Questions 7 thru 15 p2

Question 1

What happens to your body BEFORE they 3 phase clotting system begins?

Answer 1

1. vascular injury
2. Collagen Exposed
3. Platelet Adhesion - begin sticking to collagen
4. Platelet Release of ADP - calling more platelets
5. Platelet Aggregation

Question 2

What are the 2 pathways in Phase 1?

Answer 2

1. Intrinsic

2. Extrinsic

Question 3

What factor does the Intrinsic Pathway start with?

Answer 3

Factor XII (12)
Cascade thru XI, IX, VIII, X

Question 4

What factor does the Extrinsic Pathway start with?

Answer 4

Factor III (3)
Cascade VII, X

Question 5

What do both pathways end in?

Answer 5

After a cascade of factors - Factor X (10)

Question 6

What MUST happen to leave phase 1 and enter phase 2?

Answer 6

Factor X must be activated to Factor Xa (10a)

Question 7

In what phase does the activation of Factor X happen?

Answer 7

Phase 1

Question 8

What does factor Xa do?

Answer 8

with Lipids and MUCH needed Ca++ -

activates Factor II (Prothrombin) to Thrombin

Question 9

What is a MUST to move on to phase 3?

Answer 9

Thrombin

Question 10

What does Thrombin do?

Answer 10

activates Factor I (Fibrinogen) to
Fibrin (loose) which later becomes
Fibrin (tight) or Factor XIII (13)

Question 11

What is Fibrinogen?

Answer 11

Factor I/inactive fibers, that when activated by Thrombin, form a clot

Question 12

What is Fibrin?

Answer 12

Fibers that form an active clot (Fibrin = Factor XIII)

Question 13

What is Plasminogen?

Answer 13

Inactive form of plasmin, activated by alteplase (an enzyme found on endothelial cells)

Question 14

What is plasmin?

Answer 14

Active form of plasminogen, that once activated degrades both:

1. Fibrinogen (Factor I)
2. Fibrin (Factor XIII)

Question 15

What are the 3 categories of drugs to treat/prevent clots?

Answer 15

1. Anti-thrombotic
2. Anti-coagulants
3. Thrombolytics

Question 16

In what phase do anti-thrombotics work?

Answer 16

BEFORE the 3 phase clotting system, so more preventative

Question 17

Name the anti-thrombotic drugs and where they work.

Answer 17

1. Clopidogrel/Plavix - prevents the release of ADP from platelets and prevents platelet aggregation from occuring
2. ASA/Aspirin (a COX inhibitor) - prevents platelet aggregation EVEN when ADP has been released by inhibiting Thromboxane 2

Question 18

In what phase do anti-coagulants work?

Answer 18

Phase 1

Question 19

Name the 3 anti-coagulants

Answer 19

1. Heparin
2. Warfarin/Coumadin
3. LMWH - Low Molecular Weight Heparin

Question 20

Name the part of phase 1 where Heparin works and it’s MOA

Answer 20

1. Heparin works on Intrinsic Pathway on FVIII

2. MOA = Enhances inhibitory effects of anti-thrombin III

Question 21

What is the typical route of administration for heparin?

Answer 21

IV Drip (can be subcutaneous)
NOT GI b/c stomach degrades the protein

Question 22

What is the duration of action for heparin?

Answer 22

short half-life (1-2 hours)

Question 23

Is there an antidote for heparin?

Answer 23

Yes = Protamine

Question 24

Name the part of phase 1 where Warfarin works and its MOA

Answer 24

1. Warfin works on Extrinsic Pathway on Factor VII

2. MOA = Antagonism of Vitamin K which is needed for synthesis of Factors 2, 7, 9 and 10

Question 25

What is the typical routse of administration for warfarin?

Answer 25

Oral tablets (adjusted due to individual variation)

Question 25

What is the typical routse of administration for warfarin?

Answer 25

Oral tablets (adjusted due to individual variation)

Question 26

What should patients on Warfarin be warned about?

Answer 26

1. NOT to increase/decrease vitamin K foods
   - increase = warfarin NOT as effective
   - decrease = warfarin TOO effective
2. Avoid NSAIDS or ASA which inhibit thromboxane A2 and can increase risk of bleeding/hemorrhage

Question 26

Name the part of phase 1 where LMWH works and its MOA

Answer 26

1. LMWH works on activation of Factor X to Xa

2. MOA = inhibit activation of X to Xa, thereby preventing movement to phase 2

Question 27

What should patients on Warfarin be warned about?

Answer 27

NOT to increase/decrease vitamin K foods

Question 27

What should patients on Warfarin be warned about?

Answer 27

NOT to increase/decrease vitamin K foods

Question 28

What is the typical routse of administration for warfarin?

Answer 28

Oral tablets (adjusted due to individual variation)

Question 29

What is unique about the onset of action for warfarin?

Answer 29

1. w/ Loading Dose = 48 hours for onset

2. low dose = 5-10 days

Question 30

What should patients on Warfarin be warned about?

Answer 30

NOT to increase/decrease vitamin K foods

Question 31

Name the part of phase 1 where LMWH works and its MOA

Answer 31

1. LMWH works on activation of Factor X to Xa

2. MOA = inhibit activation of X to Xa, thereby preventing movement to phase 2

Question 32

What are the clinical indications for use of LMWH?

Answer 32

used to prevent and treat thromboembolisms

Question 33

What are the advantages of LMWH over heparin?

Answer 33

1. longer half-life
2. more SC bioavailability
3. can administer at home
4. reduced need for laboratory monitoring
5. BUT super $$$

Question 34

In what phase do thrombolytics work?

Answer 34

Phase 3 - when a clot has already been formed

Question 35

Name the 2 thrombolytics

Answer 35

1. Alteplase

2. Streptokinase

Question 36

What is the MOA of alteplase?

Answer 36

An enzyme that activates plasminogen to plasmin

Question 37

What is the MOA of streptokinase?

Answer 37

1. activates plasminogen to plasmin

2. inhibits formation of fibrin