Module 2 exam 1 lecture 4 Flashcards

1
Q

how is the clot dissolved once BV is healed

A

fibrinolytic pathway

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2
Q

major step of fibrinolytic pathway

A

activation of plasminogen to plasmin

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3
Q

What is plasminogen

A

a circulating inactive enzyme

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4
Q

plasminogen is activated by

A

TPA (tissue plasminogen activator)

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5
Q

What does plasmin do?

A

binds to plasmin clot and breaks it down

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6
Q

indication of thrombolytic drugs

A

dissolve clots, acute MI, stroke

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7
Q

What does TPA do?

A

BInds fibrin and activates plasminogen that is bound to fibrin clot. Breaks down 100X more rapidly

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8
Q

3 drugs that dissolve blood clots (TPAs)

A

Alteplase
reteplase
tenecteplase

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9
Q

alteplase structure and MOA`

A

recombinant human TPA
binds fibrin

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10
Q

Reteplase structure and MOA

A

shorter (truncated, removed aa from protease domain) no fibrin binding domain, less fibrin specific.

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11
Q

TEnecteplase structure and MOA

A

Point mutation in protease domain that increases ability to bind fibrin. longer t1/2

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12
Q

summarize how a clot is broken down

A

Plasminogen binds to fibrin clot, T-PA (altepase or tenecteplase) will bind to clor and plasminogen and activate it to plasmin

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13
Q

Which TPA is different in terms of function? why?

A

Reteplase. It has no fibrin binding domain so it cleaves plasminogen whether it is bound to the clot or not

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13
Q

How are TPA drugs cleared

A

renally and hepatically

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13
Q

ROA for alteplase, reteplase, tenecteplase? t1/2?

A

IV for all
alteplase- 5-10 min
reteplase- 13-16 min
tenecteplase- 90-130 min

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13
Q

Adverse effects of TPAs

14
Q

How do we stop bleeding caused by TPAs?

A

Antifibrinolyctic agents

15
Q

Name antifibrinolytic drugs

A

Aminocaproic acid (EACA)
Tranexamic acid

16
Q

Which aa are aminocaproic acid and tranexamic acid based on?

17
Q

Which antifibrinolytic drug is more potent

A

Tranexamic acid is 10x more potent than aminocaproic acid

18
Q

How do tranexamic acid and aminocaproic acid work?

A

Prevent binding of plasminogen and plasmin to fibrin, sparing clots and preventing hemorrhage.

19
Q

inhibitors of platelet function are normally given iin PCI, why?

A

PCI is catheterization through BV. This will cause endothelial damage and induce platelet aggregation. Inhibitors of platelet function stop this.

20
Q

What does heparin inhibit

A

antithrombin 3

21
Q

MOA of heparin

A

accelerates binding of antithrombin 3 to thrombin (factor 2a) and factor Xa

22
What does thrombin do when activated?
cleaves fibrinogen to fibrin
23
heparin inhibits conversion of
prothrombin to thrombin and fibrinogen to fibrin
24
LMWH drugs
Enoxaparin Palteparin
25
LMWH MOA difference from heparin MOA
Inactivate Xa, but has little inactivation at thrombin due to short chains
26
time required to get peak anticoag effect from warfarin
2-3 days
27
warfarin MOA
Warfarin inhibits gamma-carboxylated factors (II,VII, IX and X). They must be depleted
28
Which compound targets the binding of platelets to fibrinogen
eptifibatide (prevents crosslinking of platelets)
29
Name an antibody that binds to GPIIb/IIIa receptors
Abciximab
30
Protease activated receptor (PAR) is cleaved by what molecule in coagulation cascade
factor IIa (thrombin)
31
protein C and S are dependent of which vitamin?
K
32
What might cause deficiency in prothrombin (factor II) or in factor x
liver disease or vit K
33