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HEMA2 > WK13: Inhibitors of Coagulation > Flashcards

WK13: Inhibitors of Coagulation Flashcards

1
Q

Function to counterbalance the effects of coagulation factors, provide limitations for the forming fibrin clot, and prevent systemic thrombus formation

A

Natural Inhibitors of Coagulation

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2
Q

What are the three major coagulation inhibitor pathways?

A

Protein C & S
Tissue Factor Pathway Inhibitor
Antithrombin III

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3
Q

Forms fibrin clot and activates protein C

A

Thrombin

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4
Q

When protein C is activated it inhibits factors ______

A

V

VII

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5
Q

Enhances the inhibition of factor V and VII

A

Protein S

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6
Q

Deficient or defective protein C or S results in ________

A

hypercoagulability

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7
Q

erformed if a clinician suspects that a hypercoagulable state secondary to protein C or S deficiency is present

A

Protein C and S assays

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8
Q

genetic condition in which factor V is resistant to the actions of protein C, resulting in a hypercoagulable state

A

Factor V Leiden

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9
Q

ctivates the extrinsic pathway of the coagulation cascade

A

tissue factor (factor III)

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10
Q

inhibit the activation of the extrinsic pathway

A

TFPI

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11
Q

principal inhibitor of thrombin and factor Xa

A

Antithrombin III

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12
Q

Antithrombin III has limited inhibitory activity against factors _______

A

IXa
XIa
XIIa

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13
Q

serves as a cofactor in the inactivation, thereby increasing the reaction rate by more than 2,000 times

A

Heparin

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14
Q

Minor inhibitor of thrombin

A

α2-macroglobulin

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15
Q

Minor inhibitor of factors XIa and XIIa

A

Complement C1 inhibitor

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16
Q

Has limited inhibition of thrombin, kallikrein, and factor XIa

A

α1-antitrypsin

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17
Q

Vitamin K-dependent inhibitor that circulates as an inactive zymogen

A

protein C

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18
Q

PC is activated by ______ as part of the thrombomodulin platelet receptor complex

A

thrombin

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19
Q

PC inactivates factors VIII: C and Va in the presence of cofactor _________

A

Protein S

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20
Q

Principal inhibitor of coagulation

A

Antithrombin (AT)

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21
Q

AT inhibits ________

A

serine proteases

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22
Q

Therapeutic heparin enhances the action of

antithrombin.

A

Antithrombin (AT)

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23
Q

Vitamin K-dependent regulatory proteins

A

Proteins C and S

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24
Q

Proteins C and S Activated when thrombin binds to __________

on the endothelial cell surface

A

thrombomodulin

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25
Inhibits factor Vila-tissue factor complex
Tissue Factor Pathway Inhibitor
26
Inhibits thrombin, Xa, kallikrein, and plasmin
Beta 2-Macroglobulin
27
Inhibits XIa and inactivates plasmin
Alpha 1-Antitrypsin
28
Inhibits Cl from the complement cascade, and Xlla, | XIa, kallikrein, and plasmin
C1 Inhibitor
29
Principal inhibitor of fibrinolysis; neutralizes plasmin
Alpha2-Antiplasmin
30
Important inhibitor of fibrinolysis
PAI-1 (plasminogen activator inhibitor-1)
31
Most common factor- specific coagulation inhibitor is ________
anti-factor VIII
32
anti-factor VIII nhibitor is associated with the condition, ________
acquired hemophilia A
33
Anti-factor VIII interferes with the activity of _____
factor VIII
34
Anti-factor VIII is demonstrated in vitro in the clinical laboratory with a prolonged ___________
activated partial thromboplastin time (aPTT) test
35
major site of hemostatic protein | synthesis
liver
36
result in decreased synthesis of coagulation or regulatory | proteins; causes impaired clearance of activated hemostatic components
Hepatic Disease
37
True or False | Prolonged PT, aPTT, bleeding time, and possibly decreased platelet counts are indications of Vit K deficiency
False (hepatic disease)
38
Prolonged PT and aPTT
Vit K deficiency
39
Vitamin K is needed for liver synthesis of functional factors _________
II, VII, IX, and X
40
Deficiencies in vitamin K can result from _______ and _______
oral antibiotics with vit K antagonists (warfarin) Decreased absorption (obstructive jaundice)
41
Platelet count, anti- thrombin, and fibrinogen concentrations are decreased
DIC
42
in DIC Predisposing condition triggers systemic clotting; | leads to __________ and ________
systemic | fibrinolysis and bleeding
43
True or False | Spherocytes are present in DIC w/ secondary fibrinolysis
False (Schistocytes)
44
Triggering events if DIC
gram-negative septicemia | AML (FAB M3) obstetrical complications massive tissue damage
45
Plasminogen is inappropriately activated to plasmin in the absence of clot formation
Primary fibrinogenolysis
46
In Primary fibrinogenolysis plasmin circulates free in plasma and destroys factors ______
I, V, and VIII
47
Treatment of Primary fibrinogenolysis
``` Epsilon aminocaproic acid (EACA) ```
48
PT, aPTT, and thrombin time | are prolonged, and fibrinogen concentration is low
Primary fibrinogenolysis
49
True or False | Platelet count, RBC morphology, and antithrombin concentration are low because there is no clot formation
False (normal)
50
inhibitors are associated with bleeding
Inhibitors to factors VIII and IX
51
Thromboxane Inhibitors
Aspirin Triflusal Terutroban
52
Platelet Cox-1 inhibitors
Aspirin | Triflusal
53
Thromboxane receptor blockade
Terutroban
54
ADP P2Y receptor antagonists
Thienopyidines | Non-thienopyridines
55
Irreversibly bind the ADP receptor P2Y12
Ticlopidine Clopidogrel Prasugrel
56
Reversibly block the ADP receptor P2Y12
Ticagrelor | Cangrelor
57
GPIIb/IIIa inhibitors
Abciximab Eptifibatide Tirofiban
58
Monoclonal antibody that irreversibly block GP/IIIa | receptor
Abciximab
59
Synthetic molecules that competitively and reversibly block GPIIb/IIIa receptor
Eptifibatide | Tirofiban
60
Thrombin receptor antagonists
Varopaxar | Atopaxar
61
Oral antagonists of platelet | thrombin receptor PAR-1
Varopaxar | Atopaxar
62
Agents under pre-clinical investigation
vWF-GPIb inhibitors NCX-4016 Soluble CD39 Nitric Oxide Donors
63
Inhibit platelet adhesion by | preventing vWF-GPIb interaction
vWF-GPIb inhibitors
64
Nitric-oxide donor + aspirin releaser
NCX-4016
65
ATP and ADP metabolization
Soluble CD39
66
Treatment of choice to prevent extension of existing clots due to acute thrombotic events
Unfractionated Heparin Therapy
67
oral anticoagulant is prescribed on an outpatient basis to prevent extension of existing clots and recurrence of thrombotic events, and prophylactically it is often prescribed postsurgery to prevent thrombosis
Warfarin (Coumadin®/Coumarin) Therapy
68
________ must be present with levels of 40-60% of normal for heparin to work
Antithrombin
69
The ___________ inhibits serine proteases, including Xlla, XIa, IXa, Xa, Ha, and kallikrein
antithrombin/heparin complex
70
UFH inhibits the conversion of _______, _______ and _______
fibrinogen to fibrin platelet aggregation activation of factor XIII
71
Heparin activity can be immediately reversed by administration of _________
protamine sulfate
72
UFH is monitored with ____
aPTT
73
Daily platelet counts should be performed on heparinized patients to monitor for _________
heparin-induced thrombocytopenia
74
Warfarin has a _______ antagonist
Vit K
75
Warfarin inhibits liver synthesis of | functional prothrombin group factors _______
II, VII, IX, and X
76
True or False | Factor VIII is affected first when warfarin inhibits liver synthesis of prothrombin group factors
False (Factor VII)
77
Warfarin is monitored with ___ and ____
PT | INR
78
It is mainly an anti-Xa inhibitor; anti- IIa response is reduced
Low-molecular-weight heparin
79
Used in place of unfractionated or low-molecular-weight heparin when HIT suspected
Direct thrombin inhibitor
80
______ or ______, can be used to lyse existing clots and reestablish vascular perfusion
streptokinase or urokinase
81
These medications convert plasminogen to plasmin
Fibrinolytic therapy
82
may be used in conjunction with other anticoagulant therapies to prevent recurrence of thrombotic events
Antiplatelet medications

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