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2 Principles of Disease > Lecture 6 > Flashcards

Lecture 6 Flashcards

1
Q

Hemostasis

A

all processes that minimize blood loss when a blood vessel is opened

includes 4 related events –> vasoconstriction, platelet plug, fibrin web, clot retraction/dissolution

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2
Q

Vasoactive amines

A

Serotonin
Histamine

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3
Q

Enzymes derived from plasma

A

blood coagulatoin cascade

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4
Q

Fibrinogen

A

soluble plasma protein that can be acted upon by clotting factors to ultimately form insoluble fibrin

a part of the plasma

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5
Q

Platelets

A

release serotonin
a part of formed elements

increased amount can cause venous thromboembolism
decreased amount can be infection, leukemia

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6
Q

Initial steps of hemostasis

A

Platelets and fibrinogen circulate in the blood

when a blood vessel is injured or ruptures, platelets release serotonin and aggregate to form platelet plug

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7
Q

Coagulation

A

processes by which liquid blood changes to a solid clot (thrombus)

uses platlets, RBC, fibrin

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8
Q

The platelet plug is not ___ ______ to curtail ____ _____

A

strong enough/blood loss
must be reinforced by solid strands of fribrin

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9
Q

Clotting factors

A

enzymes made by the liver
12 –> little a means that clotting factor is activated

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10
Q

Intrinsic Pathway

A

activation of complement proteins occurs within system

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11
Q

Extrinsic pathway

A

outside factor helps to activate the system

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12
Q

What protein do the intrinsic and extrinsic pathway come together?

A

10

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13
Q

Many complement proteins are _____ ______ dependent

A

vitamin K
can be found in diet or normal flora

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14
Q

Coagulation disorders

A

Too much BLEEDING
Too much CLOTTING

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15
Q

Coagulation disorders that result in deficient clotting

A

hemophilia A and B
von Willebrand disease

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16
Q

Hemophilia A

A

genetic deficiency in clotting factor 8

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17
Q

Hemophilia B

A

Christmas disease
genetic deficiency in clotting factor 9

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18
Q

Hemophilia A/B

A

most often these are x-linked recessive traits
treatment for both–> infusion of respective deficient clotting factors

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19
Q

von Willebrand disease

A

genetic deficiency or defective von willebrand factor
VWF = plasma protein that binds factor 8 and platelets

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20
Q

Functions of VWF

A

assists in formation of plug

helps initiate initial adhesion of platelets at sites of bleeding injury

binds and stabilizes clotting factor 8

treatment depends on severity

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21
Q

Fibrinogen is

A

SOLUBLE

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22
Q

Fibrin is

A

INSOLUBLE

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23
Q

Factor V Leiden thrombophilia

A

common inherited form of thrombophilia
clotting process remains active longer than normal, increases changes of blood clots and emboli

24
Q

What factors increase the risk of clotting?

A

dehydration
increasing age (decreased mobility)
obesity
injury
srugery
pregnancy
co-morbidities
medications

25
Q

Medications that can increase clotting

A

birth control
hormone replacement therapy
fertility related drugs
NSAIDs
anabolic steroids
chemotherapy
marijuana

26
Q

Anticoagulants

A

warfarin
heparin
lovenox

27
Q

Antiplatelet drugs

A

asprin
clopidogrel (plavix)

28
Q

Thrombolytics

A

tPA–> tissue plasminogen activator

29
Q

Anticlotting drugs

A

Anticoagulants
Thrombolytics
Antiplatelet drugs

30
Q

Anticoagulants definition

A

used primarily to prevent clot fomration in venous system
work by preventing or disrupting the synthesis and/or function of clotting factors
these drugs do NOT dissolve the thrombus/clot

31
Q

Heparin

A

not orally active, typically given subcutaneous or intravenous

32
Q

Low molecular weight heparins

A

not orally active
given SQ
lovenox/enoxaparin

33
Q

Warfarin

A

orally active
(Coumadin)

34
Q

Direct oral anticoagulants

A

orally active, direct thrombin inhibitor and direct factor Xa inhibitors

35
Q

Anticoagulant therapy

A

generally starts with heparin and is then followed by warfarin or lovenox

these drugs are used in the treatment of DVT

anticoagulants do NOT dissolve the clot

36
Q

ANticoagulants help to

A

prevent enlargement of thrombus
allow for further attachment of the thrombus to the vessel wall, which reduces the likelihood of an embolus

37
Q

Antiplatelet drugs

A

used primarily to prevent clot formation in the arterial system
work by inhibiting platelet function

aspirin and clopidogrel

38
Q

Aspirin

A

antithrombotic effect at very low doses

39
Q

Clopidogrel

A

plavix
inhibits platelet aggregation/clumping

40
Q

Clinical uses of Antiplatelet drugs

A

prevention and treatment of arterial thrombosis
prevention of clot in people with high risks of clots

41
Q

ADRs of Antiplatelet drugs

A

ADRs: increases risk of bleeding, increased risk of hemorrhagic CVA, long term effect on kidneys, liver, GI

42
Q

Thrombolytics

A

clot bisters
used in emergent circumstatnces to re-establish blood flow through vessels that have been occluded

work by facilitating destruction of blood clots
only used within short well-defined window of known vessel occulusion

tissue plasminogen activator is common drug

43
Q

DVT

A

common postoperative complication
exacerbated by prolonged immobility and decreased activity

44
Q

Strategies to decrease DVTs

A

anti-coagulants
hydration
mobilization
sequential compression device

45
Q

What can be caused by a DVT?

A

stroke
pulmonary embolism
heart attack

46
Q

Risk factors for DVT

A

DAMAGE TO VEINS
previous DVT, surgery, trauma, LE fracture, varicose veins, sepsis, childbirth

STASIS
prolonged bedrest, heart failure, heart attack, neurologic disorders, chronic venous insufficiency, immobilization, prolonged air travel

HYPERCOAGUABILITY STATES
cancer, autoimmune disorder, oral contraceptives, late pregnancy

OTHERS
age >60, obesity

47
Q

Symptoms of DVT

A

pain
dull ache
tightness

48
Q

Signs of DVT

A

Erythema
Edema
Positive Homan’s Sign
Warmth

49
Q

Modified Wells Clinical Prediction Rule for DVT

A

if pt exhibits any S/S of DVT
has excellent sensitivity and specificity for DVT

50
Q

Scoring of Modified Wells

A

0 = not present
1 = predictor is present
-2 = alternative diagnosis likely

51
Q

d-dimer test

A

blood test for teh presence of a small fragment of fibrin from a blood clot

negative rules out DVT
positive = additional testing, doppler ultrasound

52
Q

Treatment of a DVT

A

anticaogulation therapy will be started
PT may be delayed so that clot can stabilize

53
Q

Lovenox and mobilizing

A

You can mobilize in about 5 hours

54
Q

Heparin and mobilizing

A

2 days before mobilizing

55
Q

Higher INR =

A

increased bleeding

56
Q

Warfarin/Coumadin

A

pt should have plasma INR checked regularly
Therex range is 2-3

higher than this indicates bleeding and could cause hemarthrosis

2 Principles of Disease (7 decks)

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