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PCOL MIDTERM 1 Flashcards

1
Q

A complex process involving multiple steps and many clotting factors

A

Hemostasis

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2
Q

The balance between clot formation and clot breakdown

A

Hemostasis

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3
Q

Steps in Hemostasis

A
  1. Vascular Phase
  2. Platelet Phase
  3. Coagulation Phase
  4. Clot formation
  5. Fibrinolysis
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4
Q

Cutting or damaging blood vessels leads to vascular spasm that produces a vasoconstriction which will slow or even stop blood flow

A

Vascular Phase

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5
Q

In larger blood vessels, platelets begin to stick to the surfaces of endothelial cells.

A

Platelet Phase

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6
Q

Aggregation of platelets leads to the formation of a platelet plug.

A

Platelet Phase

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7
Q

The overall process involves the formation of the insoluble protein Fibrin from the plasma protein Fibrinogen through the action of the enzyme Thrombin. Fibrin forms a network of fibers which traps blood cells and platelets forming a thrombus or clot

A

Coagulation phase

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8
Q

Forms a network of fibers which traps blood cells and platelets forming a thrombus or clot

A

Fibrin

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9
Q

Two pathways leading to the formation of the thrombus

A
  1. Extrinsic pathway
  2. Intrinsic pathway
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10
Q

Extrinsic pathway process

A
  • Initiated with material outside of the blood
  • Very rapid process
  • Smaller clots
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11
Q

Intrinsic pathway process

A
  • Initiated by the blood coming in contact with exposed collagen in the blood vessel wall
  • Slower process
  • Larger clots
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12
Q

Extrinsic pathway Factors

A

VIIa, and Tissue Factor

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13
Q

Intrinsic pathway Factors

A

VIIIa, IXa, XIa, calcium, and phospholipids

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14
Q

Prothrombinase complex Factors

A

Va, X, calcium, and phospholipids

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15
Q

Blood Clotting Factors

(Foolish People Try Climbing Long Slopes After Christmas, Some People Have Fallen)

A

I Fibrinogen
II Prothrombin
III Tissue Factor
IV Calcium (Ca2+)
Va Proaccelerin
VII Proconvertin
VIII Antihemophilic Factor
IX Christmas Factor
XI Stuart Factor
XII Plasma thromboplastin antecedent
XIII Hageman factor
XIII Fibrin Stabilizing Factor

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16
Q

After 2 or 3 days, the clot begins to contract. Platelets in the clot contain contractile proteins.

A

Clot Retraction

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17
Q

Platelets in the clot contain contractile proteins

A

Clot Retraction

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18
Q

These proteins pull the edges of the wound together and reduces the chance of further hemorrhage

A

Clot Retraction

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19
Q

Platelets in the clot contain ___________

A

contractile proteins

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20
Q

This activity also assists the repair processes.

A

Clot Retraction

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21
Q

Dissolution of the clot

A

Fibrinolysis

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22
Q

The breakdown of the clot is due to the production of a powerful proteolytic enzyme Plasmin.

A

Fibrinolysis

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23
Q

Removing a blood clot is essential to restoring normal circulation.

A

Fibrinolysis

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24
Q

The breakdown of the clot is due to the production of a powerful proteolytic enzyme ______

A

Plasmin

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25
Once a stationary clot forms (thrombus), it often grows larger as more fibrin is added.
Blood Clots
26
Pieces of the clot may break off and travel in the blood stream to possibly lodge elsewhere.
Blood Clots
27
When clots or emboli form, drug therapy becomes necessary.
Blood Clots
28
A traveling clot is known as an
Embolus
29
Used to prevent the formation of clots
Anticougulants
30
Used to inhibit platelet aggregation
Antiplatelets
31
Used to dissolve such life – threatening clots
Thrombolytics
32
Used to speed clot formation, or to limit bleeding from a surgical site.
Hemostatics
33
Drugs for Coagulative and Bleeding Disorder
- Anticoagulant - Antiplatelets - Thrombolytics - Hemostatics
34
Prevent the formation and enlargement of clots.
Anticoagulant
35
Drugs example of Anticoagulants
- Warfarin - Heparin - LMWH / Low Molecular Weight Heparin
36
Anticoagulants Action
1. Inhibit certain clotting factors 2. Lengthen clotting time 3. Prevent thrombi from forming or growing larger
37
Warfarin Chemistry
Coumarin
38
Warfarin Mechanism Of Action
Inhibits vitamin K synthesis
39
Warfarin Route
Oral or IV
40
Warfarin Monitoring
PT - INR
41
Warfarin Target
INR 2-3
42
Warfarin Uses
Prophylactic for acute MI, prevention of progression or recurrence of acute deep vein thrombosis or pulmonary embolism
43
Warfarin Side effects
Bleeding and Teratogenic
44
Warfarin Antidote
Vitamin K
45
Heparin Chemistry
Sulfated glycosaminoglycan
46
Heparin Mechanism Of Action
Activates antithrombin III
47
Heparin Route
IV or SC IM is contraindicated = Hematoma
48
Heparin Monitoring
aPPT
49
Heparin Target
1.5-2.5x control
50
Heparin Uses
prevention of venous thrombosis, tx of pulmonary embolism and acute myocardial infarction
51
Heparin Side effects
Bleeding, allergy, and thrombocytopenia
52
Heparin Antidote
Protamine SO4
53
A procoagulant used as antidote for Warfarin toxicity.
Vitamin K
54
Foods high in Vitamin K (must be avoided during Warfarin Therapy):
- Green leafy vegetables - Milk and milk products - Some cereals - Orange juice - Cauliflower - Cucumbers
55
What food must be avoided during WarfarinTherapy
Foods High in Vitamin K
56
Drugs of Low Molecular Weight Heparin (LMWH)
- Enoxaparin (Lovenox) - Tinzaparin (Fragmin) - Dalteparin (Innohep)
57
Anticoagulants of choice for treating pregnant women with prosthetic heart valves or venous thromboembolism
LMWH
58
LMWH Notes:
- Do not require intense monitoring - Longer half - life than heparin - With less bleeding
59
Drugs of Direct Thrombin Inhibitors
- LEPIRUDIN - ARGATROBAN - FONDAPARINUX
60
Polypeptide that is closely related to hirudin
Lepirudin
60
Polypeptide that is closely related to hirudin
Lepirudin
61
Effective in the treatment of HIT (Heparin‐induced thrombocytopenia)
Lepirudin
62
Lepirudin CI:
Streptokinase or Alteplase
63
Directly inhibits thrombin
Argatroban
64
Prophylactic for the treatment of thrombosis in patients with HIT (Heparin‐induced thrombocytopenia)
Argatroban
65
First in a new class of pentasaccharide anticoagulants that is purely synthetic
Fondaparinux
66
Prophylaxis of deep - vein thrombosis
Fondaparinux
67
Adverse Effects of Anticoagulants
- Bleeding (Most common) - Bruising - Bleeding gums - Nosebleed - Blood in urine or stool
68
_____ agents prolong bleeding time by interfering with platelet aggregation
Antiplatelets
69
4 Primary Subclasses
1. Aspirin 2. Adenosine diphosphate (ADP) receptor blockers 3. Glycoprotein IIb / IIIa receptor blockers 4. PDE inhibitors
70
Acetylsalicylic Acid or Aspirin Mechanism Of Action
Irreversible inhibition of COX
71
Prophylactic for transient cerebral ischemia and to reduce the incidence of recurrent MI
Aspirin
72
Aspirin Dose
100 - 325 mg
73
Adverse Effects of Aspirin
- Increased incidence of hemorrhagic stroke - Gastrointestinal bleeding - Salicylism = Tinnitus
74
Contraindication of Aspirin
- Anticoagulants - increase bleeding - Ibuprofen - antagonize platelet inhibition
75
Increase bleeding
Anticoagulants
76
Antagonize platelet inhibition
Ibuprofen
77
ADP (Adenosine Diphosphate) Receptor Blockers Mechanism Of Action
Irreversibly inhibit the binding of ADP to its receptors on platelets
78
ADP Receptor Blockers aka
Thienopyridines
79
Drugs example of ADP Receptor Blockers
- Clopidogrel (Plaxix) - Ticlopidine (Ticlid) - Prasugrel (Effient)
80
ADP Receptor Blockers Notes:
- Clopidogrel is the preferred agent in ischemic heart disease events - Clopidogrel is safer than ticlopidine - Ticlopidine causes neutropenia / agranulocytosis, thrombotic thrombocytopenic purpura (TTP), and aplastic anemia
81
Drugs example of Lycoprotein IIA or IIB Blockers
- Abciximab (Reopro) - Eptifibatide (Integrilin) - Tirofiban (Aggrastat)
82
Chimeric monoclonal antibody Given IV along with heparin or ASA as an adjunct for patients undergoing angioplasty
Abciximab
83
Adverse Effect of Glycoprotein IIA or IIB
Bleeding
84
Drug example of Phospodiesterase Inhibitor
Dipyridamole
85
Used to dissolve existing clots. Prescribed for disorders in which a clot has already formed
Thrombolytics
86
Thrombolytics are used in
1. Acute MI 2. Pulmonary embolism 3. Cerebrovascular accident (CVA) 4. DVT (Deep Vein Thrombosis) 5. Arterial or Coronary thrombosis
87
Streptokinase Brand name
Streptase
88
Protein from streptococci
Streptokinase
89
Streptokinase Side effects
Allergy, and Bleeding
90
Derived from cultured human melanoma cells
Tissue Plasminogen Activators
91
Drugs example of Tissue Plasminogen Activators
- Alteplase (Activase) - Reteplase ( Retavase )
92
Reteplase Brand name
Retavase
93
Alteplase Brand name
Activase
94
More selective than streptokinase
Tissue Plasminogen Activators
95
Side effect of Tissue Plasminogen Activators
Bleeding
96
Anisoylated plasminogen streptokinase activator complex a prodrug
Anistreplase
97
Side effect of Anistreplase
Bleeding
98
Used to promote the formation of clots.
Hemostatics
99
A consequence of a deficiency in plasma coagulation factors
Hemophilia
100
A rare disorder in which your blood doesn't clot normally because it lacks sufficient blood clotting proteins (clotting factors)
Hemophilia
101
Types of Hemophilia
- Hemophilia A - Hemophilia B - Von Willerbrand Disease
102
Factor of Hemophilia A
VIII (FVIII)
103
Deficiency or classic hemophilia
Hemophilia A
104
Hemophilia occurs in approximately 1 in 5,000 live births
Hemophilia A
105
4x as common as hemophilia B while more than half of patients with hemophilia _ have the severe form of hemophilia
Hemophilia A
106
Deficiency or Christmas disease
Hemophilia B
107
Factor of Hemophilia B
IX (FIX)
108
Genetic disorder caused by missing or defective ________ factor, a clotting protein.
Von Willebrand Disease
109
A key clotting protein, and platelets in blood vessel walls, which help form a platelet plug during the clotting process
Von Willebrand Disease
110
Factor of Von Willerbrand Disease
VIII
111
Type 1 VWD
-60% -80% of patients
112
Type 2 VWD
-15% -30% of patients
113
Type 3 VWD
-5% -10% of patients
114
Results after a diagnosis of an autoimmune disease, such as lupus, or from heart disease or some types of cancer. It can also occur after taking certain medications
Acquired VWD
115
Measurement of the intrinsic power of the blood to convert fibrinogen to fibrin
Coagulation Time Test
116
Measures how quickly your blood clots. aka pro time test or PT test, INR
Prothrombin Time Test
117
Drugs example of Hemostatics
- Aminocaproic - Tranexamic Acid - Aprotinin
118
Aminocaproic & Tranexamic Acid
- Synthetic - Inhibit plasminogen activation - Potential side effect of treatment is intravascular thrombosis

kekw (5 decks)

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