Antiplatelet Factors Secreted by ____ ? Promote ____? Inhibit _______ ?
Endothelial Cells Vasodilation Platelet adhesion and aggregation
Prostacyclin PGI2 Signal with _____ Opposes the effects of _____?
Nitric Oxide signals with_____?
What are the 4 antithrombotic activities?
- Heparan sulfate anchors Antithrombin III (ATIII) - ATIII inactivates Xa, IXa, XIa, and XIIIa - Tissue factor pathway inhibitor (TFPI) - Thrombin-thrombomodulin complex activates protein C (C) + Protein C and protein S cleave Va, VIIIa and activate t-PA
Antithrombin III Looks like _____? Is a ______ of serine proteases including these 5 clotting factors
Inactive clotting factors - It is a suicide substrate Thrombin, IX, X, XI, XII
Antithrombin is clinically activated by ____ what medicine?
Heparin - Indirect
Tissue factor pathway inhibitor does what?
Blocks Tissue factor which blocks the whole pathway
What protein complex inactivates the inhibitor of t-PA
What does t-PA do? What is the end result?
Turns Plasminogen into plasmin Result is digestion of fibrin clot
Only one type of heparin can inhibit II
Thrombomodulin----> _____------>_______ ----->______? Activates _____ ---- _____? This is called?
Thrombin APC/PS complex t-PA Plasminogen ----> Plasmin Fibrinolysis
t-PA can be activated by both _____ and _____
Protein C/S complex and fibrin
What are the Antiplatelet drugs
- Aspirin - Clopidogrel -Dipyridamole (increases cAMP, and cGMP) -Abciximab, eptifibatide, tirofiban GPIIb,a blockage
What are the anticoagulant drugs?
Heparins DTIs Warfarin Factor Xa inhibitors
Unfractionated heparin works against?
Factor X and factor II Can cause HIT
Pentasaccharide, and low molecular weight heparindont act on? What is the reeason for this?
Factor II thrombin reduce the risk of HIT Indirect through antithrombin III
Warfarin Induces ____ deficiency?
Vitamin K deficiency
What is the target of warfarin?
Warfarin has delayed _____ and ______
Onset and off set, Teratogenic
What are the two tests that need to be done when a patient is on Warfarin? When do these tests need to be done?
Prothrombin Time ( Before and after taking) International Normalized Ratio - Pt is converted into this through division
Activated partial thromboplastin time deals with what meds?
Heparin, also helpful in diagnosis of hemophilia
If someone takes too much warfarin what do you do?
Apixaban is a ______
Direct factor Xa inhibitors
Rudins are? Monitored by?
Direct thrombin inhibitors Monitored by aPTT same as Heparin
Plase drugs do what?
Activate plasminogen to plasmin
What are the adverse effects of Recombinant tissue-plasminogen activators?
Cardiac Arrythmias Intracranial, GI bleeding Cholesterol Embolization
What are the contraindications for Fibrinolytic therapy?
-Prior intracranial hemorrhage - Known structural cerebral vascular lesion - Known malignant intracranial neoplasm - Ischemic stroke within 3 months -Active bleeding or bleeding diathesis - Closed head trauma or facial trauma within
Heparin is reversed by?
Inhibits reuptake of adenosine and inhibits phosphodiester that degrades cAMP
Direct oral Factor Xa inhibitors?
xabans A fib - Cant be reversed
Drugs that activate tissue plasminogen to create plasmin Given soon after event