mechanism
could result to either ______ or _______

A

Excessive bleeding
or Thrombosis.

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3
Q

What are the common causes of dysregulated
hemostasis?

A
  1. Hereditary
  2. Acquired defects in the clotting
    mechanism
  3. Secondary effects of infection/cancer
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4
Q

What are the steps in Hemostasis?

A
  1. Vasoconstriction
  2. Primary hemostatic plug
  3. Secondary hemostasis
  4. Counter regulation
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5
Q

It is the site of injury due to local nueral response and release of endothelin from the endothelium

A

VASOCONSTRICTION

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6
Q

This is due to the platelet adhesion, activation, degranulation (ADP,TXA2) and recruitment of other platelets

A

PRIMARY HEMOSTATIC PLUG

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7
Q

It is the activation of coagulation cascade by tissue factor and phospholipid via extrinsic pathway

A

SECONDARY HEMOSTASIS

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8
Q

It is the fibrin formation (clot)

A

SECONDARY HEMOSTASIS

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9
Q

The tissue plasminogen activator (t-PA promotes fibrinolysis)

A

COUNTER REGULATION

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10
Q

It is the antithrombotic cascade (ATIII and others)

A

COUNTER REGULATION

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11
Q

It is involved in the formation of thrombi that serves a plug to the injured blood vessel, thus arrest bleeding and prevent blood loss

A

PRIMARY HEMOSTASIS

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12
Q

What are the stages of Primary Hemostasis?

A
  1. Platelet adhesion
  2. Platelet Activation
  3. Platelet Aggregation
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13
Q

Injury to the cell membrane exposes
collagen and von Willbrand factor

A

Platelet Adhesion

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14
Q

The platelet membrane receptors,
glycoprotein (GP) Ia receptor binds to
collagen (C) and GP Ib receptor binds to
von Willebrand factor (vWF) causes the
platelet to adhere into the wall

A

Platelet Adhesion

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15
Q

This event is followed by subsequent
activation of the platelets

A

Platelet Adhesion

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16
Q

Upon adhesion of the platelet to the
injured wall, activation follows along with
the synthesis and secretion of
vasoconstrictors and platelet-recruiting
and activating molecules

A

Platelet Activation

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17
Q

The degranulating platelet releases adenosine diphosphate (ADP), thromboxane A2 (TXA2), and serotonin (5-HT) which are aggregating
substances

A

Platelet Activation

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18
Q

It is synthesized
from arachidonic acid within platelets
and is a platelet activator and potent
vasoconstrictor.

A

Thromboxane A2 (TXA2)

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19
Q

A powerful inducer of platelet aggregation

A

Adenosine diphosphate (ADP)

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20
Q

It stimulates
aggregation and vasoconstriction

A

Serotin (5-HT)

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21
Q

Activation of platelets results in a
conformational change in what?

A

GP IIb/IIIa receptor

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22
Q

Fibrinogen cross-links to adjacent
platelets, resulting in aggregation and
formation of a platelet plug

A

Platelet Aggregation

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23
Q

It cross-links to adjacent
platelets, resulting in aggregation and
formation of a platelet plug

A

Fibrinogen

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24
Q

The coagulation system
cascade is activated, resulting in thrombin
generation and a fibrin clot, which
stabilizes the platelet plug

A

Platelet Aggregation

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25
Q

The unstable primary platelet plug (thrombus) is stabilized through a cascade of events that converts fibrinogen into
fibrin (stable) clot

A

Blood Coagulation Cascade

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26
Q

The exposure of TF
on damaged endothelium or to blood that hasextravasated into tissue binds TF
to factor VIIa

A

Initiation of Clotting

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27
Q

Clotting factor IXa together with VIIIa activates what?

A

X into Xa

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28
Q

Factor Xa along with factor Va catalyze what?

A

The conversion of prothrombin (factor II) to thrombin (factor IIa)

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29
Q

Thrombinm (Factor IIa) converts the _______

A

Soluble fibrinogen (Factor I)

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30
Q

Soluble fibrinogen (Factor I) converts into an __________

A

Insoluble fibrin (Factor Ia)

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31
Q

It further activates upstream clotting
factors

A

THROMBIN

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32
Q

What are the primary factors resulting in amplification of thrombin generation.

A

Primary factors V, VIII, and XI

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33
Q

What are the clotting factors that inhibited by heparin?

A

Clotting factors;
1. IXa
2. Xa
3. IIa

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34
Q

What are the clotting factors that is inhibited by warfarin?

A

Factors;
1. VII
2. IX
3. X
4. II

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35
Q

It is attenuate blood
clotting by proteolysis of cofactors Va and
VIIIa

A
  1. Protein C
  2. Protein S
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36
Q

Drugs that inhibit blood
coagulation.

A

Anticoagulants

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37
Q

These are substances that act on the
secondary hemostatic stage or the blood
coagulation cascade

A

Anticoagulants

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38
Q

What are the classes of anticoagulants

A
  1. Endogenous anticoagulant
  2. Indirect thrombin inhibitors
  3. Warfarin and Coumarin Anticoagulants
  4. Oral direcct factor Xa Inhibitors
  5. Direct thrombin inhibitors
39
Q

It is the Protein C and Protein S, Antithrombin III (ATIII)

A

Endogenous Anticoagulant

40
Q

Unfractionated heparin (UFH) also known as what?

A

High Molecular Weight (HMW) heparin

41
Q

Unfractionated heparin (UFH), also known as high-molecular-weight (HMW) heparin, low molecular-weight (LMW) heparin, and
the synthetic pentasaccharide fondaparinux

A

Indirect thrombin inhibitors

42
Q

From what class is these drugs belong? Rivaroxaban, Apixaban, and Edoxaban

A

Oral direct factor Xa inhibitors

43
Q

From what class these drugs belong? Hirudin (leech protein), Bivalirudin, Argatroban, Lepirudin

A

Direct thrombin inhibitors

44
Q

What causes proteolysis?

A

Protein C and Protein S

45
Q

It inactivates clotting factors IIa, IXa, Xa, XIa, and XIIa

A

Antithrombin (AT)

46
Q

Heparin binds to ________ and enhance its inactivation of factor _____ Xa

A

Antithrombin; Xa

47
Q

Acts like a catalyst that speeds up the interaction between AT and thrombin

A

Heparin

48
Q

Heparin’s activity as anticoagulant is dependent on what?

A

Antithrombin III

48
Q

Heparin’s activity as anticoagulant is dependent on what?

A

Antithrombin III

49
Q

It inhibits clotting factors thrombin (IIa), IXa, and Xa, by forming
equimolar stable complexes with them

A

Antithrombin

50
Q

In the absence of heparin, these reactions are ______; but in the presence of heparin,
these reactions are accelerated by _______

A

Slow; 1000-fold

51
Q

The accelerating effect of heparin is due
to the unique _________ that has high binding affinity to
antithrombin

A

Pentasaccharide sequence

52
Q

It is work by
interfering the synthesis of Vitamin K-dependent clotting factors (II, VII, IX, X)

A

Coumarin anticoagulants

53
Q

It is directly inhibit factor Xa, thus preventing
the cascade to proceed

A
  1. Rivaroxaban
  2. Apixaban
  3. Edoxaban
54
Q

It exert their anticoagulant effect by directly binding to the active site of thrombin,
thereby inhibiting thrombin’s downstream
effects

A

Direct thrombin inhibitors (DTIs)

55
Q

_______ and ______ bind at the catalytic or active site of thrombin as well as at a substrate recognition site.

A

Hirudin; bivalirudin

56
Q

_____ and ______(small molecules) bind only at the thrombin active site

A

Argatroban; melagatran

57
Q

What are he indications of Heparin?

A
  1. Prevent post-op. deep vein thrombosis
  2. Pulmonary embolism
58
Q

What are the undesirable effects of heparin?

A
  1. Bleeding
  2. Hemorrhage
  3. Thrombocytopenia
  4. Hematoma
59
Q

What are the reversal of action in heparin?

A
  1. For excessive anticoagulaion-discontinuation of the drug
  2. If bleeding occurs- IV administation of specific antagonist, Protamine sulfate
60
Q

What is the below normal values/level?

A

Increases risk of thrombosis

61
Q

What is the above normal values/level?

A

Serious bleeding risk increases

62
Q

What is the toxicity and miscellaneous effects of heparin?

A

Bleeding

63
Q

What are the toxicity and miscellaneous effects of heparin?

A

Should be used with caution in hypersensitive patients

64
Q

What are the toxicity and miscellaneous effects of heparin?

A

Increased hair loss and reversible alopecia

64
Q

What are the toxicity and miscellaneous effects of heparin?

A

Osteoporosis - long-term therapy

65
Q

What are the toxicity and miscellaneous effects of heparin?

A

accelerates the clearing of postprandial lipemia by causing the
release of lipoprotein lipase from tissues

66
Q

What are the toxicity and miscellaneous effects of heparin?

A

Long-term use is associated with
mineralocorticoid deficiency

67
Q

A systemic hypercoagulable state that occurs in 1–4% of individuals treated with
UFH

A

Heparin-Induced Thrombocytopenia (HIT)

68
Q

Could lead to increase risk of thrombosis
(e.g.,venous thrombosis) and skin
necrosis in individuals treated with
warfarin

A

Heparin-Induced Thrombocytopenia (HIT)

69
Q

Patients who develop HIT are treated by what?

A
  1. Discontinuance of heparin
  2. Administration of the direct thrombin inhibitor. Argatroban
70
Q

What are the contraindications of Heparin?

A
  1. HIT
  2. Hypersensitivity to the drug
  3. Active bleeding
  4. Hemophilia
  5. Significant thrombocytopenia
71
Q

What are the contraindications of Heparin?

A
  1. Purpura
  2. Severe hypertension 3. Intracranial hemorrhage
  3. Infective endocarditis
  4. Active tuberculosis
72
Q

What are the contraindications of Heparin?

A
  1. Ulcerative lesions of the gastrointestinal
    tract
  2. Threatened abortion
  3. Visceral carcinoma
  4. Advanced hepatic or renal disease
73
Q

What are the two containdications that will not likely lead to bleeding?

A
  1. HIT
  2. Hypersensitivity
74
Q

Should be avoided in patients who have

A
  1. Brain surgery
  2. Spinal cord surgery
  3. Eye surgery
  4. undergoing lumbar puncture
  5. Regional anesthetic block
75
Q

Should be used in patients whoa are

A
  1. Pregnant
76
Q

What are the indications under warfarin (Coumadin)?

A
  1. Deep venous thrombosis
  2. Ischemic heart disease
  3. RHD
  4. Pulmonary embolism
77
Q

What are the undesirable effects of warfarin?

A
  1. Bleeding
  2. Hemorrhage
  3. Necrosis
  4. GI upset
78
Q

What is the contraindication of warfarin?

A

Do not administer to pregnant women since it can cause a hemorrahgic disorder in the fetus (teratogenic)

79
Q

What are the reversal of action in warfarin for excessive anticoagulant effect and bleeding?

A
  1. Stopping the drug
  2. Oral or Parenteral vitamin K1 (phytonadione)
  3. Fresh-frozen plasma
  4. Prothrombin complex concentrates
  5. Recombinant factors VIIa (rFVIIa)
80
Q

What is the term in therapeutic range for oral anticoagulant therapy?

A

International normalize ratio (INR)

81
Q

INR is the ______

A

Prothrombin time ratio

82
Q

ISI exponent refers to what?

A

International Sensitivity Index

83
Q

It is a narrow therapeutic index drug

A
84
Q

It is a narrow therapeutic index drug

A

Warfarin

85
Q

INR Below 2.0

A

Increases risk of thrombosis

86
Q

INR above 4.0 1

A

Serious bleeding risk increases

87
Q

What are the Pharmacokinetic effects of warfarin?

A
  1. Enzyme induction
  2. Enzyme inhibition
  3. Reduced plasma protein binding
88
Q

What are the Pharmacodynamic effects of warfarin?

A
  1. Synergism
  2. Competitive antagonism
  3. Altered physiologic control loop for vitamin K
89
Q

Given as fixed doses and do not require
monitoring

A

ORAL DIRECT FACTOR Xa INHIBITORS

90
Q

Have a rapid onset of action and shorter
half-lives than warfarin

A

ORAL DIRECT FACTOR Xa INHIBITORS

90
Q

Drugs that prevent
platelet aggregation, thus are also
referred to as antiplatelets.

A

Antithrombotics

91
Q

What are the classes under antiplatelet drugs?

A
  1. GP IIb/IIIa receptor antagonist
  2. ADP receptor antagonist
  3. TXA2 (COX) inhibitor
  4. PDE/adenosine uptake inhibitor

PHARMACOLOGY 2 - HEMATOLOGIC LESSON 1 (2 decks)

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