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BSNC 3000 > Module 8 - Clotting > Flashcards

Module 8 - Clotting Flashcards

1
Q

Hemostasis

A

series of events that result in formation of a blood clot that seals a site of vascular injury

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2
Q

Stages of hemostasis

A 
vascular spasm
platelet plug
coagulation
clot retraction
clot dissolution
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3
Q

Stages of platelet plug formation

A

adhesion/activation
degranulation
aggregation

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4
Q

Platelet Adhesion

A

platelets are exposed to subendothelial collagen –> attach via vWF & become activated

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5
Q

von Willebrand Factor

A

glycoprotein located in the subendothelial matrix

binds platelets to collagen by attaching to platelet receptors

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6
Q

Platelet Degranulation

A

release of substances from alpha/dense granules that activate circulating proteins and increase aggregation

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7
Q

ADP & Platelets

A

ADP binds to platelet membrane –> causes a conformational change in platelet receptors gpIIA/IIb
platelets can now bind with fibrinogen –> catch circulating proteins

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8
Q

TXA2

A

prostaglandin involved in platelet aggregation

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9
Q

Platelet aggregation

A

ADP & TXA2 promote platelet aggregation –> act on circulating platelets to activate them & begin to build the clot by binding with fibrinogen

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10
Q

Types of thrombi

A

venous
arterial
mural

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11
Q

Mural Thrombi

A

attaches to the wall of the heart

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12
Q

Composition of venous arterial thrombi

A

venous thrombi usually form d/t blood stasis –> pooling of RBCs & activation of the coagulation pathway

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13
Q

Antiplatelet drugs

A

ex: clopidogrel, baby aspirin
target the platelet plug by inactivating receptors
indicated for conditions where risk of coagulation activation is low

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14
Q

Anticoagulant drugs

A

ex: warfarin, heparin, DOACs, LWMH
interfere with the coagulation pathway preventing the formation of a clot
indicated for conditions where coagulation is likely to occur

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15
Q

Required components for clotting

A

platelets
clotting factors
calcium
Vitamin K

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16
Q

Laminar blood flow

A

normal flow of blood where formed elements are located centrally & plasma maintains contact with the endothelium

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17
Q

Alpha granules

A 
fibrinogen
clotting factors
plasminogen
PA inhibitor 
platelet derived growth factor
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18
Q

Dense granules

A

calcium
ADP
serotonin
histamine

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19
Q

TXA2 release

A

platelet activation –> activate phospholipase A2
PLA –> arachidonic acid –> COX-1 –> thromboxane A2
TXA2 acts on platelet receptors to stimulate platelet activation & aggregation

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20
Q

Time for platelet plug formation

A

3-7 minutes

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21
Q

Clopidogrel MOA

A

antiplatelet drug that blocks ADP receptors on platelets –> prevents binding w/ fibrinogen

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22
Q

Clopidogrel MOA

A

antiplatelet drug that blocks ADP receptors on platelets –> prevents binding w/ fibrinogen

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23
Q

Aspirin MOA

A

irreversibly locks COX-1 preventing TXA2 synthesis –> prevents platelet activation & aggregation

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24
Q

Where is tissue factor located

A

on subendothelial cells –> fibroblasts, smooth muscle cells
exposed following vascular injury

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25
Extrinsic pathway mechanism
tissue factor activates Factor VII | TF/VIIa enzyme complex --> activates factor X (common) and Factor IX (intrinsic)
26
What is factor Xa
prothrombinase
27
Intrinsic pathway mechanism
Factor XII activated by contact with a foreign substance (subendothelial collagen) --> eventually leads to activation of IXa Factor IX can also be activated by the TF/VIIa complex from the extrinsic pathway IXa/VIIIa enzyme complex activates factor X
28
Common pathway mechanism
Xa & Va form an enzyme complex that converts prothrombin --> thrombin
29
Primary hemostatic plug
temporary blood clot formed from activated platelets & fibrinogen
30
Secondary hemostatic plug
blood clot formed from activation of the coagulation cascade | fibrin + platelets
31
Thrombin function
converts fibrinogen --> fibrin amplifies the intrinsic pathway by acting on factors V, VIII, XI activates platelets --> promoting activation/aggregation
32
Sources of Vitamin K
fat-soluble vitamin green, leafy vegetables, grains + organ meats synth by bacteria in the colon
33
Vitamin K dependent clotting factors
II, VII, IX, X | prothrombin
34
Calcium function
bridges binding of gla residue of clotting factors to platelet surface (platelet surface is negatively charged)
35
Gla residue
negatively charged carboxyl group added to glutamate | binds with calcium
36
Endogenous anticoagulants
proteins C & S antithrombin tissue factor pathway inhibitor
37
Antithrombin function
binds & inactivates thrombin & Xa --> prevents FURTHER clot growth amplified by heparin
38
Heparin function
released from mast cells | causes a conformational change in antithrombin --> enhances binding of AT to clotting factors thrombin & Xa
39
Fibrinolysis
system responsible for breaking down blood clots
40
Plasmin
plasminogen --> plasmin | enzyme responsible for breaking down fibrin
41
Plasminogen activators
tPA | urokinase
42
D-dimer
fibrin degradation product | D-dimer levels in blood indicate existence of blood clots
43
Warfarin MOA
blocks the enzyme needed to reactivate Vitamin K for clotting factor synthesis blocks all pathways of the coagulation cascade
44
LWMH properties
small molecules = 100% bioavailability longer HL than unfractionated heparin does not require lab monitoring less risk of heparin-induced thrombocytopenia
45
Antidote for heparin
protamin sulfate
46
Antidote for warfarin
Vitamin K
47
Antidote for DOAC
none
48
aPTT test
assess intrinsic & common pathways | used to measure heparin
49
PT test
assess extrinsic & common pahways | used to measure warfarin
50
INR test
international normalized ratio --> standardized PT value | used to measure warfarin
51
Therapeutic INR for warfarin
2.0-3.0
52
Normal INR range
0.9-1.2
53
Therapeutic INR for mechanical heart valves
2.5-3.5
54
Risk factors for thrombosis
``` genetics immobility atrial fibrillation cigarette smoking medications ```
55
Risk factors for bleeding
thrombocytopenia genetics liver disease medications
56
Consequences of thrombosis
``` blood vessel occlusion, impaired tissue perfusion ischemia & infarction back up of blood --> edema pain embolism ```
57
Consequences of excessive bleeding
``` hemorrhage hypovolemia & hypotension impaired central & tissue perfusion anemia hypovolemic shock ```
58
VTE
venousthromboembolic disorders includes DVT & PE
59
Virchow's triad
indicators three conditions that increase risk for clotting 1) endothelial injury 2) blood stasis 3) hypercoagulabiltiy
60
RF for endothelial injury
*exposes collagen & tissue factor --> platelet plug & clotting ``` smoking hypertension indwelling venous catheters fractures surgery (esp orthopedic) ```
61
RF for blood stasis
* blood pooling --> activates coagulation pathway immobility A. fib neurologic/spinal injury
62
RF for hypercoagulability
* increased procoagulants or reduced anticoagulants ``` estrogen alcohol polycythemia dehydration PSR (increased production of clotting factors) ```
63
Medication for arterial thrombi
antiplatelet
64
Medication for venous/mural thrombi
anticoagulants
65
Fibrin polymerization
thrombin cleaves fibrinogen into fibrin monomers | these monomers combine to form a fibrin polymer that stabilize the clot
66
S/S of bleeding
gum bleeding nose bleeds easy bruising prolonged bleeding after trauma, surgery, dental work hematuria melena/hematochezia petechiae, purpura fatigue, weakness, dizziness, dyspnea, HR, decreased BP, oliguria (internal bleeding) labs - decreased Hgb, Hct, increased INR/PTT
67
S/S of a DVT
``` unilateral swelling >3cm in diameter discoloration warm skin tenderness/pain d/t phlebitis dilated superficial veins paresthesia (edema causing nerve compression) low grade fever (systemic inflammation) ```
68
DVT diagnostic tests
D-dimer | ultrasonography
69
Heparin-induced thrombocytopenia
transinet, immune-mediated reaction to heparin causes antibody complexes that form platelet aggregations or sent to spleen for destruction--> thrombocytopenia can lead to paradoxical clotting
70
HIT mechanism
PF4 released from activated platelets binds with heparin antibodies form against PF4-heparin complex complex binds to platelet surface
71
Petechiae
pin point hemorrhages look like a rash
72
Purpura
larger hemorrhages <1cm on skin
73
DVT duration of therapy
minimum 3 months
74
Vena cava filter
venous mesh that is inserted into the inferior vena cava a the level of the renal veins catch any potential emboli from a proximal DVT used when anticoagulation is contraindicated
75
DVT prevention
anticoagulation mobilize leg exercises mechanical prophylaxis
76
DVT treatment
anticoagulants (prevent clot propagation & recurrence) IVC filter thromboltics/thrombectomy
77
How long does warfarin take to become therapeutic
36-72 hours
78
Location of superficial veins
adipose tissue
79
Location of deep veins
in skeletal muscle, along bones

BSNC 3000 (11 decks)

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