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Pathology > Hemodynamics II > Flashcards

Hemodynamics II Flashcards

1
Q

What are the three general components that contribute to hemostasis?

A
  1. Endothelium/vascular wall
  2. Platelets
  3. Coagulation cascade
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2
Q

What are the “bricks” of the clotting system?

A

Platelets

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3
Q

What is the “cement” of hemostasis?

A

Coagulation cascade and fibrin

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4
Q

What is the very first thing to happen in an initial injury?

A

Vasoconstriction

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5
Q

What happens in the hemostasis after the initial vasoconstriction?

A

Endothelial damage exposes subendothelium causing platelets to become activated and adhere

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6
Q

What is the cytokine that activates the coagulation cascade?

A

Tissue factor (factor III)

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7
Q

What happens after tissue factor is released?

A

Platelets activation further coagulates

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8
Q

What are the two main components of a clot?

A

Platelets and fibrin

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9
Q

What is the function of vWF?

A

Causes platelets to adhere to the region of a clot

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10
Q

What does vWF bind to?

A

Collagen IV

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11
Q

What is in alpha granules in clotting? What does this do?

A

TXA2, recruits more platelets

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12
Q

What are the two cytokines that endothelial cells release to keep the clot in check?

A

tPA

Thrombomodulin

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13
Q

What are the four things mentioned in lecture that are procoagulative?

A

Infectious agents
Hemodynamic forces
Cytokines
Plasma mediators

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14
Q

What are the two cytokines that endothelium releases that are anti thrombotic?

A

PGI2

NO

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15
Q

What is the enzyme that endothelium produces that prevents platelet aggregation? What does this do?

A

Adenosine diphosphatase which degrades ADP

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16
Q

What is heparin?

A

Polysaccharide that are cofactors to antithrombin

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17
Q

What is the function of thrombomodulin?

A

Converts thrombin to an anticoagulant

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18
Q

What is the function of vWF?

A

Firmly adhere platelets to the endothelium via GPIb

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19
Q

What is the substance that the endothelium secretes to inhibit tPA?

A

Plasminogen activator inhibitor

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20
Q

What causes the release of tissue factor?

A

Endotoxin, trauma, cytokines

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21
Q

What activates protein C, and what does it in turn inactivate?

A

Activated by protein S

Factors V and VIII

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22
Q

What activates protein C?

A

Thrombin/antithrombin complex

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23
Q

In general, under normal conditions, what do endothelial cells do?

A

Inhibit platelet adherence

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24
Q

What produces platelets?

A

Megakaryocytes

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25
Q

What exactly are platelets?

A

Anuclear cell fragments

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26
Q

What are the contents of platelets?

A

Alpha granules and dense granules

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27
Q

What are the three steps that ensure to platelets after vWF binds to collagen IV?

A

Adhesion
Secretion and activation
Aggregation

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28
Q

Is the initial platelet adhesion to the ECM firm?

A

No

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29
Q

What does vWF bind on platelets?

A

Glycoprotein Ib receptors

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30
Q

Adhesion of platelets causes what?

A

Release of platelet granules

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31
Q

What ion is needed in the coagulation cascade?

A

Ca

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32
Q

What is the function of the ADP release by platelets?

A

Mediates platelet aggregation which drives increasing platelet aggregation at the site

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33
Q

What is the function of platelet factor 4 released by platlets?

A

Inactives heparin

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34
Q

What is the function of serotonin that platelets release?

A

Induces vasoconstriction

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35
Q

What is the function of ADP and TXA2 that platelets release?

A

Further stimulates platelet aggregation

36
Q

What is the protein found on the surface of platelets that link fibrin together?

A

GpIIb-IIIa

37
Q

Where does thrombin bind to?

A

Platelet surface

38
Q

Platelet activation causes expression of what on the surface to bind coag factors? What do these do?

A

Phospholipid complexes, which act as surfaces to bind coagulation factors.

39
Q

What are the three major platelet secretions that further activates platelets?

A

ADP
TXA2
Thrombin

40
Q

What is the end product of the coagulation cascade?

A

Fibrin

41
Q

What are clotting factors?

A

Inactive enzymes (S proteases)

42
Q

What is the ion needed for the assembly of the complex of coagulation factors?

A

Ca

43
Q

What is serum?

A

Liquid part - clot factors

44
Q

What is plasma?

A

Liquid + clotting factors

45
Q

What is added to plasma to prevent clotting? How?

A

EDTA containing solution to get rid of Ca

46
Q

What converts fibrinogen to fibrin?

A

Thrombin

47
Q

What is the order of factor activation in the extrinsic pathway?

A

3, 7, 10

48
Q

What is the order of factor activation in the intrinsic pathway?

A

12, 11, 9, 8, 10

49
Q

What two factors make up the prothrombinase complex?

A

factor V and factor X

50
Q

Where do both the intrinsic and extrinsic pathway converge?

A

Factors 9 and 10

51
Q

What does prothrombin time (PT) measure?

A

The extrinsic arm

52
Q

What does PTT measure?

A

Intrinsic arm

53
Q

What is PT prolonged by? PTT?

A 
PT = Warfarin
PTT = Heparin
54
Q

What happens in the clotting cascade is not kept in check?

A

Thrombus can form

55
Q

What are the three main anticoagulants produced by the body?

A

Antithrombin III
Protein C
Plasmin

56
Q

What is the function of antithrombin III? What is it potentiated by?

A

Inactivates serine proteases (factors 9, 10, 11, and 12)

Potentiated by Heparin

57
Q

What is the function of Protein C?

A

Inhibits V and VIII

58
Q

What is the function of plasmin?

A

breaks down fibrin

59
Q

What is the function of protein S?

A

Enhances protein C

60
Q

What is thrombomodulin activated by? What does it do?

A

Thrombin

Activates protein C

61
Q

What is the function of thrombomoduin?

A

Binds to thrombin and alters its conformation

62
Q

What is the function of tissue pathway factor inhibitor?

A

Inhibits III and VII (tissue factor = factor III, thus “tissue factor pathway inhibitor)

63
Q

Free plasmin is inactivated by what?

A

Circulating alpha2 antiplasmin

64
Q

tPA is inactivated by what?

A

plasminogen activator inhibitor (PAI)

65
Q

What do endothelial cells secrete to balance coagulation/anticoagulation?

A

plasminogen activator inhibitor (PAI)

66
Q

What are the three substances that can activate plasminogen?

A

Urokinase
tPA
Streptokinase

67
Q

What activates antithrombin III? What does that inactivate?

A

Activated by heparin

Inactivates Factors 10 and 9

68
Q

What prevents plasmin from circulating freely and dissolving clots?

A

alpha2-antiplasmin

69
Q

What are anticoagulants?

A

Prevents clot formation and extension

70
Q

What are antiplatelets?

A

Drugs that interfere with platelet activity

71
Q

What are thrombolytic agents?

A

Dissolve existing thrombi

72
Q

What are the two traditional anticoagulants?

A

Heparin and warfarin

73
Q

What cells produce heparin?

A

Basophils and mast cells

74
Q

Does heparin disintergrate clots that have already formed?

A

No

75
Q

What are the two routes Heparin is given?

A

IV and SQ

76
Q

How does heparin work? What are the three main clotting factors it inhibits?

A

Binds and activated antithrombin III

Inhibits thrombin, factors 9 and 10

77
Q

What is the MOA of coumadin?

A

Interfering with vitamin K metabolism

78
Q

What are the vitamin K dependent factors? What drug interferes with their synthesis?

A

10, 9, 7, 2 (vitamin K was born in 1972)

Coumadin

79
Q

What is the MOA of dabigatran?

A

Direct thrombin inhibitor

80
Q

What is the MOA of rivaroxaban and apixaban?

A

Inhibit factor X

81
Q

What is the MOA of Tissue factor pathway inhibitor (TFPI)?

A

Inhibits factors 3 and 7

82
Q

Hageman factor = what number?

A

12

83
Q

What activates plasminogen activator inhibitor?

A

Thrombin

various cytokines

84
Q

What cells produce tPA?

A

Endothelial cells

85
Q

What is streptokinase?

A

A bacterial product used clinically to activated plasminogen

Pathology (32 decks)

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