1
Q
3 SERIES OF STEPS FOR INJURY
A
- vasoconstriction
- platelet plug
- coagulation
2
Q
the step for injury that causes temporary relief only
A
platelet plug
3
Q
INJURY
this is the basis of the platelets to determine if there is injury
A
exposed COLLAGEN FIBERS
4
Q
INJURY
GLYCOPROTEIN Ia binds to
A
COLLAGEN
5
Q
INJURY
GLYCOPROTEIN Ib will attach to
A
VON WILLEBRAND FACTOR (VWF)
6
Q
INJURY
platelet secretes these substances that attracts more platelets
A
aggregation substances
* ADP
* TXA
* 5HT
* PDE
* Cytokines
7
Q
INJURY
fibrinogen attach to ____
A
GLYCOPROTEIN IIb/IIIa
8
Q
it is a mesh-like substance and is the active form of FIBRINOGEN
A
FIBRIN
9
Q
A
10
Q
EVENTS IN HEMOSTASIS
what is the product of Platelet Migration and Aggregation
A
PLATELET PLUG (white thrombus/primary hemostasis)
11
Q
EVENTS IN HEMOSTASIS
what is the product of ACTIVATION OF COAGULATION CASCADE
A
PERMANENT CLOT (red thrombus/secondary hemostasis)
12
Q
PRIMARY HEMOSTASIS steps
A
- platelet adhesion
- platelet activation
- platelet aggregation
13
Q
PRIMARY HEMOSTASIS
- the GP Ia receptor binds to collagen
- GP Ib receptor binds to Von Willebrand factor (vWF)
A
PLATELET ADHESION
14
Q
PRIMARY HEMOSTASIS
- GP IIb/IIIa binds to fibrinogen and other macromolecules
- presence of aggregating substances to attract more platelets
A
PLATELET ACTIVATION
15
Q
PRIMARY HEMOSTASIS
AGGREGATING SUBSTANCES:
* is synthesized from arachidonic acid within platelets and is a platelet activator and POTENT VASOCONSTRICTOR
A
THROMBOXANE
16
Q
PRIMARY HEMOSTASIS
AGGREGATING SUBSTANCES:
* a powerful inducer of platelet aggregation
A
ADENOSINE DIPHOSPHATE (ADP)
17
Q
PRIMARY HEMOSTASIS
AGGREGATING SUBSTANCES:
* stimulates aggregation and vasoconstriction
A
SEROTONIN (5HT)
18
Q
the activation of BLOOD COAGULATION CASCADE occurs within how many hours from the time of injury
A
6-12 hours
19
Q
ACTIVATION OF BLOOD COAGULATION CASCADE
Clotting factor IIa
A
thrombin
20
Q
inactive form of THROMBIN
A
PROTHROMBIN
21
Q
ACTIVATION OF BLOOD COAGULATION CASCADE
Clotting factor I
A
FIBRINOGEN
22
Q
ACTIVATION OF BLOOD COAGULATION CASCADE
- this is required in converting FIBRINOGEN to its active form FIBRIN
A
Clotting factor IIa - THROMBIN
23
Q
the polymerized form of FIBRINOGEN that stabilizes the platelet plug
A
FIBRIN
24
Q
ACTIVATION OF BLOOD COAGULATION CASCADE
2 PATHWAYS
A
Extrinsic
Intrinsic
25
# **ACTIVATION OF BLOOD COAGULATION CASCADE**
DOMINANT pathway
EXTRINSIC
26
# **BLOOD COAGULATION CASCADE**
SERIES OF STEPS IN **INTRINSIC** PATHWAY
12 -> 12a
11 -> 11a
9 -> 9a
9a with the help of 8 -> 8a = 10 -> 10a
10a with 5 -> 5a = Prothrombin -> thrombin -> cuts fibrinogen to fibrin
27
# **BLOOD COAGULATION CASCADE**
SERIES OF STEPS IN **EXTRINSIC** PATHWAY
7
7 + TF (clotting factor III - tissue factor)
10 -> 10a + 5 -> 5a = prothrombin -> thrombin -> cuts fibrinogen -> fibrin
28
# **BLOOD COAGULATION CASCADE**
EXTRINSIC PATHWAY:
* what is the **starting clotting factor**
CF 7
29
# **BLOOD COAGULATION CASCADE**
**tissue factor** is also known as
clotting factor III
30
**VITAMIN K** DEPENDENT CLOTTING FACTORS
10
9
7
2
| 1972
31
ANTIDOTE for **bleeding**
VITAMIN K
32
____ is **still active** even if the patient is FREE from disease
coagulation cascade
33
# **REGULATION OF THROMBOSIS**
* A **protease**; responsible for facilitating **FIBRINOLYSIS**
PLASMIN
34
the process of **fibrin digestion**
FIBRINOLYSIS
35
# **REGULATION OF THROMBOSIS**
a REGULATOR that **prevents blood clot**
PLASMINOGEN
36
# **REGULATION OF THROMBOSIS**
* **Directly INACTIVATES** activated clotting factors (IIa, IXa, Xa, XIa, XIIa, XIIIa)
ANTITHROMBIN III (AT III)
37
# **REGULATION OF THROMBOSIS**
* **attenuate** the **blood clotting cascade** by PROTEOLYSIS of two co-factors: **Va & VIIIa**
PROTEIN C and S
38
TWO CO-FACTORS
Va
VIIIa
39
* it is the **general term** for all the agents that **prevents FORMATION of clot**
ANTITHROMBOTICS
40
agents under ANTITHROMBOTICS
ANTIPLATELET
ANTICOAGULANT
41
# **ANTITHROMBOTICS**
* slow down clotting
* **PREVENT FORMATION of clotting**
ANTICOAGULANT
42
# **ANTITHROMBOTICS**
* **prevent PLATELET AGGREGATION**
ANTIPLATELET
43
# **ANTICOAGULANTS**
ENDOGENOUS anticoagulant
PROTEIN C
44
# **ANTICOAGULANTS**
2 CLASSES OF **Heparin**
Unfractionated/Regular Heparin
Low Molecular Weight Heparin
44
# **ANTICOAGULANTS**
**Mucopolysaccharide Antithrombin III**
HEPARIN
45
# **ANTICOAGULANTS**
* **Vitamin K analogue**
* were first used as **rodenticides**
* the ONLY **coumarin derivative** that has medicinal use
WARFARIN
46
# **ANTICOAGULANTS**
ANTICOAGULANTS target what clotting factors
IIa, Xa
47
# **ANTICOAGULANTS**
**DIRECT** anticoagulants inhibit what clotting factor
CF IIa
48
# **ANTICOAGULANTS**
DIRECT PARENTERAL
Hirudin
Lepirudin
Bivalirudin
Argatroban
49
# **ANTICOAGULANTS**
DIRECT ORAL
Dabigatran
| the ONLY oral
50
# **ANTICOAGULANTS**
* a **direct** anticoagulant that is administered **parenterally** that are from **LEECHES**
HIRUDIN
51
# **ANTICOAGULANTS**
* derivatives of **Hirudin**
Lepirudin
Bivalirudin
52
# **ANTIPLATELETS**
* inhibits **COX** which **decreases Thromboxane**
ASPIRIN
53
# **ANTIPLATELETS**
dose of **Aspirin** that has **antiplatelet activity**
LOW DOSE: 80-81mg
54
# **ANTIPLATELETS**
dose of **Aspirin** that has **analgesic** activity
HIGH DOSE: 325mg
55
# **ANTIPLATELETS**
* inhibits **ADP**
Clopidogrel
Ticlopidine
| "CLOP"
56
# **ANTIPLATELETS**
* inhibits **PDE**
Dypiridamole
Cilostazol
57
# **ANTIPLATELETS**
* inhibits **GP IIb/IIIa**
Eptifibatide
Abciximab
Tirofiban
58
# **ANTICOAGULANTS**
INDIRECT PARENTERAL
HEPARIN
59
# **ANTICOAGULANTS**
INDIRECT ORAL
WARFARIN
60
# **ANTICOAGULANTS**
INDIRECT NEW AGENTS
* targets CF **Xa**
Apixaban
Rivaroxaban
| XA
61
THROMBOLYTICS / FIBRINOLYTICS
| EXPENSIVE
Streptokinase
Anistreplase
Urokinase
Alteplase
Reteplase
62
# **THROMBOLYTICS/FIBRINOLYTICS**
* from **bacteria**
* has high risk for **allergic reaction**
* used ONLY ONCE
STREPTOKINASE
63
# **ANTICOAGULANT**
* a heterogenous mixture of **sulfated mucopolysaccharides**
* an **indirect** thrombin inhibitor (**parenteral**)
* can be used in **pregnant** women
HEPARIN
64
# **ANTICOAGULANT**
HEPARIN:
* **LMW**
Enoxaparin
Dalteparin
Fondaparinux
Fraxiparin
Danaproid
65
# **ANTICOAGULANT**
HEPARIN **MOA**
binds to ATIII and accelerates ATIII's action by **1000-fold**
66
# **ANTICOAGULANT**
HEPARIN: **LMW** are **more selective** binding at
Xa
67
# **ANTICOAGULANT**
* given when **initiating** coagulation therapy
* management of **acute coronary syndrome** and **deep vein thrombosis**
* Tx (IV) and prevention (IV or SQ) of **pulmonary embolism**
* only when necessary in **pregnancy**
HEPARIN
68
# **ANTICOAGULANT**
HEPARIN:
* **toxicity**
BLEEDING
69
# **ANTICOAGULANT**
* ANTIDOTE for **Heparin**
* **highly BASIC**
PROTAMINE SULFATE
70
ANTIDOTE FOR HEPARIN:
* **100 units of Heparin** = ____ mg of Protamine Sulfate (IV)
1mg
71
HEPARIN came from the word ____
Heparinic acid
72
what is the reaction that formed between **Heparin** and **Protamine sulfate**
NEUTRALIZATION
acid + basic
73
# **ANTICOAGULANT**
* the ONLY **ORAL** anticoagulant
* it inhibits **hepatic synthesis** of **Vitamin K-dependent clotting factors**
* blockade of gamma-carboxylation of several glutamate residues in clotting factors X, IX, VII, II
* 8 to 12 hour delay in the action
* **teratogenic**
WARFARIN
74
# **ANTICOAGULANT**
WARFARIN:
* **PT INR** (Prothrombin Time-International Normalized Ratio)
2-3
75
# **ANTICOAGULANT**
WARFARIN:
* **undesirable effect** that is seen at least 3 weeks of use due to **cholesterol embolization**
PURPLE TOE SYNDROME
76
# **ANTICOAGULANT**
* exert their anticoagulant effects by **directly binding** to the active site of thrombin
DIRECT THROMBIN INHIBITORS
77
# **ANTICOAGULANT**
DIRECT:
* used in px with thrombosis related to **heparin-induced thrombocytopenia**
LEPIRUDIN
78
# **ANTICOAGULANT**
DIRECT:
* FDA-approved for use in **percutaneous transluminal coronary angioplasty**
BIVALIRUDIN
79
# **ANTICOAGULANT**
DIRECT:
* FDA-approved for use in px with **HIT** with or without thrombosis and **coronary angioplasty** in px with HIT
ARGATROBAN
80
# **ANTICOAGULANT**
* approved use for use in **Europe** for prevention of **venous thromboembolism** in px who have undergone **hip or knee replacement surgery**
DABIGATRAN
81
# **ANTIPLATELETS**
* inhibits **COX**
* prevents **TXA2** and **PGs**
ASPIRIN
82
# **ANTIPLATELETS**
* inhibit **ADP** pathway of platelet formation
Clopidogrel
Ticlopidine
83
# **ANTIPLATELETS**
* **PDE** inhibitor = **increasing cAMP levels to potentiate PGI2** (platelet aggregation inhibitor)
DIPYRIDAMOLE
84
# **ANTIPLATELETS**
* inhibit **GP IIb/IIIa** - a necessary molecule for platelet aggregation
ABCIXIMAB
EPTIFIBATIDE
TIROFIBAN
85
# **ANTIPLATELETS**
* for **primary prophylaxis** of **MYOCARDIAL INFARCTION** (325mg/day)
* for **secondary prevention** of **vascular events** among patients with a history of vascular disease
ASPIRIN
86
# **ANTIPLATELETS**
* reduces the risk of **myocardial infarction** in px with **unstable angina**
ASPIRIN
87
# **ANTIPLATELETS**
* reduction of **atherosclerotic events**
* prevents **thrombosis**
CLOPIDOGREL
TICLOPIDINE
88
# **ANTIPLATELETS**
* prevents **emboli**
DIPYRIDAMOLE
89
# **ANTIPLATELETS**
* used for **acute coronary syndrome**
ABCIXIMAB
EPTIFIBATIDE
TIROFIBAN
90
# **ANTIPLATELETS**
it has **fewer** adverse effects than Ticlopidine
Clopidogrel
91
* used in the management of **acute myocardial infarction**
* indicated in cases of **pulmonary embolism with hemodynamic instability**
* for **severe** **deep venous thrombosis**
* **ascending thrombophlebitis**
FIBRINOLYTICS
92
DRUGS USED IN **BLEEDING DISORDERS**
Vtiamin K
Plasma Fractions
Desmopressin Acetate
Fibrinolytic inhibitors: Aminocaproic acid
Serine Protease Inhibitors: Aprotinin
93
# **DRUGS FOR BLEEDING DISORDERS**
VITAMIN K:
* found in **food**
* used in treating **Warfarin overdosage**
* currently administered to **all newborns** to prevent hemorrhagic disease of Vitamin K deficiency
VITAMIN K1
phytonadione
94
# **DRUGS FOR BLEEDING DISORDERS**
VITAMIN K:
* found in **human tissues** and is synthesized by **intestinal bacteria**
VITAMIN K2
menaquinone
95
# **DRUGS FOR BLEEDING DISORDERS**
VITAMIN K:
* **water soluble**; **INEFFECTIVE** in warfarin dosage
VITAMIN K3
menadione
96
# **DRUGS FOR BLEEDING DISORDERS**
used for treatment of **blood clotting factors deficiencies**:
* Factor **VIII** deficiency
* Factor IX deficiency
PLASMA FRACTIONS
97
BLOOD CLOTTING FACTORS DEFICIENCIES:
* **classic HEMOPHILIA** or **hemophilia A**
Factor VIII deficiency
98
BLOOD CLOTTING FACTORS DEFICIENCY:
* **CHRISTMAS disease** or **hemophilia B**
FACTOR IX deficiency
99
# **DRUGS FOR BLEEDING DISORDERS**
PLASMA FRACTIONS:
* is a factor **VIII** concentrate approved by FDA for the tx of bleeding associated with **von Willebrand disease**
HUMATE-P
100
# **DRUGS FOR BLEEDING DISORDERS**
* increases the **factor VIII** activity og px with **mild hemophilia A** or **von Willebrand disease**
* can be used in **preparation** for **minor surgery** such as **tooth extraction**
* available in HIGH-DOSE INTRANASAL
DESMOPRESSIN
101
# **DRUGS FOR BLEEDING DISORDERS**
* plasma protein fraction obtainable from **whole blood**
* contains **300mg** of fibrinogen
* used to treat deficiencies or qualitative abnormalities of fibrinogen
* may also be used for patients with **factor VIII** deficiency and **von Willebrand disease** if desmopressin is not indicated
CRYOPRECIPITATE
102
103
# **DRUGS FOR BLEEDING DISORDERS**
* A **synthetic inhibitor** of fibrinolysis
* an adjunctive therapy in **hemophilia**
* as therapy for bleeding from fibrinolytic therapy
* **prophylaxis** for **rebleeding** from **intracranial aneurysms**
AMINOCAPROIC ACDID
104
# **DRUGS FOR BLEEDING DISORDERS**
* is an **analog** of **AMINOCAPROIC ACID**
TRANEXAMIC ACID
PCOL 2 Lec
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