Quiz 5: Hematology Flashcards
1
Q
What are the three elements that are largely responsible for maintaining the circulation as a closed hemodynamic system referred to as hemostasis:
A
- Coagulation
- fibrinolysis
- Wound healing
2
Q
What are the three main points that make up Virchow’s Triad:
A
- Hypercoagulable State
- Vascular Wall injury
- Circulatory Stasis
3
Q
Virchow’s Triad of hypercoagulable state consist of:
A
- Malignancy
- Pregnancy and peri-partum period
- Oestrogen Therapy
- Truama or surgery of lower extremity hip abdomen or pelvis
- Inflamation bowel disease
- Nephrotic Syndrome
- Sepsis
- Thrombophilia
4
Q
Virchow’s Triad of Vascular wall injury consist of:
A
- Trauma or surgery
- Venepuncture
- Chemical irritation
- Heart valve disease or replacement
- Atherosclerosis
- Indwelling catheters
5
Q
Virchow’s Triad of circulatory stasis consist of:
A
- Atrial fibrillation
- Left ventricular dysfunction
- Immobility or paralysis
- Venous insufficiency or varicose veins
- Venous ovstruction from rumour, obesity or pregnancy
6
Q
(Extrinsic Pathway) Damage outside (extrinsic to) blood vessels triggers the release of _______ from damaged tissue cells.
A
Thromboplastin (Factor III)
7
Q
(Extrinsic Pathway) Thromboplastin activates factor ___. Thromboplasten when complexed on the surface of the platelet with ______ (factor IV) and ________ (IIIa) activates factor _ to __.
A
- VII
- calcium
- thromboplastin
- X
- Xa
8
Q
(Intrinsic Pathway) Trauma to the blood itself or exposure of the blood to collagen in a traumatized blood vessel wall activates factor __.
A
XII
9
Q
(Intrinsic Pathway) XIIa activates factor __ and __ activates factor __.
A
- XI
- XI
- IX
10
Q
(Intrinsic Pathway) IXa when complexed on the platelet surface with activated factor __:Ca and Ca++ activates factor _.
A
- VIII
- X
11
Q
(Common Pathway) Activated factor X when complexed on the platelet surface with activated factor _ and _______ (factor __) on the platelet surface, converts ________ (Factor II) to _______ (IIa).
A
- V
- calcium
- IV
- prothrombin
- thrombin
12
Q
The therapies such as ASA, Plavix, Ticlid, and possible NSAID are TESTED by _____ ______ and the SYSTEM tested is ______ and _________.
A
- bleeding time
- Platelets
- Capillaries
13
Q
The therapy such as Warfarin are TESTED by _____ and the system tested is the _______ and ______.
A
- PT
- Extrinsic
- Common
14
Q
The therapy such as Haparin are TESTED by APTT and the system tested is the _____ and _____.
A
- Intrinsic
- Common
15
Q
The therapy such as Heparin are
TESTED by TT and the SYSTEM
tested is ____________ to ______.
A
- fibrinogen
- fibrin
16
Q
How does heparin work on the INTRISIC pathway?
A
-NEUTRALIZES
thrombin
Factor Xa
17
Q
What is the source of heparin?
A
- Porcine intestinal
- Bovine Lung
18
Q
What is the mechanism of action for heparin:
A
-Heparin increases the rate of the thrombinantithrombin III reaction serving as a catalytic template to which both the AT III and protease bind.
19
Q
By how much does Heparin increase thethrombinantithrombin II reaction:
A
1000
20
Q
What does Heparin do to the PTT and TT:
A
Prolongs the time
21
Q
T/F: Heparin acts both on bound and unbound factors.
A
FALSE (Heparin acts only on UNBOUND factors)
22
Q
What is so interesting about the half life of heparin?
A
-APPROXIMATELY as the dose double the half life of heparin exponentially increases
23
Q
Does heparin cross the placenta?
A
NO
24
Q
What does abnormal LFTs due to heparin toxicity increase?
A
- transaminases
25
Heparin toxicity has ________ risk of osteoporosis and spontaneous vertebral fractures.
-infrequent
26
When will HIT most likely be seen in a patient receiving treatment.
-1 to 2 WEEKS
27
In heparin toxicity arterial thrombosis with platelet-fibrin clots are referred to as:
White clots(HITTS)
28
What is the antidote to heparin?
-Protamine
29
What is the mechanism of action of protamine?
-protamine complexes with strongly acidic and anionic heparin to form a STABLE SALT
30
How are the complexes formed by heparin and protamine removed?
-Reticuloendothelial system
31
Are LMWH as susceptible to protamine antagonism?
NO (Protamine will approximately neutralize 65%)
32
What will occur when protamine is given rapidly?
- Acute histamine related:
* hypotension
* bradycardia
* pulmonary hypertension
* Transient flushing
* Dyspnea
33
What will hypersensitivity of protamine cause:
- Uticaria
- angioedema
- acute pulmonary hypertension
34
What type of reaction is it called when protamine causes a lysosomal enzymes from neutrophils with prostaglandins and thromboxane genertation:
-Anaphylactoid reaction
35
NOT SURE ON THIS ONE:You may be more ypersensitive to protamine if:
- Hypersensitive to fish
- Previous protamine reversal of heparin
- Protamine containing insulin (NPH)
- Prvious vasectomy
36
What would be the pretreatment of a sensitivity reaction to protamine?
- Corticosteroid
| - Antihistamine
37
What would happen if protamine is given alone or in excess of heparin?
-result in bleeding theoretically because it has anticoagulatn and antiplatelet effects.
38
What is the mechanism of action for LMWH:
- Inhibition of factor Xa by antithrombin
| - (some factor IIa inhibition)
39
T/F: PTT and PT relatively insensitive with LMWH therapy.
TRUE
40
What co-morbidity would you want to decrease the dose of LMWH?
-Chronic renal insufficiency
41
Fondaparinux (Arixtra) mechanism of action is:
-SYNTHETIC indirect specific inhibitor of FACTOR Xa
-MEDIATED
ATIII
42
Fondaparinux (Arixtra) has no effect on:
- factor IIa
| - platelet function
43
T/F: Fondaparinux (Arixtra) is associated with H.I.T.
FALSE
44
Argatroban is used for the prevention and treatement of thrombosis in patient with ___ or _____.
- HIT
| - HITTS
45
T/F: Argatroban reversal agent is protamine.
FALSE (Argatroban has no reversal agent)
46
What are direct thrombin inhibitors use for:
People whom are intolerant of heparin
47
(Direct Throbin Inhibitors) Hirudin analogs is the plypeptide that is responsible for the anticoagulant properties of the _____ of the medicinal ______.
- saliva
| - leeches
48
(Direct Thrombin Inhibitors) Hirudin analogs bind _____ to the active catalytic and substrate recognition sites of both _______ and ______ Thrombin (Factor __).
- irreversibly
- circulating
- clot bound
- IIa
49
Hirudin analogs are excreted by the:
KIDNEYS
50
What are the hirudin analogs:
- Bivalirudin (Angiomax)
| - Lepirudin (refludin)
51
What protein are natural anticoagulant:
- C
| - S
52
What is the mechanism of action of Warfarin:
-has an INDIRECT anticoagulant that alter sysnthesis of factor II, VII, IX, and X by interfering with the action of vita. K.
53
How long does the anticoagulant such as vita. K1 take to act from a warfarin toxicity:
24 hours
54
T/F: What route of administration of vita. K is unacceptable?
SQ
55
What would be done if a reversible antidote is needed right away for warfarin toxicity?
-FFP of 10-20 ml/kg
56
Y/N: Is it safe to administer warfarin to a pregnant mother.
NO
57
________ (tPA) binds to fibrin and plasminogen and converts bound plasminogen to plasmin.
Alteplase
58
_________ has no intinisic enzymatic activity, but forms a stable 1:1 complex with plasminogen causing conformational changes that expose the active site that cleaves free plasminogen to plasmin.
-Streptokinase
59
____________ is a two chain serine protease isolated from human kidney cells that converts plasminogen to plasmin.
Urokinase
60
What does streptokinase require prior to a normal dose for an adult and why?
- Loading dose
- Loading dose is needed to overcome plasma antibodies that inactivate the protein due to a prior streptococcal infection.
61
How long could fibrinolytic activity last for after discontinuation of drug?
-7 to 24 hours
62
What labs would be monitored for patient on fibrinolytic therapy?
- fibrinogen concentration
- thrombin times
- PTT
63
(Hemostatics) Epsilon aminocaproic acid or AMICAR is a synthetic ____________________ acid.
.-monoaminocarboxylic
64
(Hemostatic) What does amicar inhibit:
- fibrinolysis
| - indirect inhibitor of plasmin's anti-platelet effects
65
(Hemostatic) What would rapid IV infusion of amicar cause:
- hypotension
- bradycardia
- Arrhythmias
66
This drug would be used in completion of surgery after stopping oozing in patient with cirrhosis.
-Amicar
67
(Hemostatic) Novoseven RT is the coagulation factor of:
-VIIa (recombinant)
68
(Hemostatic) On whom would you use Novoseven on:
- Hemophilia A or B
| - Patient with congenital factor VII defiency
69
(Hemostatic) Novoseven works on the EXTRINSIC pathway how:
-rFVIIa binds to platelets receptors and then activates factor X and generates thrombin and fibrin
70
What are some off label uses for Novoseven:
- Warfarin induced bleeding which FFP or vita. K did not work
- spontaneous intracranial hemorrhage
- massive bleeding
* uncrrectable by surgery
* Bleeding requiring >6units PRBC in 12 hours
* No Hx of DVT, PE, arterial thrombosis (MI or CVA)
71
What are the most significant complications of Novoseven:
- myocardial ischemia
| - Cerebral ischemia
72
(Oral Agents that are blood thinners) Dabigatran (Pradaxa) works as an oral direct _____ inhibitor.
thrombin (IIa)
73
(Oral Agents that are blood thinners) Apixaban (Eliquis) works as an oral direct factor __ inhibitor.
Xa
74
(Oral Agents that are blood thinners) Rivaroxaban (Xarelto) work as a oral factor __ inhibitor.
Xa
75
What makes the vonWillebrand's factor (VIII;vWF)
Endothelial Cells
76
What does vonWillebrand factor do?
-Promotes adhesions to damaged vascular walls
77
What is the most common inherited coagulation defect?
-vonWillebrand's Disease
78
Thromboxane -A2 and ADP promote platelet:
Aggregation
79
Fibrinogen (factor I) ataches to the receptors linking the _______ to each other.
platelets
80
What does aspirin do to the platelet:
-it inhibits the cyclo-oxygenase as nonfunctional for the life of the platelet
81
NSAIDS ______ of thromboxan A2 production by platelets is only temporary by about ______ hours.
- depression
| - 24 to 48
82
(Platelet Aggregation Inhibitors) What drugs are thienopyridine ADP-receptor antagonists:
- clopidogrel (Plavix)
- Ticlopidyne (ticlide)
- Prasugrel (effient)
- Ticagrelor (Brilinta)
83
T/F: Ticagrelor (Brilinta) is reversible.
TRUE
84
(Platelet aggreation Inhibitors) What drugs are platelet glycoprotein (GP IIb/IIIa) receptor Inhibitors:
- Abciximab (ReoPro)
- Eptifibatide (Integrilin)
- Tirofiban (Aggrastat)
85
How long will it take for platelet aggregation and bleeding time return to baseline values:
5 days
86
How long must you wait before going to surgery if you are on Plavix:
7 days
87
What will methylprednisilone 20 mg IV do to people using ticlopidine (Ticlid):
-normalize prolonged bleeding time in ~ 2 hours
88
How long must you wait before going to surgery if on Ticlopidine (Ticlid):
- 10 to 14 days
89
What is the difference of Prasugrel (effient) compared to Plavix:
-Effient does not have the resistence of plavix
90
Ticagrelor (Brilinta) is a CYP3A4 Substrate.
YES
91
How long must you wait before going to surgery if on ticagrelor (Brilinta).
5 day
92
What lab would you use to measure the percentage of platelet inhibition.
P2Y12
93
What P2Y12 would it be considered safe to proceed with surgery:
<20 %
94
(Platelet Aggregation Inhibitors) What are some platelet glycoprotein GP IIB/IIIa) receptor Inhibitors:
- Abciximab (Reopro)
- Eptifibatide (Integrelin)
- Tirofiban (Aggrastat)
95
(Platelet Aggregation Inhibitors) ______ (______): Fab fragment of a monoclonal antibody that binds selectively to GP IIb/IIIa receptors and dissociates slowly from it.
Abciximab (Reopro)
96
(Platelet Aggregation Inhibitors) ______ (_____): Synthetic cyclic heptapeptide rapidly reversible.
Eptifibatide (Integrelin)
97
(Platelet Aggregation Inhibitors) _______ (_______): synthetic nonpeptide tyrosine derivative, rapidly reersible.
Tirofiban (Aggrastat)
98
(Platelet Aggregation Inhibitors) What are the uses of platelet glycoprotein (GP IIb/IIIa) receptor inhibitors.
- Acute ischemic complication of percutaneous coronary intervention (PCI)
- Unstable angina and non-Q wave MI
99
(Platelet Aggregation Inhibitors) Adverse effect are:
- Bleeding (Not associated with bleeding issues after CABG
- Thrombocytopenia
- N/V
- Hypotension
- Anaphylaxis
100
Desmopressin is a synthetic analogue of ___.
-Anti diuretic hormone
101
Desmopressin causes endothelial cells to release:
- vonWillebrand factor
- tissue type plasminogen activator
- Prostaglandins
102
Desmopressin uses are:
```
-Treatment
DI
Uremia
Chronic liver diseases
types of hemophilia
minamize blood loss
-
```
103
What are the side effects of desmopressin:
- hypotension OR hypertension
- Hyponatramia
- Nausea
104
How early should a catheter insertion take place before the first heparin is administered if no coagulopathy exists.
1 hour
105
How early could a neuraxial catheter be removed after last dose of heparin AFTER evaluating the patient's coagulation status?
2 to 4 hours
106
T/F: ASA and NSAIDs does not appear to be associated with an increased risk of epidural hematoma.
TRUE (It is false if ASA and/or NSAIDS are used with another anti-coagulate.)
107
How long would you wait for a neuraxial blockade is on clopidogrel (plavix):
7 days
108
How long would you wait for a neuraxial blockade is on Ticlopidyne:
14 days
109
How long would you wait for a neuraxial blockade is on Abciximab:
24-48 hours
110
How long would you wait for a neuraxial blockade is on Eptifibatide and tirofiban:
4 to 8 hours
111
What labs measure coumadin:
- PT
| - INR
112
What labs measure heparin:
- PTT
| - ACT
113
When can a neuraxial catheter be removed when a person is on coumadin:
INR < 1.5
114
How much time should be allotted before placing a neuraxial blockade on a low and high LMWH.
LOW =12
| High = 24
115
How much time should be alotted before administering a LMWH after removal of a neuraxial catheter:
2 to 4 hours
116
What is Dextran good for:
- Expansion of intravascular volume
| - prevention of thromboembolism by decrease of blood viscosity
117
What antibody is present in most adults that would be a concern when using dextran:
-IgG
118
If a rouleaux formation occurs when using dextran what may it do:
-make subsequent cross matching of blood difficult.
119
Xigris (Drotrecogin alpha) is a recombinant human activated protein C.
TRUE (It was pulled from the market due to elevated mortality rates in patients.
120
Cyclooxygenase is the rate limiting enzyme in the conversion of ______ acid to ________ a2.
- arachidonic
| - thromboxane
