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2 Principles of Disease > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Hemostasis

A

all processes that minimize blood loss when a blood vessel is opened

includes 4 related events –> vasoconstriction, platelet plug, fibrin web, clot retraction/dissolution

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2
Q

Vasoactive amines

A

Serotonin
Histamine

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3
Q

Enzymes derived from plasma

A

blood coagulatoin cascade

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4
Q

Fibrinogen

A

soluble plasma protein that can be acted upon by clotting factors to ultimately form insoluble fibrin

a part of the plasma

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5
Q

Platelets

A

release serotonin
a part of formed elements

increased amount can cause venous thromboembolism
decreased amount can be infection, leukemia

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6
Q

Initial steps of hemostasis

A

Platelets and fibrinogen circulate in the blood

when a blood vessel is injured or ruptures, platelets release serotonin and aggregate to form platelet plug

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7
Q

Coagulation

A

processes by which liquid blood changes to a solid clot (thrombus)

uses platlets, RBC, fibrin

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8
Q

The platelet plug is not ___ ______ to curtail ____ _____

A

strong enough/blood loss
must be reinforced by solid strands of fribrin

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9
Q

Clotting factors

A

enzymes made by the liver
12 –> little a means that clotting factor is activated

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10
Q

Intrinsic Pathway

A

activation of complement proteins occurs within system

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11
Q

Extrinsic pathway

A

outside factor helps to activate the system

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12
Q

What protein do the intrinsic and extrinsic pathway come together?

A

10

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13
Q

Many complement proteins are _____ ______ dependent

A

vitamin K
can be found in diet or normal flora

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14
Q

Coagulation disorders

A

Too much BLEEDING
Too much CLOTTING

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15
Q

Coagulation disorders that result in deficient clotting

A

hemophilia A and B
von Willebrand disease

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16
Q

Hemophilia A

A

genetic deficiency in clotting factor 8

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17
Q

Hemophilia B

A

Christmas disease
genetic deficiency in clotting factor 9

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18
Q

Hemophilia A/B

A

most often these are x-linked recessive traits
treatment for both–> infusion of respective deficient clotting factors

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19
Q

von Willebrand disease

A

genetic deficiency or defective von willebrand factor
VWF = plasma protein that binds factor 8 and platelets

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20
Q

Functions of VWF

A

assists in formation of plug

helps initiate initial adhesion of platelets at sites of bleeding injury

binds and stabilizes clotting factor 8

treatment depends on severity

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21
Q

Fibrinogen is

A

SOLUBLE

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22
Q

Fibrin is

A

INSOLUBLE

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23
Q

Factor V Leiden thrombophilia

A

common inherited form of thrombophilia
clotting process remains active longer than normal, increases changes of blood clots and emboli

24
Q

What factors increase the risk of clotting?

A

dehydration
increasing age (decreased mobility)
obesity
injury
srugery
pregnancy
co-morbidities
medications

25
Medications that can increase clotting
birth control hormone replacement therapy fertility related drugs NSAIDs anabolic steroids chemotherapy marijuana
26
Anticoagulants
warfarin heparin lovenox
27
Antiplatelet drugs
asprin clopidogrel (plavix)
28
Thrombolytics
tPA--> tissue plasminogen activator
29
Anticlotting drugs
Anticoagulants Thrombolytics Antiplatelet drugs
30
Anticoagulants definition
used primarily to prevent clot fomration in venous system work by preventing or disrupting the synthesis and/or function of clotting factors these drugs do NOT dissolve the thrombus/clot
31
Heparin
not orally active, typically given subcutaneous or intravenous
32
Low molecular weight heparins
not orally active given SQ lovenox/enoxaparin
33
Warfarin
orally active (Coumadin)
34
Direct oral anticoagulants
orally active, direct thrombin inhibitor and direct factor Xa inhibitors
35
Anticoagulant therapy
generally starts with heparin and is then followed by warfarin or lovenox these drugs are used in the treatment of DVT anticoagulants do NOT dissolve the clot
36
ANticoagulants help to
prevent enlargement of thrombus allow for further attachment of the thrombus to the vessel wall, which reduces the likelihood of an embolus
37
Antiplatelet drugs
used primarily to prevent clot formation in the arterial system work by inhibiting platelet function aspirin and clopidogrel
38
Aspirin
antithrombotic effect at very low doses
39
Clopidogrel
plavix inhibits platelet aggregation/clumping
40
Clinical uses of Antiplatelet drugs
prevention and treatment of arterial thrombosis prevention of clot in people with high risks of clots
41
ADRs of Antiplatelet drugs
ADRs: increases risk of bleeding, increased risk of hemorrhagic CVA, long term effect on kidneys, liver, GI
42
Thrombolytics
clot bisters used in emergent circumstatnces to re-establish blood flow through vessels that have been occluded work by facilitating destruction of blood clots only used within short well-defined window of known vessel occulusion tissue plasminogen activator is common drug
43
DVT
common postoperative complication exacerbated by prolonged immobility and decreased activity
44
Strategies to decrease DVTs
anti-coagulants hydration mobilization sequential compression device
45
What can be caused by a DVT?
stroke pulmonary embolism heart attack
46
Risk factors for DVT
*DAMAGE TO VEINS* previous DVT, surgery, trauma, LE fracture, varicose veins, sepsis, childbirth *STASIS* prolonged bedrest, heart failure, heart attack, neurologic disorders, chronic venous insufficiency, immobilization, prolonged air travel *HYPERCOAGUABILITY STATES* cancer, autoimmune disorder, oral contraceptives, late pregnancy *OTHERS* age >60, obesity
47
Symptoms of DVT
pain dull ache tightness
48
Signs of DVT
Erythema Edema Positive Homan's Sign Warmth
49
Modified Wells Clinical Prediction Rule for DVT
if pt exhibits any S/S of DVT has excellent sensitivity and specificity for DVT
50
Scoring of Modified Wells
0 = not present 1 = predictor is present -2 = alternative diagnosis likely
51
d-dimer test
blood test for teh presence of a small fragment of fibrin from a blood clot negative rules out DVT positive = additional testing, doppler ultrasound
52
Treatment of a DVT
anticaogulation therapy will be started PT may be delayed so that clot can stabilize
53
Lovenox and mobilizing
You can mobilize in about 5 hours
54
Heparin and mobilizing
2 days before mobilizing
55
Higher INR =
increased bleeding
56
Warfarin/Coumadin
pt should have plasma INR checked regularly Therex range is 2-3 higher than this indicates bleeding and could cause hemarthrosis

2 Principles of Disease (7 decks)

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