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Coags Flashcards

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1
Q

What is the term for the formation of a thrombosis?

A

Thrombogenesis

Thrombogenesis is a way to stop bleeding by forming clots.

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2
Q

What are the two main categories of coagulation factors?

A
  • Pro-coagulants
  • Anti-coagulants

Pro-coagulants promote clot formation, while anti-coagulants prevent it.

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3
Q

What are the two types of anticoagulants mentioned?

A
  • Oral anticoagulants
  • Injectable anticoagulants

These categories refer to how anticoagulants are administered.

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4
Q

What do thrombolytics do?

A

Break down clots

Thrombolytics are used to dissolve existing clots.

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5
Q

What is the role of platelets in clotting?

A
  • Adhere to damaged tissue
  • Aggregate together
  • Release substances for activation

Platelets are crucial for the clotting process and help prevent excessive bleeding.

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6
Q

What is the difference between red and white clots?

A
  • Red clots: contain red blood cells, found in low flow areas (venous system)
  • White clots: contain mostly platelets, found in high flow areas (arteries)

The composition of clots varies based on their location in the circulatory system.

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7
Q

What is fibrinolysis?

A

The breakdown of clots

Fibrinolysis is essential to prevent embolisms after a clot has served its purpose.

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8
Q

What is the role of thrombin in the coagulation cascade?

A
  • Activates fibrinogen to fibrin
  • Stimulates platelet aggregation
  • Activates other clotting factors

Thrombin is a central component in the clotting process.

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9
Q

What activates the intrinsic pathway of coagulation?

A

Phospholipids which activate Arachidonic acids pathway - COX 2

The intrinsic pathway is activated by factors already present in the bloodstream.

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10
Q

What activates the extrinsic pathway of coagulation?

A

Tissue factor (3)

The extrinsic pathway is activated by external factors from damaged tissues.

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11
Q

What is the common pathway in coagulation?

A

Activation of thrombin

The common pathway is where intrinsic and extrinsic pathways converge to form fibrin.

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12
Q

What is the function of protein C in coagulation?

A

Inhibits clotting cascade

Activated protein C helps regulate clot formation by inhibiting factors 5 and 8 .

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13
Q

What is the role of anti-thrombin?

A

Blocks thrombin and factor 10

Anti-thrombin is crucial for controlling the clotting process.

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14
Q

True or false: NSAIDs are generally pro-coagulant.

A

TRUE

Most NSAIDs, except aspirin, can promote coagulation by blocking prostacyclin production.

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15
Q

What are the three primary substances released by platelets during degranulation?

A
  • Adenosine
  • Thromboxane A2
  • Serotonin

These substances play roles in activating additional platelets and promoting aggregation.

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16
Q

What is the function of fibrin in clotting?

A

Cross-links platelets to form a stable clot

Fibrin acts as the structural framework for the clot.

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17
Q

What is the first step in the platelet response to injury?

A

Adhesion to exposed connective tissue

Platelets adhere to collagen and von Willebrand factor at the site of injury.

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18
Q

What is the inactive form of factor 5 referred to as?

A

Lightened factor

This refers to the inactive state of factor 5 before it becomes active.

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19
Q

What does factor 10 represent in the coagulation cascade?

A

Common factor

Factor 10 is crucial in the conversion of prothrombin to thrombin.

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20
Q

Which factors does thrombin activate?

A
  • Factor 5
  • Factor 8
  • Factor 13

Thrombin plays a key role in the coagulation cascade by activating these factors.

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21
Q

What is the role of protein C in the coagulation process?

A

Blocks factor 5 and factor 8

Protein C is activated by thrombin and helps regulate coagulation.

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22
Q

What is the Virchow’s triad associated with?

A
  • Injury to the vessel
  • Stasis of blood flow
  • Hypercoagulability

These factors contribute to the formation of deep vein thrombosis (DVT).

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23
Q

What are the common symptoms of deep vein thrombosis (DVT)?

A
  • Pain
  • Redness
  • Swelling
  • Heat

DVT typically occurs in the lower limbs.

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24
Q

True or false: Red thrombi are more likely to cause pulmonary embolisms.

A

TRUE

Red thrombi form in low-pressure veins and can detach, leading to pulmonary embolism.

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25
What is **disseminated intravascular coagulation (DIC)** characterized by?
* Random bleeding * Use of clotting factors * Clots throughout the body ## Footnote DIC is a severe pathology with a high mortality rate.
26
What is the primary treatment for **DIC**?
Plasma transfusions ## Footnote Treatment focuses on replenishing clotting factors and addressing the underlying cause.
27
What does **fibrinolysis** refer to?
Breakdown of fibrin clots ## Footnote This process is essential for regulating coagulation and preventing excessive clotting.
28
What activates **plasminogen** to plasmin?
Tissue plasminogen activator ## Footnote This activation occurs at the site of the clot.
29
What is the function of **aminocaproic acid**?
Blocks conversion of plasminogen to plasmin ## Footnote It is used to stabilize clots during surgeries.
30
What are the two main classifications of **thrombin inhibitors**?
* Indirect thrombin inhibitors * Direct thrombin inhibitors ## Footnote Indirect inhibitors enhance anti-thrombin activity, while direct inhibitors bind to thrombin.
31
What is the source of **unfractionated heparin**?
* Cow intestine * Pig intestine ## Footnote Heparin is derived from animal sources and is crucial for preventing clots.
32
What is the primary action of **heparin**?
Inactivates thrombin and factor 10 By enhancing anthrombin ## Footnote Heparin is used to prevent venous thrombosis.
33
What is the effect of **warfarin** on clotting factors?
Decreases clotting factors by blocking vitamin k reductase enzyme Decreasing vitamin k prevents clotting factors from receiving y-Carboxyl group ## Footnote Warfarin takes time to activate and is often used after heparin.
34
What is the main risk factor for **DVT** during long flights?
Decreased blood flow ## Footnote It is recommended to move around or do leg exercises to prevent DVT.
35
What is the primary source of **heparin**?
* Animal sources (e.g., pig intestine, bovine lung) ## Footnote Heparin is crucial for preventing clots during cardiac surgeries.
36
Heparin's mechanism of action involves binding to which protein?
Anti-thrombin ## Footnote Heparin enhances the activity of anti-thrombin, making it much more effective.
37
What is the **pentasaccharide complex** in relation to heparin?
A sequence of five saccharide units that binds to anti-thrombin ## Footnote This complex is essential for heparin's anticoagulant effect.
38
Low molecular weight heparin is more specific for which factor?
Factor 10 ## Footnote It has less overall effect on coagulation compared to high molecular weight heparin.
39
What is a common side effect of heparin known as **transient thrombocytopenia**?
Temporary decrease in platelets (HIT) ## Footnote This condition can occur in 1-5% of patients receiving heparin.
40
What should be done if a patient develops **heparin-induced thrombocytopenia (HIT)**?
Discontinue heparin and switch to an alternative ## Footnote Alternatives include low molecular weight heparin or fondaparinux.
41
What does **APTT** stand for in coagulation monitoring?
Activated Partial Thromboplastin Time ## Footnote It is used to monitor the intrinsic pathway of coagulation.
42
What is the target **INR** range for patients on warfarin?
2 to 3 ## Footnote This range indicates effective anticoagulation without excessive bleeding risk.
43
What is the role of **vitamin K** in coagulation?
Encourages carboxylation of clotting factors ## Footnote It is essential for the synthesis of several clotting factors in the liver.
44
Warfarin works by inhibiting which enzyme?
Vitamin K reductase ## Footnote This inhibition reduces the production of active clotting factors.
45
What is a significant toxicity associated with warfarin?
Bleeding disorders ## Footnote This includes risks such as hemorrhagic complications and cutaneous necrosis.
46
What are the newer anticoagulants that specifically target activated factor 10?
* Apixaban * Rivaroxaban * Edoxaban ## Footnote These drugs have a lower toxicity profile compared to warfarin.
47
True or false: **Fondaparinux** is a direct thrombin inhibitor.
FALSE ## Footnote Fondaparinux is a pentasaccharide that specifically targets anti-thrombin and factor 10.
48
What is the primary action of **direct thrombin inhibitors**?
Bind and inactivate ACTIVATED thrombin ## Footnote Examples include argatroban and dabigatran.
49
What is the significance of **protamine** in heparin therapy?
It reverses heparin activity DUE TO ITS POSITIVE CHARGE ## Footnote Protamine binds to heparin (NEG CHARGE), counteracting its anticoagulant effects.
50
What is the difference between **TTP** and **transient thrombocytopenia**?
TTP involves massive loss of platelets due to a different mechanism ## Footnote TTP is associated with a condition involving ADAMTS13.
51
What is the primary function of **fibrinolytic drugs**?
To break down clots by activating plasminogen into plasmin ## Footnote Plasmin is a serine protease that breaks down fibrin and fibrinogen.
52
Name two examples of **fibrinolytic drugs**.
* Streptokinase * Urokinase Altepase ## Footnote Streptokinase is derived from streptococci, while urokinase is produced by the kidneys.
53
What is the role of **aspirin** in antiplatelet therapy?
Inhibits the enzyme COX-1, preventing thromboxane A2 production ## Footnote This action increases bleeding time and is used to prevent platelet aggregation.
54
True or false: **Clopidogrel** is an NSAID.
FALSE ## Footnote Clopidogrel is an antiplatelet medication that blocks ADP receptors, not an NSAID.
55
What is **vitamin K** necessary for?
Efficient blood coagulation ## Footnote It is essential for the carboxylation of prothrombin and factors 7, 9, and 10.
56
Fill in the blank: **Desmopressin acetate** is used to increase factor ______.
VIII ## Footnote It activates factor VIII but does not help if factor VIII is completely absent.
57
What are **plasma fractions** used for?
* Deficiencies in plasma coagulation factors * Hemophilia treatment * DIC ## Footnote They can be unfractionated or targeted to specific factors.
58
What is the function of **tranexamic acid**?
Inhibits the conversion of plasminogen to plasmin TXA opposite of TPA ## Footnote It is used to manage major bleeding disorders and is abbreviated as TXA.
59
Name the four categories of drugs discussed.
* Anticoagulants * Thrombolytics * Antiplatelet agents * Hemostatics ## Footnote Each category serves a specific role in managing blood coagulation and bleeding.
60
What is the main concern with using **new anticoagulants** compared to warfarin?
No reversal agent available ## Footnote While they have a decreased toxicity profile, they lack a fail-safe like vitamin K for warfarin.
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