Hemostasis Flashcards Preview

► Med Misc 44 > Hemostasis > Flashcards

Flashcards in Hemostasis Deck (99)
Loading flashcards...
1

what are the 3 parts to hemostasis?

  1. Primary hemostasis
  2. Secondary Hemostasis
  3. Anticoagulation

2

What is the main Factor in Hemostasis?

platelet

3

what is part 1 of hemostais and what if the main objective

Primary hemostasis

Platelet plug

4

what is part 2 of hemostasis and what if the main objective

Secondary Hemostasis

Fibrin production

5

what is part 3 of hemostasis and what if the main objective

 

Anticoagulation

break down clot

 

6

Steps in primary Hemostasis:

what are the 3 steps in primary hemostasis?

 

  1. Adhesion
  2. Activatiion
  3. Aggregation

 

ALL A's

 

7

Steps in primary Hemostasis:

How is Adhesion accomplished?

 

Adhesion of platelets to damaged vascular wall 

 

8

Steps in primary Hemostasis:

Adhesion of the platelets requires what hemostasis factor

 

vWF (VIII)

 

9

Steps in primary Hemostasis:

how is activation accomplished?

 

activation of platelets requires thrombin (factor IIa)

 

10

Steps in primary Hemostasis:

how is aggregation accomplished?

 

aggregation of platelets requires ADP and thromboxane A2

 

11

Steps in primary Hemostasis:

again the main ingrediant to all hemostasis is what?

 

the platelet

 

12

Steps in primary Hemostasis:

what is required  for adhesion

 

vWF

 

13

Steps in primary Hemostasis:

what is required for activation?

 

thrombin (IIa)

 

14

Steps in primary Hemostasis:

what is required for aggregation

 

 

ADP

Thromboxane A2

 

 

15

Adhesion of Platelets:

what is platelets life span

8-12 days

16

Adhesion of Platelets:

normal platelet count

150,000-400,000 cells/mL

17

Adhesion of Platelets:

Approx 33% of platelets are sequestered where?

Spleen

18

Adhesion of Platelets:

what factor Adheres platelets to the collogen layer of the subendothelium?

vWF

19

Adhesion of Platelets:

vWF is synthesized and reeased from where?

endothelial cells

20

Adhesion of Platelets:

the illistration show vWF anchoring platelets to the wall of a damaged blood vessel. 

this is the adhesion aspect of the primary hemostasis

 

21

Adhesion of Platelets:

Magnified look at how vWF anchors platelets

 

22

Adhesion Disorders:

what is the most common inherited coagulation defect

von Willebrands disease

23

Adhesion Disorders:

what is the 1st line treatment for von Willebrands disease

D-amino-D-arginine vasopressin (desmopressin, DDAVP)

24

Adhesion Disorders:

how does DDAVP work

causes release of endogenous stores of vWF

25

Adhesion Disorders:

what is the dose of DDAVP

0.3 mcg/kg IV over 10-20 min

26

Adhesion Disorders:

with DDAVP administration platelet adhesion is increased within how long

 

30 min

 

27

Adhesion Disorders:

DDAVP can cause what in type 2B von WIllebrands disease

thrombocytopenia

28

Adhesion Disorders:

vWF can be increased by giveing DDAVP as well as what other 2 drugs?

 

 

Cryoprecipitate

Purified factor VIII

29

Adhesion Disorders:

Cyo cantains what coag factors

I

VIII

XIII

(1,8,13)

 

30

Adhesion Disorders:

if a pt does not respond to DDAVP what should be given next

cryo

31

Adhesion Disorders:

again what are 3 treatments for von Willebrands disease

DDAVP

Cryo

Purified Factor VIII

32

What is the 2nd step of PRIMARY hemostasis?

Activation

33

Activation of Platelets:

what is the mechanism in which a platelet becomes activated?

Thrombin (IIa) combines w/ thrombin receptor on the platelet surface

a process ensues and the platelete changes shape and releases mediators

The main 2 mediators are Thromboxane A2 and ADP

(these will later promote aggregation)

34

Activation of Platelets:

what is the most important molecule in teh activation of platelets

Thrombin

35

Activation of Platelets:

what are the 2 mediators released from platelet activation

ADP

Thromboxane A2

36

Activation of Platelets:

what do Thromboxane A2 and ADP do?

uncover Fibrinagen (I) receptors (more secefic GPIIb/IIIa)

37

Activation of Platelets:

see the picture as a reference. Note the shape change and the release of mediators

 

38

Activation of Platelets:

what is the precurser to Thrombin?

prothrombin II

once activated becomes IIa Aka thrombin

39

what is the 3rd step  in primary hemostasis?

Aggregation of platelets

40

Aggregation of Platelets:

what is teh main molecule that is responsiable for aggregations platelets?

Fibrinogen (I)

41

Aggregation of Platelets:

___ and ____ uncover the fibrinogen recetors on the actvated platelets

 

TXA2

ADP

 

42

Aggregation of Platelets:

once the receptors are uncovered fibrinogen atteches to it's receptors and links platets to what?

other platelets

43

Aggregation of Platelets:

at this point when the fibrinogen is adhearing platelets to other platelets the developing clot in water soluble and firable and it is termed what 3 things

Platelet plug

white thrombus

white clot

44

Aggregation of Platelets:

check out the picture

 

45

Aggregation Disorders:

with aspirin the acetylation of platelet cyclooxygenase persist for how long?

 

the life of the platelet 8-12 days

 

46

Aggregation Disorders:

what is the rate limiting enzyme in the conversion of arachidonic acid to TXA2

cyclooxygenase (COX)

47

Aggregation Disorders:

without _____ platelete aggregation in impaired

TXA2 (thromboxane A2)

48

Aggregation Disorders:

NSAIDs such as ketorolac and ibuprofen produce the same effects as aspirin, but the depressin of Thromboxane A2 production by platlets if temporary. How long is it for

24-48 hours

49

Aggregation Disorders:

How does Clopidogrel (plavix) work to cause coagulation

anti ADP agent 

works the life of platelet

50

Aggregation Disorders:

what antiplatelet medication increases cAMP in platelets and thus prevents aggrigation?

Dipyridamole (persantine)

also is classified as a PDE-I inhibitor

51

Aggregation Disorders:

What receptors do Anti-fibrinogen receptor drugs work on

GPIIb/IIIa

52

Aggregation Disorders:

how do anti-fibrinogen receptor drugs work?

the "cap" and block the fibrinigen receptor, thus preventing fibrinogen from attaching and linking platelets together. 

53

Aggregation Disorders:

what are 3 anti-fibrinogen receptor drugs in use

  • Eptifibatide (integrilin)
  • Abciximab (ReoPro)
  • Tirofiban (aggrastat)

54

what is the second part of hemostasis? not primary hemostasis but hemostasis in general?

secondary hemostasis

55

What is the main goal of 2ndary hemostasis?

Production of fibrin

56

Secondary hemostasis:

fibrin production involves what?

all of the clotting factors

57

Secondary hemostasis:

name the cloting factors

  1. Fibrinogen
  2. prothrombin
  3. tissue factor
  4. calcium
  5. Proacceleration
  6. NONE
  7. proconvertin
  8. vWF & Antihemophiliac factor
  9. christmas factor
  10. stuart-prower factor
  11. Plasmin thromboplastin antecedent
  12. Hagamen factor
  13. Fibrin stabilizing factor

58

Secondary hemostasis:

what are the vit K dependent factors

2

7

9

10

C

S

59

Secondary hemostasis:

what is Factor I (fibrinogen) once activated (Ia) called

Fibrin

60

Secondary hemostasis:

After platelets aggregate ___ is woven into platelets and cross-linked. 

Fibrin

61

Secondary hemostasis:

the cross linked fibrin is _____ in water

Insoluble in water

62

Secondary hemostasis:

After platlets aggregate, fibrin is woven into platelets and cross linked, the crosslinked fibrin is insoluble in water. thus the fibrin clot is now stable. The clot is now called what 2 things

red thrombus

red clot

63

Secondary hemostasis:

cross linking of fibrin strands requires what factor

XIIIa

Fibrin stabilizing factor

64

Secondary hemostasis:

the final steps in fibrin prouction involve what pathways

Intrinsic

Extrinsic

Final common 

65

Secondary hemostasis:

heres a picture

 

66

Secondary hemostasis:

here is a colored picture

 

67

Secondary hemostasis:

what type of bond stabilizes the fibrin network

Covalent

68

Secondary hemostasis:

so we learned about cryo earlier now why is cryo an important drug for coagulation?

  • Factor (I) Fibrinogen (Ia) fibrin- causes crosslinking
  • VIII vWF- promotes platelet adhesion
  • XIII Fibrin stabilizing factor- forms covalent bond at cross-linked areas stabilizing the fibrin clot

69

Secondary hemostasis: Coagulation Cascade

what factors are in the extrinsic pathway?

III- Thromboplastin or tissue factor

VII- proconvertin

 

70

Secondary hemostasis: Coagulation Cascade

where does damage occur is the extrinsic pathway is activated

outside the cell

71

Secondary hemostasis: Coagulation Cascade

what factors are in the intrinsic pathway?

XII- hagamen

XI- Plasma thromboplastin

IX- christmas 

VIII- vWF

72

Secondary hemostasis: Coagulation Cascade

the ending factors in both the intrinsic and extrinsic pathways combine with what factor to go to factor 10 in the common fina pathway

IV calcium

73

Secondary hemostasis: Coagulation Cascade

what factors are in the final common pathway

X

V

II

I

XIII

74

Secondary hemostasis: Coagulation Cascade

what factors are Ca++ dependent factors

2,7,9,10

same as Vit K dependent factors

75

Secondary hemostasis: Coagulation Cascade

what drug works on the extrinsic pathway?

what labs monitor it? 

Coumadin

PT/INR

76

Secondary hemostasis: Coagulation Cascade

what drug works on the intrinsic pathway? what labs monitor it?

Heparin

PTT

ACT

77

Secondary hemostasis: Coagulation Cascade

my drawing of the pathway

 

78

Secondary hemostasis: Coagulation Cascade

what pathway does cryo mostly work on and why?

Common final pathway

b/c it has factors 1,8,13 and 1 and 13 are both in the final pathway

79

Secondary hemostasis: Coagulation Cascade

Valley's picture

 

80

Congenital Disorders of Coagulation:

hemophilia A affects what factor

VIII:C deficiency

81

Congenital Disorders of Coagulation:

treatment for Hemophilia A

FFP and Cryo (both have VIII

Factor VIII concentration

82

Congenital Disorders of Coagulation:

What factor deficiency causes hemphilia B

AKA Christmas disease

IX

83

Congenital Disorders of Coagulation:

treatment of Hemophilia B Christmas disease

Heat treated concentration of factor IX

84

Anticoagulation:

how does antithrombin work

Activated antithrombin binds to thrombin (IIa) and factor Xa greatly

By attaching to these clotting factors esp thrombin and Xa antithrombin effectivly removes them from circulation

thus anticoagulating blood

85

Anticoagulation:

what drug works by increasing the effectivness of antithrombin by 1,000 fold or more?

heparin

86

Anticoagulation:

besides IIa and Xa what other factors does antitrhombin work on

IX
XIa

XIIa

87

Anticoagulation:

Antithrombin is made in the liver and neutralizes the final pathway by what factors? and the intrinsic pathway by what factors?

Common IIa and Xa

Intrinsic XIIa,  XIa, and IX

88

Anticoagulation:

what is a required cofactor for heparin to work

antithrombin

89

Anticoagulation:

aquired anithrombin def states are found in what type of patients

cirrhosis of liver

Nephrotic syndrome

90

Anticoagulation:

what is the most common reason a pt is unresponsive to heparin

antithrombin def

91

Anticoagulation:

if someone is unresponsive to heparin what would u give them and why?

FFP

it comtains all coagulation and anticoagulation factors produced by the liver

92

Anticoagulation:

heparin block what pathway(s)

Intrinsic and common

93

Anticoagulation:

protamine reverses the effects of heparin how?

neutralization

94

Anticoagulation: fibrinolysis

what breaks down fibrin

Plasmin

95

Anticoagulation: fibrinolysis

what is converted into plasmin to break down fibrin

Plasminogen

96

Anticoagulation: fibrinolysis

after plasminogen is converted into plasmin and plasmin starts to breakdown fibrin, what are the fibrin degradation products refered to as

Fibrin split products

97

DIC:

what are the most common precipitating factors in the surgical pt

Shock

Ischemia

and infection

98

DIC:

what happens to lab values

Platelets

Fibrinogen

Prothrombin

Factors V, VIII, XIII

Fibrin split products

Platelets- decreased

Fibrinogen- decreased

Prothrombin- decreased

Factors V, VIII, XIII- decreased

Fibrin split products- Increased

99

Memory master pages

 

IA8a-e

IB13

Decks in ► Med Misc 44 Class (72):