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Hemodynamics II Flashcards

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1
Q

What are the three general components that contribute to hemostasis?

A
  1. Endothelium/vascular wall
  2. Platelets
  3. Coagulation cascade
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2
Q

What are the “bricks” of the clotting system?

A

Platelets

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3
Q

What is the “cement” of hemostasis?

A

Coagulation cascade and fibrin

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4
Q

What is the very first thing to happen in an initial injury?

A

Vasoconstriction

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5
Q

What happens in the hemostasis after the initial vasoconstriction?

A

Endothelial damage exposes subendothelium causing platelets to become activated and adhere

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6
Q

What is the cytokine that activates the coagulation cascade?

A

Tissue factor (factor III)

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7
Q

What happens after tissue factor is released?

A

Platelets activation further coagulates

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8
Q

What are the two main components of a clot?

A

Platelets and fibrin

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9
Q

What is the function of vWF?

A

Causes platelets to adhere to the region of a clot

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10
Q

What does vWF bind to?

A

Collagen IV

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11
Q

What is in alpha granules in clotting? What does this do?

A

TXA2, recruits more platelets

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12
Q

What are the two cytokines that endothelial cells release to keep the clot in check?

A

tPA

Thrombomodulin

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13
Q

What are the four things mentioned in lecture that are procoagulative?

A

Infectious agents
Hemodynamic forces
Cytokines
Plasma mediators

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14
Q

What are the two cytokines that endothelium releases that are anti thrombotic?

A

PGI2

NO

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15
Q

What is the enzyme that endothelium produces that prevents platelet aggregation? What does this do?

A

Adenosine diphosphatase which degrades ADP

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16
Q

What is heparin?

A

Polysaccharide that are cofactors to antithrombin

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17
Q

What is the function of thrombomodulin?

A

Converts thrombin to an anticoagulant

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18
Q

What is the function of vWF?

A

Firmly adhere platelets to the endothelium via GPIb

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19
Q

What is the substance that the endothelium secretes to inhibit tPA?

A

Plasminogen activator inhibitor

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20
Q

What causes the release of tissue factor?

A

Endotoxin, trauma, cytokines

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21
Q

What activates protein C, and what does it in turn inactivate?

A

Activated by protein S

Factors V and VIII

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22
Q

What activates protein C?

A

Thrombin/antithrombin complex

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23
Q

In general, under normal conditions, what do endothelial cells do?

A

Inhibit platelet adherence

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24
Q

What produces platelets?

A

Megakaryocytes

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25
What exactly are platelets?
Anuclear cell fragments
26
What are the contents of platelets?
Alpha granules and dense granules
27
What are the three steps that ensure to platelets after vWF binds to collagen IV?
Adhesion Secretion and activation Aggregation
28
Is the initial platelet adhesion to the ECM firm?
No
29
What does vWF bind on platelets?
Glycoprotein Ib receptors
30
Adhesion of platelets causes what?
Release of platelet granules
31
What ion is needed in the coagulation cascade?
Ca
32
What is the function of the ADP release by platelets?
Mediates platelet aggregation which drives increasing platelet aggregation at the site
33
What is the function of platelet factor 4 released by platlets?
Inactives heparin
34
What is the function of serotonin that platelets release?
Induces vasoconstriction
35
What is the function of ADP and TXA2 that platelets release?
Further stimulates platelet aggregation
36
What is the protein found on the surface of platelets that link fibrin together?
GpIIb-IIIa
37
Where does thrombin bind to?
Platelet surface
38
Platelet activation causes expression of what on the surface to bind coag factors? What do these do?
Phospholipid complexes, which act as surfaces to bind coagulation factors.
39
What are the three major platelet secretions that further activates platelets?
ADP TXA2 Thrombin
40
What is the end product of the coagulation cascade?
Fibrin
41
What are clotting factors?
Inactive enzymes (S proteases)
42
What is the ion needed for the assembly of the complex of coagulation factors?
Ca
43
What is serum?
Liquid part - clot factors
44
What is plasma?
Liquid + clotting factors
45
What is added to plasma to prevent clotting? How?
EDTA containing solution to get rid of Ca
46
What converts fibrinogen to fibrin?
Thrombin
47
What is the order of factor activation in the extrinsic pathway?
3, 7, 10
48
What is the order of factor activation in the intrinsic pathway?
12, 11, 9, 8, 10
49
What two factors make up the prothrombinase complex?
factor V and factor X
50
Where do both the intrinsic and extrinsic pathway converge?
Factors 9 and 10
51
What does prothrombin time (PT) measure?
The extrinsic arm
52
What does PTT measure?
Intrinsic arm
53
What is PT prolonged by? PTT?
``` PT = Warfarin PTT = Heparin ```
54
What happens in the clotting cascade is not kept in check?
Thrombus can form
55
What are the three main anticoagulants produced by the body?
Antithrombin III Protein C Plasmin
56
What is the function of antithrombin III? What is it potentiated by?
Inactivates serine proteases (factors 9, 10, 11, and 12) Potentiated by Heparin
57
What is the function of Protein C?
Inhibits V and VIII
58
What is the function of plasmin?
breaks down fibrin
59
What is the function of protein S?
Enhances protein C
60
What is thrombomodulin activated by? What does it do?
Thrombin Activates protein C
61
What is the function of thrombomoduin?
Binds to thrombin and alters its conformation
62
What is the function of tissue pathway factor inhibitor?
Inhibits III and VII (tissue factor = factor III, thus "tissue factor pathway inhibitor)
63
Free plasmin is inactivated by what?
Circulating alpha2 antiplasmin
64
tPA is inactivated by what?
plasminogen activator inhibitor (PAI)
65
What do endothelial cells secrete to balance coagulation/anticoagulation?
plasminogen activator inhibitor (PAI)
66
What are the three substances that can activate plasminogen?
Urokinase tPA Streptokinase
67
What activates antithrombin III? What does that inactivate?
Activated by heparin | Inactivates Factors 10 and 9
68
What prevents plasmin from circulating freely and dissolving clots?
alpha2-antiplasmin
69
What are anticoagulants?
Prevents clot formation and extension
70
What are antiplatelets?
Drugs that interfere with platelet activity
71
What are thrombolytic agents?
Dissolve existing thrombi
72
What are the two traditional anticoagulants?
Heparin and warfarin
73
What cells produce heparin?
Basophils and mast cells
74
Does heparin disintergrate clots that have already formed?
No
75
What are the two routes Heparin is given?
IV and SQ
76
How does heparin work? What are the three main clotting factors it inhibits?
Binds and activated antithrombin III Inhibits thrombin, factors 9 and 10
77
What is the MOA of coumadin?
Interfering with vitamin K metabolism
78
What are the vitamin K dependent factors? What drug interferes with their synthesis?
10, 9, 7, 2 (vitamin K was born in 1972) Coumadin
79
What is the MOA of dabigatran?
Direct thrombin inhibitor
80
What is the MOA of rivaroxaban and apixaban?
Inhibit factor X
81
What is the MOA of Tissue factor pathway inhibitor (TFPI)?
Inhibits factors 3 and 7
82
Hageman factor = what number?
12
83
What activates plasminogen activator inhibitor?
Thrombin | various cytokines
84
What cells produce tPA?
Endothelial cells
85
What is streptokinase?
A bacterial product used clinically to activated plasminogen

Pathology (32 decks)

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