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PHARMACOLOGY 2 - HEMATOLOGIC LESSON 1 > Hematologic Lesson 1 > Flashcards

Hematologic Lesson 1 Flashcards

(94 cards)

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1
Q

Maintaining fluidity of the blood, repairing vascular injury, and
limiting blood loss

A

HEMOSTASIS

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2
Q

Breakdown of the hemostatic mechanism
could result to either ______ or _______

A

Excessive bleeding
or Thrombosis.

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3
Q

What are the common causes of dysregulated
hemostasis?

A
  1. Hereditary
  2. Acquired defects in the clotting
    mechanism
  3. Secondary effects of infection/cancer
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4
Q

What are the steps in Hemostasis?

A
  1. Vasoconstriction
  2. Primary hemostatic plug
  3. Secondary hemostasis
  4. Counter regulation
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5
Q

It is the site of injury due to local nueral response and release of endothelin from the endothelium

A

VASOCONSTRICTION

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6
Q

This is due to the platelet adhesion, activation, degranulation (ADP,TXA2) and recruitment of other platelets

A

PRIMARY HEMOSTATIC PLUG

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7
Q

It is the activation of coagulation cascade by tissue factor and phospholipid via extrinsic pathway

A

SECONDARY HEMOSTASIS

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8
Q

It is the fibrin formation (clot)

A

SECONDARY HEMOSTASIS

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9
Q

The tissue plasminogen activator (t-PA promotes fibrinolysis)

A

COUNTER REGULATION

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10
Q

It is the antithrombotic cascade (ATIII and others)

A

COUNTER REGULATION

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11
Q

It is involved in the formation of thrombi that serves a plug to the injured blood vessel, thus arrest bleeding and prevent blood loss

A

PRIMARY HEMOSTASIS

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12
Q

What are the stages of Primary Hemostasis?

A
  1. Platelet adhesion
  2. Platelet Activation
  3. Platelet Aggregation
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13
Q

Injury to the cell membrane exposes
collagen and von Willbrand factor

A

Platelet Adhesion

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14
Q

The platelet membrane receptors,
glycoprotein (GP) Ia receptor binds to
collagen (C) and GP Ib receptor binds to
von Willebrand factor (vWF) causes the
platelet to adhere into the wall

A

Platelet Adhesion

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15
Q

This event is followed by subsequent
activation of the platelets

A

Platelet Adhesion

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16
Q

Upon adhesion of the platelet to the
injured wall, activation follows along with
the synthesis and secretion of
vasoconstrictors and platelet-recruiting
and activating molecules

A

Platelet Activation

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17
Q

The degranulating platelet releases adenosine diphosphate (ADP), thromboxane A2 (TXA2), and serotonin (5-HT) which are aggregating
substances

A

Platelet Activation

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18
Q

It is synthesized
from arachidonic acid within platelets
and is a platelet activator and potent
vasoconstrictor.

A

Thromboxane A2 (TXA2)

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19
Q

A powerful inducer of platelet aggregation

A

Adenosine diphosphate (ADP)

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20
Q

It stimulates
aggregation and vasoconstriction

A

Serotin (5-HT)

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21
Q

Activation of platelets results in a
conformational change in what?

A

GP IIb/IIIa receptor

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22
Q

Fibrinogen cross-links to adjacent
platelets, resulting in aggregation and
formation of a platelet plug

A

Platelet Aggregation

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23
Q

It cross-links to adjacent
platelets, resulting in aggregation and
formation of a platelet plug

A

Fibrinogen

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24
Q

The coagulation system
cascade is activated, resulting in thrombin
generation and a fibrin clot, which
stabilizes the platelet plug

A

Platelet Aggregation

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25
The unstable primary platelet plug (thrombus) is stabilized through a cascade of events that converts fibrinogen into fibrin (stable) clot
Blood Coagulation Cascade
26
The exposure of TF on damaged endothelium or to blood that hasextravasated into tissue binds TF to factor VIIa
Initiation of Clotting
27
Clotting factor IXa together with VIIIa activates what?
X into Xa
28
Factor Xa along with factor Va catalyze what?
The conversion of prothrombin (factor II) to thrombin (factor IIa)
29
Thrombinm (Factor IIa) converts the _______
Soluble fibrinogen (Factor I)
30
Soluble fibrinogen (Factor I) converts into an __________
Insoluble fibrin (Factor Ia)
31
It further activates upstream clotting factors
THROMBIN
32
What are the primary factors resulting in amplification of thrombin generation.
Primary factors V, VIII, and XI
33
What are the clotting factors that inhibited by heparin?
Clotting factors; 1. IXa 2. Xa 3. IIa
34
What are the clotting factors that is inhibited by warfarin?
Factors; 1. VII 2. IX 3. X 4. II
35
It is attenuate blood clotting by proteolysis of cofactors Va and VIIIa
1. Protein C 2. Protein S
36
Drugs that inhibit blood coagulation.
Anticoagulants
37
These are substances that act on the secondary hemostatic stage or the blood coagulation cascade
Anticoagulants
38
What are the classes of anticoagulants
1. Endogenous anticoagulant 2. Indirect thrombin inhibitors 3. Warfarin and Coumarin Anticoagulants 4. Oral direcct factor Xa Inhibitors 5. Direct thrombin inhibitors
39
It is the Protein C and Protein S, Antithrombin III (ATIII)
Endogenous Anticoagulant
40
Unfractionated heparin (UFH) also known as what?
High Molecular Weight (HMW) heparin
41
Unfractionated heparin (UFH), also known as high-molecular-weight (HMW) heparin, low molecular-weight (LMW) heparin, and the synthetic pentasaccharide fondaparinux
Indirect thrombin inhibitors
42
From what class is these drugs belong? Rivaroxaban, Apixaban, and Edoxaban
Oral direct factor Xa inhibitors
43
From what class these drugs belong? Hirudin (leech protein), Bivalirudin, Argatroban, Lepirudin
Direct thrombin inhibitors
44
What causes proteolysis?
Protein C and Protein S
45
It inactivates clotting factors IIa, IXa, Xa, XIa, and XIIa
Antithrombin (AT)
46
Heparin binds to ________ and enhance its inactivation of factor _____ Xa
Antithrombin; Xa
47
Acts like a catalyst that speeds up the interaction between AT and thrombin
Heparin
48
Heparin's activity as anticoagulant is dependent on what?
Antithrombin III
48
Heparin's activity as anticoagulant is dependent on what?
Antithrombin III
49
It inhibits clotting factors thrombin (IIa), IXa, and Xa, by forming equimolar stable complexes with them
Antithrombin
50
In the absence of heparin, these reactions are ______; but in the presence of heparin, these reactions are accelerated by _______
Slow; 1000-fold
51
The accelerating effect of heparin is due to the unique _________ that has high binding affinity to antithrombin
Pentasaccharide sequence
52
It is work by interfering the synthesis of Vitamin K-dependent clotting factors (II, VII, IX, X)
Coumarin anticoagulants
53
It is directly inhibit factor Xa, thus preventing the cascade to proceed
1. Rivaroxaban 2. Apixaban 3. Edoxaban
54
It exert their anticoagulant effect by directly binding to the active site of thrombin, thereby inhibiting thrombin’s downstream effects
Direct thrombin inhibitors (DTIs)
55
_______ and ______ bind at the catalytic or active site of thrombin as well as at a substrate recognition site.
Hirudin; bivalirudin
56
_____ and ______(small molecules) bind only at the thrombin active site
Argatroban; melagatran
57
What are he indications of Heparin?
1. Prevent post-op. deep vein thrombosis 2. Pulmonary embolism
58
What are the undesirable effects of heparin?
1. Bleeding 2. Hemorrhage 3. Thrombocytopenia 4. Hematoma
59
What are the reversal of action in heparin?
1. For excessive anticoagulaion-discontinuation of the drug 2. If bleeding occurs- IV administation of specific antagonist, Protamine sulfate
60
What is the below normal values/level?
Increases risk of thrombosis
61
What is the above normal values/level?
Serious bleeding risk increases
62
What is the toxicity and miscellaneous effects of heparin?
Bleeding
63
What are the toxicity and miscellaneous effects of heparin?
Should be used with caution in hypersensitive patients
64
What are the toxicity and miscellaneous effects of heparin?
Increased hair loss and reversible alopecia
64
What are the toxicity and miscellaneous effects of heparin?
Osteoporosis - long-term therapy
65
What are the toxicity and miscellaneous effects of heparin?
accelerates the clearing of postprandial lipemia by causing the release of lipoprotein lipase from tissues
66
What are the toxicity and miscellaneous effects of heparin?
Long-term use is associated with mineralocorticoid deficiency
67
A systemic hypercoagulable state that occurs in 1–4% of individuals treated with UFH
Heparin-Induced Thrombocytopenia (HIT)
68
Could lead to increase risk of thrombosis (e.g.,venous thrombosis) and skin necrosis in individuals treated with warfarin
Heparin-Induced Thrombocytopenia (HIT)
69
Patients who develop HIT are treated by what?
1. Discontinuance of heparin 2. Administration of the direct thrombin inhibitor. Argatroban
70
What are the contraindications of Heparin?
1. HIT 2. Hypersensitivity to the drug 3. Active bleeding 4. Hemophilia 5. Significant thrombocytopenia
71
What are the contraindications of Heparin?
1. Purpura 2. Severe hypertension 3. Intracranial hemorrhage 4. Infective endocarditis 5. Active tuberculosis
72
What are the contraindications of Heparin?
1. Ulcerative lesions of the gastrointestinal tract 2. Threatened abortion 3. Visceral carcinoma 4. Advanced hepatic or renal disease
73
What are the two containdications that will not likely lead to bleeding?
1. HIT 2. Hypersensitivity
74
Should be avoided in patients who have
1. Brain surgery 2. Spinal cord surgery 3. Eye surgery 4. undergoing lumbar puncture 5. Regional anesthetic block
75
Should be used in patients whoa are
1. Pregnant
76
What are the indications under warfarin (Coumadin)?
1. Deep venous thrombosis 2. Ischemic heart disease 3. RHD 4. Pulmonary embolism
77
What are the undesirable effects of warfarin?
1. Bleeding 2. Hemorrhage 3. Necrosis 4. GI upset
78
What is the contraindication of warfarin?
Do not administer to pregnant women since it can cause a hemorrahgic disorder in the fetus (teratogenic)
79
What are the reversal of action in warfarin for excessive anticoagulant effect and bleeding?
1. Stopping the drug 2. Oral or Parenteral vitamin K1 (phytonadione) 3. Fresh-frozen plasma 4. Prothrombin complex concentrates 5. Recombinant factors VIIa (rFVIIa)
80
What is the term in therapeutic range for oral anticoagulant therapy?
International normalize ratio (INR)
81
INR is the ______
Prothrombin time ratio
82
ISI exponent refers to what?
International Sensitivity Index
83
It is a narrow therapeutic index drug
84
It is a narrow therapeutic index drug
Warfarin
85
INR Below 2.0
Increases risk of thrombosis
86
INR above 4.0 1
Serious bleeding risk increases
87
What are the Pharmacokinetic effects of warfarin?
1. Enzyme induction 2. Enzyme inhibition 3. Reduced plasma protein binding
88
What are the Pharmacodynamic effects of warfarin?
1. Synergism 2. Competitive antagonism 3. Altered physiologic control loop for vitamin K
89
Given as fixed doses and do not require monitoring
ORAL DIRECT FACTOR Xa INHIBITORS
90
Have a rapid onset of action and shorter half-lives than warfarin
ORAL DIRECT FACTOR Xa INHIBITORS
90
Drugs that prevent platelet aggregation, thus are also referred to as antiplatelets.
Antithrombotics
91
What are the classes under antiplatelet drugs?
1. GP IIb/IIIa receptor antagonist 2. ADP receptor antagonist 3. TXA2 (COX) inhibitor 4. PDE/adenosine uptake inhibitor

PHARMACOLOGY 2 - HEMATOLOGIC LESSON 1 (2 decks)

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