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114 Cards in this Set
- Front
- Back
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after injury to the blood vessels what are the steps in clotting:
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vasospasm: vasoconstriction to decrease blood loss
platelet plug: collagen and mediators fibrin clot: tissue facots fibrinolysis: plasmin. . . once repaired. . . get rid of clot |
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what holds the clot together
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fibrin
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why aren't clots made all the time
endothelial surfaces ----, w/ --- layer, and w/ ---- on surface of cells |
smooth
glycocalyx layer thrombomodulin |
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what covers the surface of the and keeps blood from intercting w/ cell wall
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glycocalyx layer
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thrombomodulin binds to ---- and complex activates --- C inactivates factors ---and ----
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thrombin
protein 5 and 8 |
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this helps prevent clots from being made all the time by circulating and binding and inactivating thrombin
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antithrombin 3
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heparin is a -- cell
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mast
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heparin binds to ------- --, activates 100-1000 fold to inactivat factors 12, 11, 10, 9
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antithrombin 3
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what does protein c inactivate
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factors 5 and 8
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what will activate protein c
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thrombomodulin
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prostacyclin (PGI2) inhibits --- ---
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platelet activation
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prostacycline vaso----
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relaxes
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thromboxane A2 (TXA2) stimulates --- ----
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platelet activation
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what digest fibrin and inactivates factors 5, 8, 12
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plasmin
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thromboxan A vaso----
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contricts
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prostacyclin and --- work together to balance out clotting/bleeding
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thromboxane
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t/f
thromboxan inhibits platelet activation |
f
stimulates |
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fibrin interconnect ----
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platelets
forms a meshwork to catch the rbc, which creates a clot |
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damage to bl vessels will remove ----- so blood in contact w/ ----
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thrombomodulin
collagen |
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platelet activation
glycoprotein Ib (GP1b) binds w/ --- --- factor collagen binds w/ ---- ----- this relases --- and ---- |
Von Willebradt factor
glycoprotein Ia/IIa (GPIa/IIa) TXA2 and ADP released |
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what does ADP, TXA2 cause ---- change exposing ----
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conformational change
GP2b/3a |
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what binds GP2b/3a that cross links the platelet plug
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fibrinogen
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thrombin interacts w/ ---- and ----- recetorrs to also stimulate platelet activation
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PAR1
PAR4 (protease activated) |
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what stimulates platelet activation
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thrombin
PAR1 PAR4 |
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--- activates P2Y1/P2Y12 receptors which acitvate platelets
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ADP
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ADP activates ----- and -------receptors which acitvate platelets
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P2Y1/P2Y12
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P2Y1/P2Y12 acitvate ----
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platelets
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what secrets PGI2
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endothelium
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what does PGI2 inhibit
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platelet activation
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---- not exposed covered by ---- inhibits platelet activation
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collagen
endothelium |
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low levels of ---- and platelets that don't express ------ on surface will inhibit platelet activation
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thrombin
GP2b/3a |
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PAF derived from ---- that make up membranes
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lipids
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what secrets PGI2
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endothelium
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what does PGI2 inhibit
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platelet activation
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---- not exposed covered by ---- inhibits platelet activation
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collagen
endothelium |
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low levels of ---- and platelets that don't express ------ on surface will inhibit platelet activation
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thrombin
GP2b/3a |
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PAF derived from ---- that make up membranes
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lipids
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what secrets PGI2
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endothelium
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what does PGI2 inhibit
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platelet activation
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---- not exposed covered by ---- inhibits platelet activation
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collagen
endothelium |
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low levels of ---- and platelets that don't express ------ on surface will inhibit platelet activation
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thrombin
GP2b/3a |
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PAF derived from ---- that make up membranes
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lipids that make up the membrane
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what liberates PAF
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phospholipase A2
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once liberated what does PAF form
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AA and glycerophosphocholine
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t/f
together asa and streptokinase are more efficacious than by themselves |
t
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asa ---- acetylates COX enzymes
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irreversible
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asa irreversibly --- COX enzymes
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acetylates
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asa blocks only cox 2
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f
both cox 1 and 2 |
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asa inhibits ----
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TXA2
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how long will asa inhibit txa2
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for life of the platelets (7-10 days)
COX1 |
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asa inhibits ---- partially in endothelium via ----
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PGI2
COX2 |
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t/f
COX2 inhibitors will inhibit both TXA2 and PGI2 |
f
only PGI2 |
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cox maximally inhibited at ---- mg/day
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160
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PAF also vaso------
has inflammatory response to damage mucosal wall in stomach |
vasodilates/constricts
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less than 160mg asa inhibits -----
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TXA2
decrease platelet activation this will allow more PGI2. .. which will prevent platelet activation |
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glycerophosphocholine makes --- and ---
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PAF
TXA2 when one is being made, so is the other |
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is there a nucleus in platelets
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no
so doesn't synthesize proteins |
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thromboxane A2 ---- platelet aggregation and vaso----
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increases
vasoconstricts |
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protacyclin I2 decreases --- ----
inceases ------- vaso----- decreases ---- acid |
decrease platelet aggregation
increases rbf vasodilates decreases gastric acid |
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prostaglandin E2
increases/decreases rbf vaso------ ----- decrease/increase gastric acid |
increases rbf
vaso dilates natriuresis decrease gastric acid |
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asa acetylates both ---- and ----
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cox 1
cox 2 |
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prostaglandin F2alpha
contracts ---- vaso---- broncho---- |
contracts uterus
vasoconstricts bronchoconstricts |
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cox -- expressed in endothelial cells and w/ inflammation
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2
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--- in humans due to cox 2 in endothelial cells
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PGI2
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cox - inhibitors block PGI2 and not TXA2
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2
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why are ibuprofen, diflusinsal, naproxen, diclofenac, indomethacin, and piroxicam no as effective as asa
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cuz they are reversible
very little platelet inhibitory activity |
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se of nsaids
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dyspepsia
gerd pud bleeding: bruising |
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dypyridamole is a vaso -------
is used in combo w/ ------ |
vasodilator
asa: aggrenox warfarin: postop heart valve replacement to prevent thromboemboli |
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dipyridamole used for --- or ischemic sroke due to thrombosis
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TIA's
stroke prevention |
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dipyrimidalole inhibits --- uptake and ------
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adenosine
cGMP - phosophodiesterase |
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dipyridamole will decrease/increase camp and decrease/increase Ca
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increase camp
decrease Ca - this will decrease platelets |
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via the P2Y1 receptor --- Ca++ pathway induce --- change and ----
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IP3
shape aggregation |
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via P2Y12 Gi inhibits --- ---- which will increase/decrease camp
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adenylate cyclase
decrease camp |
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decreasing camp will cause
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platelet aggregation
so activating P2Y12 (via ADP) will allow platelet aggregation |
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how do inhibt P2Y1 and P2Y12
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inhibit ADP
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another method to inhibit activation:
direct inhibition of fibrinogen to ----- |
GP2b/3a
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what's wrong w/ interfering w/ binding of von Willebrandt
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no agents available
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ticlopidine and clopidogrel block --- receptor
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ticlopidine
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adp receptor blockers:
concentration ----- inibition of platelet activation |
dependent
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t/f
adp receptors blockers will work right away |
f
delayed 2-3 days for clinical effect max effect in 8-11 days |
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t/f
adp receptors blockers will have active metabolites |
t
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adp receptor blockers will be synergistic w/ -----
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asa
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indicaitons for adp receptor blockers
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prevent stroke
mi peripheral artery disease angioplasty |
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ticlopidine is a ----
and is activated by |
prodrug
hepatic activation |
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what type of bonds are formed w/ ticlopidine
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disulfide bridge w/ P2Y12 receptor
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what prolongs the effect of ticlopidine
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cystosine and sulfur
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ae of ticlopidine
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hemorrhage
neutropenia thrombotic thrombocytopenic purpura (immune response) n/v/d rash |
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how does hemorrhage occur w/ ticlopidine
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so many platelets are activated that you run out and end up bleeding
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t/f
clopidogrel is a prodrug |
t
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clopidogrel binds w/ ----- on the P2Y12 receptor, synergistic w/ asa
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sulfur
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clpidogrel binds w/ sulfur on the --- recpeotor
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P2Y12
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how is clopidogrel activated
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hepatic
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ae of clopidogrel
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hemorrhage
neutroenia ttp n/v/d rash |
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glycoprotein 2b/3a blockers
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abciximab
eptifibatide tirofiban |
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abciximab is humanized ---- antibody
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monoclonal
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route of abciximab
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iv
over 1/2 hrs |
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how fast does abciximab begin to work
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immediately
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how long does abciximab stay bound
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18-24 hrs after infusion stopped
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indication fo abciximab
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angioplasty w/ asa and heparin
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abciximab prevents --------
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restenosis
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abciximab used in acute ----
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MI
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ae of abciximab
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bleeding
thrombocytopenia immunogenic |
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eptifibatide is a --- inhbitor of fibrinogen binding to PG2b/3a
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peptide
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eptifibatide is a peptide inhibitor of --- binding to ---/----
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fibrinogen
PG2b/3a |
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infusions of eptifibatide for --- hrs
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up to 96 hrs
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route of eptifibatide
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iv
can't crooss GI gets chewed up too fast |
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indication of eptifibatide
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angioplasty
acute coronary events |
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ae of eptifibatide
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bleeding
thrombocytopenia less immunongenicity |
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tirofiban is a --- inhbitor
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non-peptide
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how is tirofiban eliminated
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renal
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route of tirofiban given
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IV
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what is tirofiban given w/
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heparin
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indications of tirofiban
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angioplasty
acute coronary events |
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ae of tirofiban
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bleeding
bradycardia dizziness |
