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Physio II > hemostasis > Flashcards

hemostasis Flashcards

1
Q

hemostasis

A

dilation (release and excess bleeding)

quickly followed by constriction

platelet aggregation and plug while fibrin clot forms
(loosly first and then contracts)

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2
Q

vascular constriction is the resutl of

A

myogenic response and trauma to smooth muscle organ you will get this response

constriction is proportional to the damage

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3
Q

what product do you see in small vessel damage that leads to constricrion

A

thromboxane A 2

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4
Q

surface proteins found on platelets

what is their function

A

remember platelets have no nucleus

surface protein helo to adhere the platelets with vessel injury

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5
Q

megakaryocytes

A

this is the progenitor to platelets

that never leaves the bone marrow

vesicles form around these myeloid stem cell lineage

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6
Q

half life of platlets

A

8-12 days

important for ASA tx

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7
Q

GPIB/IX

A

glycoprotein adhesion molecule

ans surface receptor

recognizes subendothelium through vWF

could

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8
Q

what is it exactly that GOIB/IX bind to in the subendothelieum

A

vWF in different places

basement membrane and collagen

or tunica media and smooth muscle in the wall of the vessel

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9
Q

GIIb/IIIa

A

fibrinogen binding protein

allows platelet can adhere to blood vessel wall and can adhere to circulating fibrinogen in the blood which is going to be an important of forming the clot

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10
Q

Clotting factor/Ca++ complex

A

multiple clotting factors that require Ca to be formed and activated

Xa/Va complex limits activation of thrombin at site of injury

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11
Q

whenever you have exposure to the tunica intima

Or basement membrane under the endothelium of the blood vessel

you are going to form a platelet plug

what happens in this process

A

they get “activated” response involves swelling up and pseudopodia allowing the platelet to move around

release clotting factors and enzyme

adhere to vWF

form thromboxane A2 which activates neighboring platlets

makes the sticky and aggregate

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12
Q

formation of the clot depends on what?

A

the balance of clotting factors
what dictates this is the floating factors found in the blood stream

when in balance we aren’t bleeding out of throwing thrombin

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13
Q

the process of of clotting begins with what

A

Process begins with formation of complex called prothrombin activator

converts prothrombin to thrombin

process requires Vit K

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14
Q

where is prothrombin activator made

A

liver

along with fibrinogen

this can be a big problem with severe liver disease

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15
Q

how does warfarin work

A

disturbes the process of vitamin K dependent factors

one of them being prothrombin

structural analog of vitamin K that can bnd upf factors

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16
Q

job of thrombin

A

Thrombin removes fibrin proteins from fibrinogen (made in liver)

Long fibrin fibers form meshwork/reticulum of clot and trap blood cells to form a firm clot

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17
Q

what specifically needs to happen in oder to use fibrin to clot

A

disulfide bridges connect the fibrin subunits on the lateral sides of the molecules. In order to convert it to fibrin, we need to break off those bonds via thrombin

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18
Q

charged molecules that keep fibrin from self aggregating in fibrinogen form

A

fibrinopeptides A and B

thrombin catalyzes the removal of these and they form fibrin

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19
Q

what stabilizes fibrin

A

initially the fibrin is unstable and held together solely by fibrin hydrogen bonds in the meshwork

fibrin stabilizing factor (part of the clotting cascade) is activated and causes covalent bonds and crosslinking to form

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20
Q

vitamin K dependent factors

A

2 7 9 10

all made by the liver

21
Q

stuart factor

A

10a

converts prothrombin to thrombin (2a)

and thrombin activates fibrin form fribonigin (1)

22
Q

factor III

A

part of the extrinsic pathway

thromboplastin or tissue factor

comes from exposure of the blood to tissue components outside of the blood (extrinsic)
usually phospholipids

works with factor VII to activate factor X which is the final pathway

23
Q

intrinsic pathway

A

blood trauma from within the vessel wall

initiation is intrinsic to the blood vessel

can be activated simultaneously with the extrinsic pathway

24
Q

beginning of intrinsic

A

factor XII

very sensitive to collagen

causes confirmation change that will activate platelets

can jump to extrinsic pathway and party with factor thre

25
Q

describe the intrinsic pathway after XII

A

factor XII activates factor XIa the plasma thromboplastin antecedent PTA

which is Ca dependant and acvtivates christmas factor IX
(Berry christmas )

xmas factor activated X through VIII

26
Q

describe the extrinsic pathway

A

tissue factor III combines with factor VII (proconvertin) after exposure to outside elements
which activate factor X

27
Q

VIII

A

antihemophilic

28
Q

what is the involvement of Ca in the clotting pathway

A

Liver carboxylates factors using vit K making factors able to bind Calcium

Carboxylation by the liver which requires Vit K makes the factor able to bind to that calcium molecule which is necessary to activate factors

29
Q

which factor is most commonly involved in hemophilia

A

Factor VIII is most commonly involved in Hemophilia A

Factor VIII

30
Q

which factor is most commonly involved in hemophilia B

A
  1. Factor IX is most commonly involved in Hemophilia B
31
Q

two types of clotting disordersq

A

a. Failure to clot

b. Inappropriate clotting

32
Q

PTT (aPTT

what is this used to measure

what factors does it accoutn for

A

-activate partial thromboplastin time

tttn BF
Used to monitor heparin tx
Measure of activity of factors XII, XI, IX, VIII

Factor X is the final common pathway - tested by PT and aPTT

33
Q

antithrombin factors

A

antithrombin III

inactivates by irreversibly binding

34
Q

how does heparin work

A

binds and concentrates antithrombin III, increases activity

  1. Promoting activity of anticlotting agent
  2. Heparin is not good as clot busting agent b/c all it’s doing is preventing the formation of further clots
35
Q

this is activated by binding to excess thrombin and enhanced by binding to protein S

together what to they inactivate

A

iii. Protein C
iv. Activity of APC (activated protein C) enhanced by binding to protein S, and together that complex inactivates factor Va

36
Q

S/APC complex

A

binds plasmin activator to allow clotting, activated complex cleaves creating tPA which dissolves clots

37
Q

i. Measures extrinsic pathway

A

b. PT - Prothrombin time and INR

38
Q

PT - Prothrombin time and INR measures which factors

A

ii. Factors I, II, V, VII, X (Vit K dependent factors)

T N L K TS

39
Q

iii. Used to monitor, adjust coumadin tx

A

PT - Prothrombin time and INR measures which factors

40
Q

used to measure heparin

A

PTT

activate partial thromboplastin time

41
Q

what is INR

A

PT is converted to INR (international normalized ratio) - standardized reference point so that no matter where you get the test done, the PT that is found in that particular lab will be specific to that particular lab. The INR normalizes that value to another number that we can compare from lab to lab to provide standardization

42
Q

Tests abnormality affecting conversion of fibrinogen to fibrin

A

Thrombin time (tests for activated factor II)

NO Thrombin time

can just get a fibrinogen level

43
Q

TPA

A

dissolves clots

created by APC/S

44
Q

antiplatelet drugs

A

act on platelets

ASA (platelet toxin) (NSAIDS in general)
can last 7-12 days life span of a platelet b/c permanent inhibition

Clopidogrel/Ticlodipine/plavix (inhibit platelet fxn)

Abciximab (antibody therapy)

45
Q

Anticoagulant

A

act on clotting factors
“ Heparin (preventing further formation of clot)
“ Warfarin/Coumadin

46
Q

Thrombolytics

A

clot busters
tPA
Streptokinase, urokinase, alteplase

47
Q

molecule that is formed when fibrinogen is formed into fibrin that help track disseminated intravascular coagulation

A

Presence of D-dime

48
Q

another test for DIC

A

disseminated intravascular coagulation

seen as an elevation of D dimer which is a fribrinigin breakdown product

FBP is another test of this

will also see prolong PTT and PT

this seem counterintuitive but the factors are all being taken up so it makes sense

Physio II (18 decks)

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