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CardioPulm2 > Clotting > Flashcards

Clotting Flashcards

(72 cards)

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1
Q

What causes the clotting cascade to start?

A

Injury to endothelium

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2
Q

What is primary hemostasis?

A

A localized platelet plug formed at endothelial injury

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3
Q

What is secondary hemostasis?

A

When more stuff is added to primary hemostasis, such as: fibrin (Factor 1) –> coagulum
Platelet plug + Coagulum = clot

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4
Q

What 2 things do you need to form a clot?

A

Platelet plug + Coagulum.

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5
Q

What is an antithrombiss?

A

Inhibition of clotting

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6
Q

What is Fibrinolysis?

A

Breakdown and removal of clot

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7
Q

What autonomic event happens when there’s an injury to the endothelium?

A

Vasoconstriction

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8
Q

What substance drastically accelerates production of fibrin 1000 fold?

A

Phospholipid platform formed during secondary hemostasis

sticky activated platelets

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9
Q

What starts off Extrinsic pathway?

What factors are in the extrinsic pathway?

A

7 being turned into 7a via injury. Injury lets off Tissue Factor (Thromboplastin/F).
7, 3, X (3=TF)

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10
Q

What is the overall goal of the extrinsic pathway?

A

To create Xa that goes in prothrombinase.

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11
Q

What enzyme must be created to form Xa from the extrinsic pathway?

A

The Complex of TF - 7a - Ca++

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12
Q

What enzyme must be created to form Xa from the intrinsic pathway?

A 
Tenase. 
Contains: 
9a
8a
Ca++
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13
Q

What enzyme does the intrinsic and extrinisc pathway meet at?

A

Prothrombinase
Xa
Va
Ca

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14
Q

What does Prothrombinase do?

A

Makes thrombin from prothrombin via thrombine.

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15
Q

What is the overall goal of the clotting cascade?

A

To make stable, polymer fibrin (factor 1).

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16
Q

Once you have fibrin monomers, what final factor do you need to get your product?

A

13 –> 13a via thrombine.

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17
Q

Which factors are Vitamin K dependent?

A 
2, --> (Thrombin)
7, 
9, 
X
Protein S and C

“1972”

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18
Q

How is the intrinsic pathway began?

A

Platelets conformational change to show the phospholipid- rich platform

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19
Q

How does the phospholipid platform initiate intrinsic cascade?

A

The Phospholipid platform is negatively charged, which attracts Factor 12 and HMWK

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20
Q

Factor 12 –> Factor 12a is accelerated by what 2 things?

A

HMWK & Kallikrein

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21
Q

If there’s a problem in your Factor 9 or Factor 8, what disease do you have?

A

Haemophilia

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22
Q

In general, what factors are used in what order of intrinsic?

A

12- 11- 9 - 8 -10.

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23
Q

What is the end product of the intrinsic pathway

A

Tenase
9a
8a
Ca++

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24
Q

What are thrombin’s 3 roles?

A
  • Activate downstream components (look at diagram)
  • Positive feedback upstream
  • Paracrine activity
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25
What is the paracrine activity caused by Thrombin?
Causes endothelin cells to release NO, Prostacyclin, (Vasodilators) and TPA (Tissue plasminogen activator --> dissolves clots)
26
What part of the blood is used in Hemostasis testing? | What is the tube cap color?
Plasma | Blue
27
What are the most common causes of prolonged aPTT?
Med OD: heparin, oral anticog Dilutional coagulopathy (Bleeding out) Inherited: Haemophilia DIC: Disseminated INtravascular Coagulation
28
What does Warfarin do?
Inhibit Vitamin K = Spontaneous bleeding b/c no clots Warfarin: same. More specifically inhibiting epoxide reductase
29
What are most common causes of prolonged PT?
Human error Pt on Anticoagulants Coagulation Factor deficiency from: Liver disease, hemorrhage, DIC, inherited.
30
Common cause of Vit K deficiency?
Liver sucks
31
What are the 4 components of hemostasis
1. Vascular Spasm 2. Formation of Platelet Plug 3. Formation of blood clot 4. Repair of damage
32
What are platelets composed of?
Cell fragments of megakaryocytes. - Mitochondria - Actin/Myosin - COX1 - Can secrete: thromboxane A-2, Serotonin = Vasoconstrictors
33
How does TPO regulate platelet production?
Binds to cMPL on megakaryocytes. They activate and push out platelets
34
What molecule regulates platelet production? | Where is this molecule secreted from?
TPO Liver and Kidneys
35
How is thrombopoiesis and erythropoiesis different?
Thrombopoiesis: Increases all blood cell production TPO from Liver and Kidneys Always active Erythropoisis: Increases RBC production EPO from kidneys ONly released with low O2
36
What is the function of vascular spasm? what is vascular spasm?
Vasoconstriction | Reduces blood flow ot lessen blood loss.
37
How is vascular spasm initatied?
(myogenic response) | Platelets release thromboxane and serotonin
38
Endothelial is damaged. What's the initial response of the body? How is this made?
``` Make platelet plug Damage to endothelial exposes collagen. Platelets bind to collagen via vWF Platelets recruit more platelets via thromboxane and ADP They stick together and form a plug. ```
39
One of the platelet's roles is to stabilize the clot ("retract the clot"). How does it do this?
Activates thrombin activator, thrombin, Platelet clot (fibrin) squeezes out plasma SEcretes fibrin stabilizing factor to generate and bring fibrin together.
40
What does platelet derived growth factor do and what secretes it?
STimulates fibroblasts to repair smooth muscle | Platelets
41
What main molecule is responsible for the lysis of clots? | How is it made?
Plasmin Thrombin and Thrombomodulin bind --> ACtivates Protein C --> Inacitvates tPA inhibitor --> tPA converts plasminogen --> plasmin.
42
If a patient is having a stroke, what would you give them?
tPA
43
``` What is the MOA of these molecules: Fibrin Postacyclin Antithrombin III Heparin: ```
Fibrin: Inhibits thrombin. Postacyclin: Vasodilation limits platelet aggregation Antithrombin III: Antithrombin. Heparin: Antithrombin efficacy
44
In what form is Vitamin K Active? | In what form is dietary Vitamin K?
QUinol form | Dietary: Quinone
45
What is the function of Protein C? | Protein C deficiency puts pts at an increased risk of?
Anticoagulation DVT
46
A young pt comes in bleeding a lot- - you suspect Haemophilia A. How can you test this? What are you looking for?
aPTT test will test for intrinsic pathway, which is where Factor 8 is. A deficiency in Factor 8 causes Haemophilia
47
What is the mechanism of Haemophilia?
Factor 8 is deficient. Factor 8 helps cleave X into Xa which feeds into prothrombinase.
48
What does a PT test evaluate? | Normal time?
Extrinsic and common pathway; factors: 1, 2, 5, [3, 7, 10.] 10-13
49
What does PTT test evaluate? | Normal time?
intrinsic and common; [12, 11, 9, 8] [10, 13] and kallikrein, vWf 25-35
50
WHere are the 3 sources of triacylglycerol?
Dietary processed in intestine De novo from liver De novo from adipocyte
51
In intestinal synthesis of TG, what is the backbone molecule? What is the net result?
2 monoacylglycerol Triacylglycerol +apolipoprotein + other lipids = Chylomicrons
52
In liver synthesis of TG, what is the backbone molecule? What is the net result?
glycerol 3 phosphate Triacylglycerol +apolipoprotein + other lipids = Forms VLDL
53
In adipocyte synthesis of TG, what is the backbone molecule? What is the net result?
Glycerol 3 phosphate Storage of TG in adipocytes
54
``` Which exclusive system has glycerol kinase? A. Liver B. Kidney C. Adipocytes D. Intestine What can glycerol kinase do? ```
Liver only man. Use glycerol as fuel
55
Where is the only place that TGs are broken down? What enzymes are responsible for lipolysis? What molecules do they affect?
``` Adipocytes HSL (Hormone sensitive lipase) LPL (Lipoprotein lipase) MAG Lipase ATGL **Discovered in 2006 ``` TAG to DAG via ATGL DAG to MAG via HSL MAG to fatty acid via MAG lipase
56
When is lipolysis stimulated? | What inhibits lipolysis?
Hunger and exercise (glucagon and epinephrine) | Insulin inhibits.
57
What are the functions of Apolipoproteins
Cofactors for enzymes Structurally stable. Transport of TG
58
What apolipoprotein is located in LDL? HDL? VLDL?
LDL: Apo B HDL: ApoA-1 VLDL: Apo E
59
What is Type I Familial hyperchylomicronemia caused by? What will you see in the blood?
Deficiency in lipoprotein lipase. HIGH TAG YOUNG - overnight plasma fridgeration thick creamy layer. most people die Xanthomas
60
What is Type II familial hypercholesterolemia caused by? What will you see in the blood?
LDL receptor defective. High cholesterol, high LDL , high VDL Substernal tightness - 10 minutes Xanthoma, rings around cornea Elevated cholesterol in family Given statins Artherosclerosis Most homozygous die.
61
If a patient has high cholesterol, what sorta drugs will you give them?
Statins
62
What are the benefits of high HDL?
Antioxidant Reverse cholderserol transport Reduced risk for CAD
63
A pt presents with substernal tightness that lasted for 10 minutes. Multiple xanthomas, rings around cornea and family history of elevated cholesterol. Diagnosis? Drug?
Type 2 Familial Hypercholesteronemia | Statins
64
A young pt comes in, you put his plasma in the fridge overnight. Next morning is a thick creamy layer. Diagnosis? What is the MOA
Type 1 Hypercholemia. | MOA: Deficient ApoC
65
How can aspirin aid nicotinic acid's (niacin) side effects? | MOA of Niacin?
Reduce cutaneous flushing | Antihyperlidemic agent. People think it involves PKA
66
What do we use niacin for? | What can niacin side effects be?
Hepatotoxicity if over 6 grams. Increases HDL Lowers LDL Cutaneous flushing
67
Insulin is a positive regulator of what?
Triglyceride Syntehsis in adipocytes
68
Where can adipocytes get glucose? | What does glucose become?
Glycolysis DHAP --> Glycerol 3 P add Fatty acyl CoA to make TG
69
In what organ are there multiple paths to DHAP? What are these paths? Why can this organ do multiple?
Liver. Glycolysis and Glycerol Kinase Contains Glycerol Kinase
70
What is the 7TM receptor?
Beginning of GPCR complex
71
What is the GPCR complex pathway?
Hormone hits 7TM receptor --> ATP --> cAMP --> PKA --> Triacylglycerol lipase
72
What is carnitine's role in metabolism? | What is it's biochemical role?
Best for long term exercise Transfers carnitine into mitochondria

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