Term
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Definition
| Cessation of blood loss from a damaged vessel |
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Term
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Definition
| pathological formation of a hemostatic plug |
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Term
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Definition
| a blood clot that forms in a vessel and stays there |
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Term
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Definition
| all or part of a thrombus that has become dislodged and moved to a distant site |
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Term
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Definition
| Normal proccess that prevents blood coagulation from excessive growth |
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Term
| Platelet reactions release what factors to stimulate blood coagulation |
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Definition
| ADP, thromboxane A2, serotonin, Ca, and platelet factors |
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Term
| The extrinsic pathway of coagulation begins how? |
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Definition
| the release of tissue factor, VIIa, and Ca. |
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Term
| The intrinsic pathway of blood coagulation begins how? |
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Definition
| With the activation of pro-enzymes XII or XI with thrombin (or glass). |
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Term
| What type of enzyme is anti-thrombin and what does it do? |
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Definition
| It is a serine protease suicide inhibitor of thrombin (IIa), IXa, and Xa. It degrades the clot. |
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Term
| What role does Vit K play in coagulation? |
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Definition
| It is required in its hydroquinone form for the gamma glutyml carboxylase to activate coagulation factors |
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Term
| Name 3 indirect thrombin inhibitors |
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Definition
| UFH, LMWH, and fondaparinux |
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Term
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Definition
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Term
| Name 5 direct thrombin inhibitors |
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Definition
The -rudin's
Hirudin, Lepirudin, and Bivalrudin and argatroban/dabigatran (pradaxa) |
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Term
| What kind of molecule is heparin and where is it found in the body? |
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Definition
| it is a sulfated mucopolysaccharide that is usually found in the granules of basophils and mast cells. |
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Term
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Definition
| binds to anti-thrombin catalyzes the interaction w/ thrombin (IIA), IXa, and Xa. |
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Term
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Definition
| Binds to antithrombin and catalyzes interaction w/ factor Xa. |
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Term
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Definition
| treatment of venous thrombosis, pulmonary embolism, thrmobosis w/ prosthetic heart valves, a fib pts, and MI w/ unstable angina |
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Term
| How do you administer heparin? |
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Definition
| IV, IM, or subQ (for maintenance doses) |
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Term
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Definition
bleeding #1
allergies due ot animal preparation
Osteoporosis (long term use)
Heparin induced thrombocytopenia - rare caused by Ab's to heparin and factor IV 2-14 days after treatment. |
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Term
| What do you administer in case of Heparin toxicity/overdose? |
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Definition
| protamine. in accordance w/ the dose initially given. |
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Term
MOA for Rivaroxaban
toxic effects?
Uses? |
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Definition
Xa inhibitor
Bleeding, Neuraxial anesthesia, Category C.
DVTs following hip/knee surgery |
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Term
| What class of drugs are Lepirudin and Bivalirudin? |
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Definition
| direct thrombin inhibitors that are bivalent |
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Term
| What kind of drug is Argatroban and dabigatran etexilate? |
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Definition
monovalent direct thrombin inhibitor
dabigatran etexilate is pradaxa |
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Term
| MOA of bivalent and monovalent direct thrombin inhibitors |
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Definition
bivalent: binds substrate recognition and catalytic site of thrombin
Monovalent: only bind the catalytic site |
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Term
| What are the clinical uses for direct thrombin inhibitors? |
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Definition
| used for heparin induced thrombocytopenia (HIT) or pradaxa dabigatran is used to prevent emboli in atrial flutter |
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Term
| Route of elimination for pradaxa? |
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Definition
| dabigatran is renally excreted |
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Term
| Side effects of dabigatran? |
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Definition
| bleeding and GI symptoms. |
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Term
| warfarin (coumadin) pharmacokinetics? |
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Definition
| 100% bioavailability but 99% protein bound. initial affects 12 hours delayed w/ full affects after 8 days. |
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Term
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Definition
| blocks carboxylation (activation of) VII, IX, and X via blocking reductiono f Vit K. |
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Term
| What would you give a pt w/ warfarin toxicity? |
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Definition
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Term
| contraindications for anticoagulation therapy? 6 things |
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Definition
active bleeding
Hemophilia
Liver disease
Thrombocytopenia
hx of HIT
Pregnancy |
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Term
Name 3 endogenous plasminogen activators
Name 3 plasminogen activating drugs |
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Definition
tPA, Urokinase type plasminogen activator, kallikrein, neutrophil elastase
Reteplase, Teneteplase, and altaplase |
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Term
| name 3 fibrinolytic agents |
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Definition
The -plase's + streptokinase
streptokinase, alteplase, reteplase, and teneteplase alteplase, reteplase, and teneteplase are tPA's. |
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Term
|
Definition
| activates plasminogen (fibrin bound and non fibrin bound) to plasmin in all fibrin. |
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Term
| MOA for alteplase, reteplase, and teneteplase |
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Definition
| binds to and activates fibri-bound plasminogen and not circulating plasminogen that isn't bound to fibrin |
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Term
| clinical uses of fibrinolytics? |
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Definition
| PE, DVTs, ischemic strokes (tPAs preferred), acute MI |
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Term
| name a few contraindications for thrombolytic therapy |
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Definition
| recent surgery, hx serious GI bleeding, malignant htn, CVA w/in 3 months, aortic dissection, acute pericarditis |
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Term
name a fibrinolytic inhibitor
MOA? |
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Definition
Tranexamic Acid and aminocaproic acid
completively binds and inhibits plasminogen |
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Term
release of ADP from damaged endothelium results in what?
Intracellular signal? |
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Definition
| ADP binds to P2Y12 receptor on platelets that is Gi coupled. Lowers intraplatelet cAMP and increases Ca causing activation and expression of GPIIb/IIIa receptors --> platelet aggregation |
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Term
| What effects does the local release of TxA2 by the endothelium have? |
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Definition
| stimulates thromboxane receptor to increase intracellular Ca activating GPIIb/IIIa receptors |
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Term
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Definition
| Irreversibly inhibits COX-1 that produces the TxA2 |
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Term
| Name 2 ADP antagonists? MOA Give 2 examples of these drugs When to use them? |
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Definition
| inhibit the P2Y12 receptor (Gi coupled) for ADP Clopidogrel (plavix) Prasugrel (Effient) clopidogrel - w/ aspirin to prevent stroke/MI in pts w/ history Prasugrel - reduce risk of MI after angioplasty. Do not use if pt has hx of stroke |
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Term
| SE of ADP antagonists clopidogrel and Prasugrel? |
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Definition
| thrombotic thrombocytopenia purpura |
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Term
| Name 3 GPIIb/IIIa inhibitors |
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Definition
Abciximab
Eptifibadine
Tirofiban |
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Term
| How do you treat inherted bleeding disorders? |
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Definition
| transfusion w/ fresh plasma |
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Term
| What digestive disorders can produce bleeding problems? |
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Definition
| sprue, celiac, steatorrhea, lack of bile (Vit K fat soluble) |
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