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Pharm 2 > II. Anticoagulants > Flashcards

II. Anticoagulants Flashcards

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1
Q

What are the steps of primary hemostasis?

A
  1. Injury
  2. Platelet adhesion
  3. Shape change
  4. Granulosis Release (ADP, TXA2)
  5. Recruitment of more platelets
  6. Formation of hemostatic plug
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2
Q

After injury occurs, the ____ response initiates within seconds.

A

vasoconstriction

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3
Q

What does the vasoconstriction response expose?

A

von Willebrand Factor (vWF)

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4
Q

once platelets activate, they adhere to the endothelium via ____ and ____.

A

collagen, vWF

Doesn’t bind unless you have the vasoconstriction injury response that exposes the von Willebrand’s factor

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5
Q

.vWF binds to platelets, which in turn bind to other platelets via ____, ultimately forming a ____.

A

Fibrinogen, platelet plug

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6
Q

____ is an integrin complex found on platelets thats acts as a transmembrane receptor for fibrinogen & vWF, thus aiding in platelet activation.

A

Glycoprotein IIb/IIIa

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7
Q

What forms a “chain-linkage” connecting platelets to one another (i.e., forming the platelet plug) during secondary hemostasis?

A

Fibrinogen

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8
Q

what is another name for Secondary Hemostasis

A

Coagulation cascade

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9
Q

Which neurotransmitter aids in the immediate vasoconstrictive process after injury occurs?

A

Serotonin

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10
Q

The fundamental reaction of blood clotting is the formation of a ____.

A

fibrin clot

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11
Q

____ (IIa) is a powerful platelet activator, and without there is no clot.

A

Thrombin IIa

Thrombin is the facilitator of the clot

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12
Q

____ is converted to thrombin (IIa).

A

Prothrombin (II)

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13
Q

Secondary hemostasis involves two pathways:

A
  1. Extrinsic or Tissue Factor
  2. Intrinsic
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14
Q

What is the role of the extrinsic pathway?

A

to generate a rapid rise in thrombin (IIa) via FVII-TF complex

Thrombin IIa is responsible for converting fibrinogen into fibrin clot

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15
Q

What is the coagulation test for the extrinsic pathway?

A

PT (Prothrombin Time)

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16
Q

What is the role of the Intrinsic pathway?

A

Factors IX, XI, XII lead to rise in Xa, which leads to increase in Thrombin (IIa)

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17
Q

what is the coagulation test for the intrinsic pathway?

A

PTT (Partial Thromboplastin Time)

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18
Q

What cofactors are required for secondary hemostsis?

A
  1. Calcium
  2. Phsopholipid
  3. Platelets - B12 & Folate
  4. Vitamin K - Factors II, VII, IX, X are K-dependent
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19
Q

Prothromin is Factor ____.

A

Factor II

Without Prothrombin, you don’t have Thrombin (IIa), and without Thrombin, you don’t clot

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20
Q

Fibrinolysis refers to:

A

breakdown of clot

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21
Q

What is the main enzyme responsible for the breakdown of fibrin clot?

A

Plasmin

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22
Q

What is given IOT form plasmin so that it may break down the clown in a stroke case?

A

Tissue Plasminogen Activator (TPA)

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23
Q

Secondary Hemostasis Picture

A
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24
Q

Fibrinolysis Picture

A
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25
Platelet Plug Picture 1
26
Primary Hemostasis Picture
27
Heparin Specs Picture
28
Low Molecular Wight Heparin (LMWH) Specs Picture
29
Protamine Specs Picture
30
Warfarin Spec Picture
31
Xarelto (Rivaroxaban) Specs Picture
32
Eliquis (Apixaban) Specs Picture
33
Fondaparinux (Arixtra) Specs Picture
34
Dabigatran (Pradaxa) Specs Picture
35
Recombinant Factor VIIa Specs Picture
36
Aspirin (ASA) specs picture
37
Clopidogrel (Plavix) Specs Picture
38
Desmopressin (DDAVP) Specs Picture
39
Thrombolytic Agents Picture
40
Antifibrinolytics Picture
41
Prothrombin → Thrombin = Fibrinogen → Fibrin clot Picture
42
Coagulation Factors Picture
43
If patient doesn’t respond to Heparin, give ____ to replenish ATIII
FFP
44
What is the reversal for Heparin?
Protamine *Forms an ionic bond to heparin to form a stable salt lacking anticoagulant activity*
45
Protamine quick facts:
1. Heparin reversal 2. May cause HoTN, P. HTN, P. Edema, Allergic Rxn 3. Give slowly! (15-20 min) 4. Onset 5 min 5. DOA 20-30 min 6. Heparin Rebound 7. 1mg/100 U dose 8. 10 mg/mL
46
Heparin blocks ____ & ____, while LMWH only blocks ____.
Heparin: Thrombin, Xa LMWH: Xa
47
What is the ultimate effect of HITT syndrome (Heparin Induced Thrombocytopenia & Thrombosis)?
Immunogenic reaction causing platelet activation, aggregation and thrombosis. *more likely with Unfractionated Heparin*
48
LMHW = ____ Heparin
fractionated whereas Unfractionated has both HMWH & LMWH
49
The longer tail of HMWH (i.e. Unfractionated) allows it to bind:
thrombin
50
Factor VII is a part of what pathway?
Extrinsic
51
Factor II is part of what pathway?
Common Pathway (part of the intrinsic pathway)
52
Factors IX and X are a part of what pathway?
Intrinsic
53
Which vitamin K dependent coagulation factor has the shortest half-life and is the first to drop after starting Warfarin?
VII
54
A patient on Warfarin would use what lab test to monitor clotting time?
PT test
55
what is added to the centrifuged plasma to test clotting time for a PT test for Warfarin patient?
Tissue Factor
56
normal goal INR clotting time for patient on Warfarin?
2-3
57
T/F: Warfarin is teratogenic.
TRUE
58
Warfarin overdose (INR>10) without active bleeding, give____ to reverse. If there is active bleeding, give ____.
- Vitamin K (slow reversal) 10 mg PO or IV - FFP (fast reversal) 2-4 Units - Recombinant Factor VIIa - K Centra
59
What does Warfarin inhibit?
- Vitamin K formation (II, VII, IX, X) - Protein C - Protein S
60
____ is a medication used for the urgent reversal of anticoagulation in adults with life-threatening bleeding or needing emergency surgery. It contains four clotting factors; what are they?
KCentra® II, VII, IX, X (and protein C & S)
61
____ is a medication used to promote blood clotting in individuals with certain bleeding disorders, such as hemophilia.
Recombinant Factor VIIa
62
Recombinant factor VIIa activates ____, and requires what factors for proper function?
X to Xa V, X, II (prothrombin)
63
dose of Recombinant factor VIIa
20-40 mcg/kg 40-90 mcg/kg (emergencies)
64
Amicable (Aminocaproic Acid) inhibits the binding of ____ to fibrin and its activation to ____.
- plasminogen - plasmin
65
Amicar dose
Loading dose: 5g or 10g (1st hour) Maintenance: 1g/hour
66
TXA is ____x as potent as Amicar
10
67
TXA and Amicar both bind to the **lysine** receptor on ____, thus preventing clot breakdown.
Plasminogen or Plasmin
68
Proteins dose
1 mg/100 U Heparin
69
Does warfarin affect platelet function?
No

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