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AU14 Pharmacology > Exam 3; Agents that Affect the Clotting System > Flashcards

Exam 3; Agents that Affect the Clotting System Flashcards

1
Q

The initial activation of platelets leads to what

A

platelet plugs

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2
Q

When ADP binds to the platelets, they activated what

A

glycoprotein receptors

GPIIb and GPIIIa

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3
Q

This binds to GPIIb and GPIIIa and leads to platelet aggregation

A

fibrinogen

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4
Q

This inhibits platelet aggregation

A

cAMP

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5
Q

The clot consist primarily of what

A

fibrin

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6
Q

All of the clotting factors are circulating proteins, and when activated become what

A

proteolytic enzymes

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7
Q

What does Xa stimulate

A

prothrombin to thrombin (IIa)

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8
Q

What two things does thrombin stimulate

A

fibrinogen to fibrin

activates platelets, factors VII, VIII, XIII

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9
Q

What is the purpose of fibrinogen

A

cross-linkning platelets

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10
Q

What is the purpose of fibrin

A

to form the clot

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11
Q

What does XIII to XIIIa assist in

A

stabilizing the clot

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12
Q

Which factors require Ca to work

A 
XI to XIa
X to Xa
prothrombin to thrombin
fibrinogen to fibrin
XIII to XIIIa
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13
Q

What are the steps to reverse clot formation

A

plasminogen → plasmin → clot lysis

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14
Q

What is the step to localize clotting

A

antithrombin III → causes inactivation of thrombin, factors IX, X, XI, XII

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15
Q

This is a genetic disorder that causes inadequate clotting

A

hemophilia

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16
Q

Which is more common, too little clotting or too much clotting

A

too much clotting

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17
Q

This is a clot that adheres to a blood vessel wall

A

thrombus

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18
Q

What is it when there is a thrombus in the arteries

A

white thrombi

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19
Q

What is a white thrombi associated with

A

atherosclerotic plaques

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20
Q

What is it when there is a thrombus in the veins

A

red thrombi

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21
Q

What is a red thrombi associated with

A

pooling of blood in the extremities

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22
Q

This is when a thrombus breaks off and travels through the blood stream; it will stop one it can no longer fit through the vessels clogging it

A

thromboembolus

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23
Q

In which four conditions are anti-coagulates are used

A

thromboembolic disease
after most kinds of surgery
during transfusions
in patients with heart disease

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24
Q

What are the three calcium chelators anti-coagulates

A

Citric acid
EDTA
EGTA

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25
Why do you generally not give people calcium chelators
due to Ca being widespread-ly used in the body; unless hypercalcemia
26
This anti-coagulate is not synthetic and is purified from animal tissues with a strong negative charge
heparin
27
What is the mechanism behind heparin
binds to anti-thrombin, a protease inhibitor
28
At low doses, what does heparin do
inhibits Xa | thus decreasing the formation of thrombin
29
At high doses, what does heparin do
inhibits thrombin, IXa, IXa, and XIIa
30
After thrombin is inactivated, heparin does what
is released and moves on to catalyze another reaction
31
True or False | Heparin is able to lyse existing clots
False; it is not
32
Heparin must be given by which method
Injection; usually subQ
33
Why can heparin not be given orally
It is such a large molecule that is will not be absorbed by the gut
34
True or False | Heparin easily passes the placenta and can cause major damage to the fetus
False; it cannot pass the placenta
35
What is the half life of heparin
1 hour; immediate onset
36
What degrades heparin
Heparinase
37
What is the dose response of heparin
It is somewhat unpredictable because it can bind to a variety of proteins
38
What is the toxicity level of heparin
Relatively non-toxic | Major toxicity is bleeding
39
What can be used to treat an overdose of heparin
Strongly positive protnine sulfate
40
What three things can result from long term use of heparin
Osteoporosis; due to lack of osteoclasts Thrombocytopenia; loss of platelets Hypersensitivity; because it is an animal product
41
What are two low molecular weight heparins
Enoxaparin | Dalteparin
42
What is the half live of enoxaparin and dalteparin
4 hours; longer than heparin
43
Which molecule does enoxaparin and dalteparin have more of an effect on, Xa or thrombin?
Xa
44
What are some differences between enoxaparin/dalteparin and heparin
less osteoproosis and HIT more predictable dose response more expensive not readily reversed by protiminie sulfate
45
What is a side effect of enoxaparin and dalteparin
may cause spinal hematoma in patients who have had a spinal tap or spinal anesthesia
46
This is a purely synthetic heparin-like drug with a half life of 17hrs, given subQ
fondaparinux
47
What is the mechanism of fondaparinux
works only on factor Xa
48
The saliva of a leech contains this drug
hirudin; anticoagulate
49
What is the mechanism of hirudin
works by directly inhibiting thrombin
50
These are two synthetic analogs of hirudin
bivalirudin | desirudin
51
This is a peptide derived from hirudin
agratroban
52
When are the analogs of hirudin used
when the patient has heparin induced thrombocytopenia
53
What is the mechanism of warfarin
inhibition of the enzyme that allows vitamin K to be recycled K-oagulation
54
What is vitamin K essential for
synthesis of factors VII, IX, X, and pro-thrombin
55
What is warfarin metabolized by
P450 | can be affected by other drugs and grapefruit juice
56
What are three toxicities of warfarin
many drug interactions hemorrhage can pass the placenta (cat. X)
57
This is a pro-drug that is a direct thrombin inhibitor (enzyme inhibitors)
diabigatran
58
What are two factor Xa inhibitors (enzyme inhibitors)
rivaroxaban | apixaban
59
This is a thrombin receptor blocker
vorapaxar
60
In which type of patient do you need to be care administrating vorapaxar to
patients with a history of intracranial bleeding
61
What are four ADP inhibitors (inhibits ADP from binding to receptor)
ticlopidine clopidogrel prasugrel ticagrelor
62
This ADP inhibitor can cause neutropenia and agranulocytosis
ticlopidine
63
What is the main difference between all the ADP inhibitors
pharmacokinetics
64
These are three fibrinogen receptor inhibitors
abciximab tirofiban eptifibatide
65
The fibrinogen inhibitors prevent what
platelet aggregation
66
The fibrinogen inhibitors can cause what
thrombocytopenia
67
Which method are the fibrinogen inhibitors given
IV
68
This is a COX inhibitor which inhibits thromboxane synthesis via cyclooxyrgenase inhibitor (enzyme inhibitor)
aspirin
69
What are two phosphodiesterase inhibitors
cilostazol | dipyradiamole
70
What is the mechanism behind cilostazol and dipyradiamole
inhibits the enzyme that breaks down cAMP (phosphodiesterase)
71
This drug decreases platelet formation, maturation, and number; decreasing platelet count
anagrelide
72
What are three contradictions for oral anti-coagulants
anyone with a bleeding disorder severe hypertension after surgery in the eye, brain, or spinal cord
73
Why is anyone with a bleeding disorder, contraindicative of oral anti-coagulants
could have a hidden bleeding disorder; 25% of all deaths due to GI bleeding were because they didn't know it
74
Why is anyone with hypertension, contraindicative of oral anti-coagulants
small vessels are damaged and if you remove the clotting mechanism then you will "sprout leaks"
75
What are three agents that dissolve formed clots
streptokinase urokinase tissue plasminogen activator
76
What is the mechanism behind streptokinase, urokinase, and tissue plasminogen activator
converts plasminogen to plasmin
77
plasmin hydrolyzes fibrin and degrade what
fibrinogen and factors V and VII
78
When will you use the agents that dissolve formed clots
if someone ocomes into the hospital having a heart attack due to a clot; given IV
79
What is the mechanism behind hemostatic agents
inhibits plasminogen activation (enzyme inhibitor)
80
What are the two hemostatic agents
aminocaproic acid | tranexamic acid

AU14 Pharmacology (29 decks)

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