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Basic Principles > 2 - Coagulation and Blood > Flashcards

2 - Coagulation and Blood Flashcards

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1
Q

What is the end factor of the plasma clotting factor cascade?

A

Fibrin

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2
Q

Describe Platelet Adherence in Veins

A

endothelial lining is damaged

Platelets adhere to exposed collagen via surface integrin receptors GPIa/IIa and GP VI receptors

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3
Q

Describe platelet adherence in Arteries

A

Endothelial lining is disrupted, and in addition to collagen adherence,

vWF from endothelial cells and pre-existing clot adhere to integrin Ib/IX

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4
Q

What is the role of ADP in primary hemostasis?

A

Platelet Activation

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5
Q

What is the role of COX and cyclooxygenase in primary hemostasis?

A

Platelet Activation

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6
Q

What is the role of the GP IIb/IIIa receptor in primary hemostasis?

A

Platelet Stabilization

“Inside-Out” signaling

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7
Q

How are platelets naturally inhibited in their endothelial environment?

A

Endothelial cells secrete Prostaglandin i2

they also secrete NO which inhibits TxA2 receptor (platelet activation)

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8
Q

What drugs counteract platelet adherence?

A

None!

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9
Q

Which drug is an ADP antagonist?

What part of primary hemostasis does it inhibit?

A

Clopidogrel

Platelet Activation

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10
Q

Abciximab, Eptifibatide, and Tirofiban act at which receptor?

Which part of primary hemostasis do they inhibit?

A

GP IIb/IIIa

Formation and Stabilization of the platelet plug

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11
Q

Are the extrinsic and intrinsic pathways part of primary or secondary hemostasis?

A

Secondary

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12
Q

What is secondary hemostasis?

A

The cascade of enzymes that creates fibrin to stabilize the preliminary platelet clot

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13
Q

Activation of _______ initiates secondary hemostasis.

A

Thrombin

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14
Q

What is the extrinsic pathway?

Why is it called extrinsic?

A

Initiated when endothelial damage exposes tissue factor (TF) on underlying cell membranes

The TF comes from the cell membrane, which is not part of (extrinsic) the circulation

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15
Q

What is the end product of the extrinsic pathway?

A

Thrombin (IIa)

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16
Q

What happens after the extrinsic pathway?

A

Thrombin acts on fibrinogen to form fibrin

Thrombin cleaves factor XI to XIa, which triggers the intrinsic pathway

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17
Q

What is the purpose of the intrinsic pathway?

A

Produces more Xa

Xa transforms Prothrombin to Thrombin

Thrombin transforms fibrinogen to fibrin

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18
Q

All of the clotting factors are primarily produced in the liver except ________

A

VIII (8)

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19
Q

Which factors are Vitamin K dependent?

A

2

7

9

10

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20
Q

What are the three natural clotting inhibitors?

A

TF Pathway Inhibitor

Anti-thromibn III

Protein C and S

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21
Q

What is tPA?

A

tissue plasminogen activator

Secreted in the body by endothelial cells to activate plasminogen to plasmin, which breaks down fibrin

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22
Q

What two drugs inhibit fibrinolysis?

How?

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A

Epsilon-Aminocaproic acid (EACA) and TXA

block the binding sites of plasminogen, so it can’t act on fibrin

23
Q

What is a normal platelet count?

24
Q

What is the primary role of vWF?

Study These Flashcards
A

cross-linking activated platelets to form the plug

25
What lab evaluates primary hemostasis?
Your platelet count
26
What labs evaluate secondary hemostasis?
PT/PTT INR
27
What is viscoelastic testing
ROTEM Looks at whole blood clotting and fibrinolysis
28
What is factor V Leiden?
FVL most common hypercoaguable mutation
29
What lab would show how effective apixaban or rivaroxaban are?
AntiXa
30
Why do DTIs end in "-rudin"?
Because they're derived from hirudin in LEECHES!!!!
31
What O2ER is associated with tissue hypoxia?
\> 50%
32
What MixedVO2 and CentralVO2 would indicate tissue hypoxia?
50, 60
33
What is Cryo? When is it useful?
Cryo is thawed FFP that has been centrifuged to remove everything but fibrinogen, fibronectin, vWF, F8, and F13 Cryo contains more fibrinogen by volume Useful when fibrinogen is depleted: DIC, massive hemorrhage
34
What are the two primary treatment options for patients with vWD?
DDAVP Factor concentrates
35
Why does DDAVP help stop bleeding in vWD patients?
Promotes cleavage of F8 into vWF
36
Is vWD a disease of primary or secondary hemostasis?
Primary
37
What is the most common form of hemophilia?
Hemophilia A (85%)
38
How is hemophilia treated?
DDAVP (increases factor 8) recombinant F8 (but often develop antibodies to it) Plasma transfusion
39
PT/PTT are ______ in a patient with Vit K deficiency?
Prolonged
40
Are PT/PTT accurate measures of bleeding risk in liver disease patients?
No. Often overestimate bleeding risk. The hemostatic balance is usually (fragilely) maintained by compensation during liver disease
41
DIC is always associated with \_\_\_\_\_\_\_\_\_
a comorbid condition: infection inflammation malignancy
42
Does DIC result from an abnormality of the intrinsic or extrinsic pathway?
Extrinsic TF sparks unregulated thrombin production and fibrin development
43
Which disorders are most associated with DIC?
Sepsis Malignancy Obstetric Complications
44
Name 2 cyclooxygenase inhibitors. How do they cause anticoagulation?
Aspirin and NSAIDS Inhibit platelet aggregation
45
Can aspirin be reversed?
No. Non-competitive inhibitor.
46
Why are Phosphodiesterase Inhibitors used for stroke prophylaxis?
cAMP is an active inhibitor of platelet aggregation
47
Name 2 ADP antagonists. How do they cause anticoagulation?
Clopidogrel, Ticagrelor Inhibit platelet aggregation
48
Name 3 GP IIb/IIIa Receptor Antagonists. How do they cause anticoagulation?
Abciximab, Eptifibatide, Tirofibin inhibit cross-linkage of fibrinogen (platelet aggregation)
49
Name 1 Vit K Antagonist. How does it cause anticoagulation?
Warfarin Competes with Vit K for carboxylation binding sites Inhibits synthesis of VitK dependent factors (2, 7, 9, 10, fctrs C and S)
50
Does heparin inhibit FXa directly or indirectly?
Indirectly by binding to AT-III
51
Name 2 Parenteral Direct Thrombin Inhibitors
Argatroban and Bivalirudin
52
Which drug is used to reverse heparin? How does it work?
Protamine Derived from fish sperm! Binds to heparin and forms a stable salt
53
Name 2 lysine analogues.
TXA and EACA
54
What is the average blood volume of a male? Female?
70ml/kg 65ml/kg

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