Drugs for Coagulation Disorders Flashcards
Factors XII –> XIIa is the start of which pathway? 1)
It is activated by exposure of 2);
Other necessary components for this pathway to initiate are 3)
1) INTRINSIC
2) Subendothelial collagen (SEC)
3) Prekallikrein (PK); High Molecular Weight Kininogen (HK)
Factor VII–> VIIa is the start of which pathway? 1)
it is activated by 2)
1) extrinsic
2) Tissue factor (TF) also called thromboplastin
Hemophilia A vs. B
(1) A is caused by a
deficiency of factor VIII.
(2) B is caused by a
deficiency of factor IX.
von Willebrand factor is the carrier molecule for 1) protecting it from degradation and removal
1) circulating factor VIII
A deficiency in 1) reduces the half-life of factor VIII and decrease plasma factor VIII levels.
1) von Willebrand Factor
Platelet membrane receptors include the 1) , binding to collagen (C);
2) binding von Willebrand factor (vWF);
3) binds fibrinogen and other macromolecules.
1) glycoprotein (GP) Ia receptor
2) GP Ib receptor
3) GP IIb/IIIa
Antiplatelet prostacyclin
(PGI2) is released from
the 1)
1) endothelium
Aggregating substances
released from the degranulating platelet include 1)
adenosine diphosphate (ADP), thromboxane A2 (TXA2), and serotonin (5-HT)
vWF promotes platelet adhesion by interacting with 1);
A deficiency of vWF reduces 2)
1) GP Ib receptor on PLATELETS
2) platelet adhesion
vWF plays a dual role in hemostasis affecting both platelet adhesion and coagulation; explain.
affects platelets adhesion–> Gp1b receptors on platelets;
affect coagulation–> vWF inc. half life of Factor VIII
Fibrinolysis:
Plasmin is generated by the proteolytic cleavage of 1) , a plasma protein that is synthesized in the 2)
1) plasminogen
2) liver
Fibrinolysis
The proteolytic cleavage of plasminogen is catalyzed by 1) , which is synthesized and secreted by the 2)
1) tissue plasminogen activator
(t-PA)
2) endothelium
What does the endothelium secrete?
What does endothelium store?
Secretes Tissue plasminogen activator;
vWF
PGI2 (antiplatelet);
Stores vWF-Factor VIII complex (this is where desmpressin acts)
Fibrinolysis:
Plasmin exerts its anticoagulant effect by proteolytically cleaving 1)
into 2)
1) fibrin
2) fibrin degradation products
Hemophilia
The bleeding manifestations include 1), 2) hemorrhages, and excessive bleeding after
surgery or trauma.
1) palpable ecchymoses, hemarthroses
(bleeding into joint spaces),
Hemophilia
severity of bleeding correlates with the degree of deficiency of factor 1)
1) VIII or IX
Hemophilia Disease severity:
Severe–> 1)
Moderate–> 2)
Mild–> 3)
1) Frequent spontaneous hemorrhages and
hemarthroses
2) Excessive bleeding following mild trauma
3) Few symptoms or excessive bleeding only
after significant trauma or surgery
Clinical manifestations are variable including asymptomatic, mucocutaneous
bleeding (e.g., epistaxis, gingival bleeding, menorrhagia), easy bruising, and
postoperative bleeding.
von Willebrand Disease
several types of von Willebrand Disease. Those that are
amenable to therapy include 1)
1) types 1, 2A, 2B, 2M, and 3
Systemic inflammation is associated with systemic activation of coagulation; 1) is the most severe form. There are many diverse triggers for 1).
Disseminated intravascular coagulation (DIC)
DIC leads to 1) in the microvasculature often with 2) as coagulation factors and platelets are consumed
1) fibrin clot formation
2) compensatory bleeding
Vitamin K is a 1) vitamin;
Vitamin K1 (2) is found in green leafy vegetables;
Vitamin K2 is produced by 3)
1) fat-soluble
2) phytonadione
3) bacteria in the large intestine
Vitamin K
a. Cofactor in the activation of 1)- without vitamin K
they remain inactive precursors
b. Also required for the active forms of 2)
1) factors II, VII, IX, and X
2) proteins C and S
Vitamin K deficiency
Causes bleeding as a result of marked deficiency of 1) referred to as 2).
1) factors II, VII, IX,
and X
2) vitamin K deficiency bleeding (VKDB)
Occurs in newborns- the have limited 1) at birth since
transplacental passage is limited
1) vitamin K stores
refers to Vitamin K deficiency
Vitamin K deficiency–> patients with 1) or malabsorption
1) poor nutrition
Vitamin K absorption depends on 1) and 2) to create micelles;
thus, Diseases of the 3) can lead to malabsorption
1) bile acids
2) pancreatic enzymes
3) intestine or pancreas
1) may sterilize the large intestine and prevent vitamin K2 production
1) Broad spectrum antibiotics
Broad spectrum antibiotics may sterilize the large intestine and
prevent 1)
1) vitamin K2 production
Plasma-derived Factor VIII:
Derived from plasma of thousands of donors and can
therefore 1)
1) potentially transmit disease
