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Coagulation > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

What is the goal of primary hemostasis

A

the formation of a platelet plug

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2
Q

List out the steps of primary hemostasis

A
  • vascular damage occurs
  • vasoconstriction
  • platelets activate
  • platelets adhere to injury
  • platelets secrete granule content
  • platelets aggregate
  • platelet plug is formed
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3
Q

What is the goal of secondary hemostasis

A

to form a stable fibrin clot

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4
Q

List out the steps of how secondary hemostasis occurs

A
  • proteins are in blood as inactive zymogens
  • a complex forms that activates the zymogens
  • coagulation cascade occurs
  • thrombin is produced
  • thrombin converts fibrinogen into fibrin
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5
Q

What is the final stage of hemostasis?

A

fibrinolysis- the digestion and removal of fibrin clot

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6
Q

How do endothelial cells that line the inner surface of blood vessels influence in coagulation?

A

They can secrete anticoagulant and procoagulant molecules that move the coagulation cascade along

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7
Q

What are the anticoagulant properties of intact vascular intima

A

prevents thrombosis by:
inhibiting platelet aggregation
preventing coag activation and propagation
enhancing fibrinolysis

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8
Q

What procoagulants can endothelial cells secrete

A 
VWF
P-selectin
exposure of collagen
PAI-1
TAF1
ADAMTS13
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9
Q

What anticoagulants can endothelial cells secrete

A 
nitrous oxide
PGI2
heparan
TFPI
Thrombomodulin
EPCR
TPA
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10
Q

What does prostacyclin do

A

inhibits platelets and is a vasodilator

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11
Q

What does nitric oxide do?

A

inhibits platelet activation, promotes angiogenesis

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12
Q

What does TFPI stand for and what does it do?

A

Tissue factor pathway inhibitor

controls activation of extrinsic pathaway

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13
Q

What does thrombomodulin do?

A

EPCR binds protein C–> thrombomodulin catalyzes activation of protein C pathway
Ends in thrombin inhibition

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14
Q

What does heparan sulfate do?

A

enhances activity of antithrombin

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15
Q

What is VWF? What does it do

A

it is secreted by endothelial cells, activated by thrombin,

the carpet on which platelets assemble

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16
Q

What do ICAMs, PECAMs and P selectin do?

A

they are adhesion molecules that promote platelet and leukocyte binding

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17
Q

What causes the coagulation system to activate? Extrinsic pathway

A

the exposure of Tissue factor which is right on the outside of the inner vessel lining.
TF needs to have contact with F VII

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18
Q

What do endothelial cells secrete to promote fibrinolysis?

A

TPA- tissue plasminogen activator
PAI-1- plasminogen activator inhibitor
TAFI-thrombin activatable fibrinolysis inhibitor

all preventing excessive plasmin generation

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19
Q

What molecule allows platelets to adhere

A

VWF- links platelets to collagen

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20
Q

What molecule allows platelets to aggregate

A

GP llb/lla receptors on platelets that are activated and allow fibrinogen, VWF and fibronectin to bind to platelets. Fibrinogen is the key player

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21
Q

What do platelets secrete out of their granules

A

procoagulants- V, VWF, VIII and fibrinogen

control proteins-Ca, ADP

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22
Q

What is the main ingredient for enzyme-cofactor- substrate complex to form

A

the platelet membrane must be activated, this is the foundation for secondary hemostasis

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23
Q

Where do coagulation factors come from? How many are there?

A

the liver, 16

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24
Q

What is a zymogen?

A

an inactive enzyme

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25
What are cofactors and what is their role
coagulation factors the help bind, stabilize and enhance activity of enzymes
26
What is the primary enzyme of the coagulation system
thrombin,
27
What is the substrate for the primary enzyme of the coag system
fibrinogen
28
What coagulation factor has the shortest half life? What is it?
VII- 6hr half life
29
What coagulation factor has the highest molecular weight
VWF-its really big
30
What coagulation factor if most concentrated in the blood?
I- fibrinogen
31
What coagulation factor if most concentrated in the blood?
I- fibrinogen
32
``` What is are the nicknames for coagulation factors I II III IV ```
I-fibrinogen II-prothrombin III-Tissue factor IV- ionic Ca
33
What are the nicknames for coagulation factors V VII VIII
V- five VII- seven VII- antihemophilic factor
34
``` What are the nicknames for coagulation factors IX X XI XII ```
IX-Christmas factor X-Stuart Prower factor XI-eleven XII-Hageman factor
35
``` What are the nicknames for coagulation factors pre-k HMWK XIII PF3 ```
pre-K fletcher factor-prekallikrein HMWK- Fitzgerald factor-high molecular weight kininogen XIII-fibrin stabilizing factor PF3- platelet factor 3
36
Which coagulation factors are serine proteases
``` II-prothrombin VII-seven IX-Christmas X-Stuart XI-11 XII-Hageman pre-k- pre kallikrein-fletcher 2+7=9, 10, 11, 12 prek ```
37
Which coagulation factor carries factor VIII and allows for platelet adhesion
VWF
38
What coagulation factors function as cofactors
``` III-TF V-5 VIII- antihemophilic factor HMWK- kininogen- Fitzgerald 3+5=8 HMWK ```
39
Which coagulation factor functions as a mineral
IV- ionic Ca
40
Which coagulation factor is a thrombin substrate, and polymerizes to create fibrin
fibrinogen
41
Which coagulation factor functions as transglutaminase and transamidase? enzymes
XIII- fibrin stabilizing factor
42
Which coagulation factor functions as an assembly molecule?
platelet factor 3
43
What do serine proteases do?
they are enzymes that act on a substrate by digesting the primary backbone, state as inactive zymogens
44
Which coagulation factors are vitamin K dependent?
II, VII, IX, X | 2+7=9, 10
45
Where is vitamin K found in a person's diet
green leafy vegetables | quinone, also produced by some bacteria
46
What is the function of vitamin K
catalyzes a change in the prothrombin group proteins
47
What is the prothrombin group
the group of vitamin K dependent coag factors
48
What regulatory proteins act on each of the members of the prothrombin group
II-C VII-S IX-Z X- none
49
How does vitamin K activate the factors in the prothrombin group
adds a carboxyl group enabling the factor to bind to ionic Ca (IV) The bound Ca allows vitamin K to add charged phospholipids to the coag factor coag complexes help continue coagulation cascade
50
What are the 3 coagulation complexes
Extrinsic intrinsic prothromninase
51
What are the components of the extrinsic tenase complex, what does it activate
TF, Ca, VIIa, phospholipid | IX and X
52
What are the components of the intrinsic tenase complex, what does it activate?
IXa, VIIIa, phospholipid, Ca | X
53
What are the components of prothrombinase, what do they activate?
Xa, Va, phospholipid, Ca | prothrombin
54
What does BK stand for
bradykinin
55
What lab test detects the absence of any of the factors in the intrinsic pathway
aPTT or PTT
56
What lab test measures the extrinsic pathway function?
PT
57
What are the procoagulants involved in the coag cascade
V- VWF VIII Fribrinogen
58
What are the two phases of coagulation? how much thrombin do each of them produce
initiation- TF expressing cells- 3-5% of total thrombin- extrinsic propagation- on platelets, produces 95% or more of thrombin-intrinsic
59
What is the principal enzyme of fibrinolysis
plasmin- hydrolysis off fibrin
60
How is plasminogen converted to plasmin
TPA Tissue plasminogen activator TPA | UPA- urokinase plasminogen activator - less effective
61
Where does TPA come from? and UPA?
TPA-secreted by endothelium | UPA-kidney cells
62
How is plasminogen inhibited?
PAI-1- inhibits TPA and UPA-plasminogen never turns to plasmin alpha 2- antiplasmin- inhibits free plasmin TAFI- thrombin activatable fibrinolysis inhibitor- blocks TPA and plasminogen from binding
63
What do fibrin fragments do
XYDE | inhibit hemostasis, products of fibrin digestion
64
What are contact factors?
factors that are activated by contact with a negative charge to become activated
65
What are the contact factors
XIIa, HMWK, prek- activates factor XII
66
How does thrombin activate fibrinogen
thrombin cleaves fibrinopeptides, and A and B from alpha and beta chains
67
Which procoagulant is the most concentrated
fibrinogen
68
What are the pediatric developmental stages
neonatal- first 4 weeks infancy first year childhood 1 to puberty
69
How are infants categorized by weight
large more than 4000 small 2500 or less very low 1500 or less extremely low 1000 or less
70
Who are more at risk of thrombosis
babies- No elderly - yes pregnancy -yes very
71
Difference between white clot and red
White-platelets and VWF | Red- after coag- stabilized clot
72
What triggers the eicosanoid synthesis pathway
G proteins
73
What is the purpose of the eicosanoid synthesis process
To activate platelets
74
The ___ Camp you have the __ platelet activation
less camp | more platelet activation
75
where does arachadonic acid come from
phospholipids
76
Why is arachadonic acid important
inflammation and vasodialation
77
What affects the zone of inhibition and susceptibility breakpoints
the thickness of agar too thick-falsely small zones (false resistance) too thin-falsely large zones (false susceptibility)
78
What is the purpose of placing plates with KB upside down
to avoid condensation interfering with results
79
What is the maximum of antibiotic disks per mueller hinton plate
12 for every 150 mm plate
80
What temperature can Kirby Bauer Disks be stored and for how long
2-8C for 1 week | needs to be at room temp before use
81
What does the MecA gene cause resistance for
codes for penicillinases- penicillin binding protein PBP2a | causes resistance to penicillin, methicillin, nafcillin, cloxacillin, dicloxacillin
82
What are MRSA and what are the resistant to
oxacillin resistant Staph aureus
83
What special properties do oxacillin disks have
modified mueller hinton plate with oxacillin with McFarland suspension
84
What resistance does the erm gene cause
encodes for methylation 23S RNA causes resistance to erythromycin induces clindamycin
85
What resistance does the msrA gene cause?
encodes for efflux mechanism that gives resistance to erythromycin susceptible to clindamycin
86
What is the D test for
to see if there is resistance to both erythromycin and clindamycin
87
What does it mean if the clindamycin zone is flattened in a D test
erm gene present | resistance to clindamycin
88
What does it mean if a D test is not flattened and there is resistance in the erythromycin only
msrA gene present | not resistant to clindamycin
89
What is the MHT modified Hodge Test for?
looks for carbapenemase enzyme in enterobacteriaceae gives them ability to neutralize beta lactam carbapenems if test is positive, resistant to all carbapenems clover shape

Coagulation (7 decks)

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