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178 Cards in this Set
- Front
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- 3rd side (hint)
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factors that when increased, increase risk
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APOB48, APOB100, APOCIII, APOE-4,PCSK9, APO Lp(a), OLTP
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factors that when increased, decrease risk
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LDLR,HDLc,PCAT, ABCA1, CETP, APOCII, APOA5, APOE-2, LPL, ACAT
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THROMBIN
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topical, arrest minor bleeding
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GELFOAM
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absorbable collagen, surgery/trauma
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Heparin
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IV/SC, potentiates ATIII,
sides: bleeding used DVT, PE, lab samples protamine sulfate antagonist |
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lepirudin
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hirudin derivative
irreversible thrombin inhibitor used when heparin contraindicated monitor aPTT sides:decreased Hgb, BP |
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bivalirudin
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hirudin derivative
reversible thrombin inhibitor use coronary angioplasty bleeding at site of puncture short acting |
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warfarin (coumadin)
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vitamin K antagonist
(rescue: fresh plasma, konakion/aquamephyton vit K) enzyme induction, increased clotting facotrs, increased VITK ingestion/absorption decrease warfarin effect |
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dabigatran etexilate
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use atrial fibrillation, or following surgery
direct thrombin inhibitor |
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aspirin
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decrease TXA2
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clopidogrel
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irreversible block ADP receptor on platelets
inhibits binding of fibrinogen to platelet sides: TTP |
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ticlopidine
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irreversible inhibition adp binding fibrinogen to platelet
thrombasthenia like state use for acute cerebral ischemia sides: severe neutropenia |
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prasugrel
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inhibits platelet aggregation by PalphaY12 receptor ADP
used before angioplasty significant and fatal bleeding TTP |
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ticagrelor
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inhibits platelet aggregation by PalphaY12 receptor ADP reversibly
faster onset more minor bleeding and respiratory conditions |
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dipyridamole
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increased [cAMP] in plateleys, inhibits phosphodiesterase, inhibits metabolism
not used as monotherapy, used with warfarin prophylaxis for prosthetic heart valves |
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prostacyclin (PGI2)
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increase [cAMP] in platelet
stimualtes adenylate cyclase |
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increased cAMP
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decreased platelet activity
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decreased cAMP
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increased platelet activity
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streptokinase
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short half life
complexes with plasminogen and activates systemic plasminogen activation fibrinolysis |
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urokinase
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cleaves arg-arg peptide bond in plasminogen
systemic |
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t-PA
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activates BOUND plasminogen (bound to fibrin)
clot specific, not systemic |
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aminocaproic acid
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binds to lysine binding sites on plasminogen, prevents plasmin binding fibrin
antifibrinolytic reduces OD of fibrolytic agents new clots not lysed sides: muslce weakness/myopathy |
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platelet activation
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adp, serotonin, collagen, thrombin, TXA2
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TTP
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disorder of vWF
deficiency in ADAMSTS13 (cleaves vWF into Fx form) inherited:protease def acquired: autoimmune |
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vWF
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complexes with factor VIII
stored in alpha granules and weibel-palade bodies (endotheliall cells) made by endothelial cells |
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vWD
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most common inherited bleeding disorder
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HIT heparin induced thrombocytopenia
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hypercoagulable
immune rxn to IgG to heparin bound PFIV fab portion IgG binds to PFIV-HEPARIN and Fc binds to platelet receptor activating platelet microvascular thrombi, PE, gangrene, stroke, MI more likely with unfractionated heparin less with LMWH usually give patients chance to correct, can give protamine |
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platelet storage pool disorders
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def. in alpha granules(fibrinogen, PDGF, PFIV) or dense granules (serotonin, CA++, ADP) or both
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bernard-soulier syndrome
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GPIbIX/V deficiency,
vWF cannot attach to subendothelium |
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glanzmanns thrombasthenia
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GPIIbIIIa
cannot aggregate |
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findings in coagulation disorder
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delayed bleeding, hemarthrosis, deep hematomas
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findings in platelet/vessel disorders
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petechia, purpura, superficial bleeds, mucosal bleeding
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vWD
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VIII, bleeding time, vWF
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hemophilia A
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x linked recessive
hemarthrosis, delayed bleed aPTT VIII most common severe congenital bleeding disorder bleed everywhere |
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hemophilia B
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x linked recessive, hemarthrosis, delayed bleeding
aPTT IX christmas disease bleed everywhere |
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hemophilia C
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aPTT
XI autosomal recessive jews mild to moderate |
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aPTT
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intrinsic, heparin
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PT
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extrinsic, coumadin
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Vit K deficiency
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nutritional, mutation in gene encoding y-glutamyl carboxylase
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lupus anticoagulant
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anti-phospholipid antibody syndromes
common acquired hypercoagulability lab tests look like cant clot, clot quicker Hx of miscarriages, odd thrombosis sites, no Hx of bleeding |
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hyperfibrinolysis
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occurs with liver disease
secondary to DIC increased DDIMERS elongated PT |
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T-TM
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thrombin-thrombomoduliin activate protein C cleaves V/VIII
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factor V leiden
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APC resistance
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ATIII deficiency
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serpin def.
autosomal dominant |
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DVT
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high risk stasis, mi, dic,
localized pain, heat, redness, swelling often asymptomatic Dx ddimers, ultrasound given warfarin to avoid newly synthesized clotting factors |
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clotting cascade
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XII-XI-IX-VIII-X-V-II(thrombin)-FIBRIN
or VII-X-V-II |
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immune complex vasculitis
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systemic, immunological
IG and complement found in lesion circulating complecces in SLE anti-dna complexes found in vessels some caused by hypersensitivity to drugs viral infx as well |
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drug hypersensitivity vasculitis
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Ig against drug modified proteins
skin is often a target mild to fatal |
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viral infx vasculitis
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Ig to viral proteins
30% of patients with PAN (polyarteritis nodosa) have Hep B related immunovascultitis) |
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ANCA
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circulating Ig reacts with neutrophil granules
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cANCA
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antiPR3
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pANCA
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antiMPO
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Anti Endothelial Cell Antibodies
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SLE
KAWASAKI |
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Polyarteritis Nodosa
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small/medium arteries (other vessels not involved)
renal/gi common renal cause of death young adults HTN, wt loss, fatigue, melana, fibrous thickening vessel wall, lethal lesions are different ages in same vessel no glomnephritis, no pulmonary |
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microscopic polyangitis
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arteries, caps, venules
lesions of same age palpable purpura of skin glomerulonephritis, pumlonary hemoptysis, athralgia, proteinuria, hematuria pANCA most lesions devoid of immune complexrs no granulomatous inflammation immune rxn to drugs, tumor antigens, microorganisms |
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churg-strauss
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allergic granulomatous angitis
pANCA eosinophilia neutrophilic infiltration |
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giant cell arteritis
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temporal arteries, large and small arteries, thickened, tender, nodular,
most common vasculitis in elderly granulomatous, nodular thickening intima, fragmentation of IEL temporal, opthalmic, vertebral, aorta permanent blindness |
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takayasu arteritis
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granulomatous
med/large ocular Sx weakneed pulses upper extremities neurodeficits, numb extremities visual deficits |
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infectious arteritis
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direct invasion of bacteria/fungi
mycotic aneurymss |
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kawasaki
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children, infants
conjunctivitis coronary microcutaneous lymph node syndrome skin rash, fever transmural thickening t-cell activation, secrete cytokins, b cell hyperactive, antibodies to SMC and EC |
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wegeners granulomatosis
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necrotizing vasculitis
upper resp mimics tb renal involvement more males that females, around 50 years old cANCA |
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thromboangitis obliterans
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buergers disease
medium/small arteries male smokers under 35 hypersensitivity to tobacco compounds distal finger/toes gangrene, necrosis, pain |
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cavernous hemangioma
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von hippel lindau in brain stem retina, red-blue spongy lesions, large cavernous bloood filled spaces
skin mucosal surfaces |
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capillary hemangioma
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capillaries/connective tissue
skin and usbcu red to blue lesions smaller generally |
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glomous tumor
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from glomous body
red blue painful distal fingers and toes branching vascular channels under nails |
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hemangioendothelioma
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well differentiated w channels, some malignant characteristics
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angiosarcoma
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virtually no vascular channels
anaplastic spindle cells VAT vinyl chlorida arsenic thorotrast |
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kaposis sarcoma
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HHV8
aids |
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von hippel lindau
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autosomal dominant
deletion UHC gene (tumor suppressor) hemangioblastoma/cavernous hemangioma in brainstem or retina liver, kindey, pancreas cyst |
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oslo weber rendu
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autosomal dominant
mutation TGFb binding proteings mormons dilations and convolutions of capillaries hemorrage, gi bleeds |
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sturge weber syndrome
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congenital
ipsilateral port wine stain of face glacuoma meningeal hemangiomas mr, seizures retinal detachment |
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meds that cause immune thrombocytopenia
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quinine, heparin, sulfonamides, gold salts, antibiotics, sedatives, antiinflammatory, antiplatelet, hairspray
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meds that suppress platelet production
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etoh, chemo, thiazide diuretics
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ITP
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autoimmune platelet destruction (gpIIbIIIa)
impaired megakaryocyte maturation give corticosteroids, splenectomy if doesnt work, immunotherapy, tpo mimetics itp in children associated with vaccinations resolve on own, no corticosteroids |
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gestational thrombocytopenia
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during pregnancy
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acquired platelet disorders
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aspiring, uremia, liver disease, myeloma, cardiopulmonary bypass
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platelet adhesion defect
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bernard soulier, gpIb, vWF def.
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platelet aggregation defect
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gpIIbIIIa
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scott's syndrome
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factor X/V
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antiprostaglandin antiplatelet
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aspirin
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antigpIIbIIIa
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abciximab/epitfibatide
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adp receptor PalphaY12 antagonist
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clopidogrel
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factor XII deficiency
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will not show up with aPTT or PT
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PT
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tissue factor, extrinsic, heparin
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aPTT
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intrinsic, coumadin,
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warfarin blocks
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2,7,9,10, c,s
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coumadin overdose cause
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antibiotics decrease gi flora that produce vit k
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coumadin od tx
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vitk fresh frozen plasma prothrombin complex
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heparin od tx
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withold heparin, protamine sulfate
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liver disease thrombocytopenia tx
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mgt liver disease, fresh frozen plasma, cryoprecipitate, vit K
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DIC
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infx, shock, cancer, pregnancy triggers
innapropriate coagulation consumes factors V and VIII and platelets lots of microemboli, lots of hemolysisi, increased fibrinolysis, thrombocytopenia, |
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primary fibrinolysis
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snake bites, electrocution
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abnormal fibrinolysis
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secondary triggered by DIC
increased PT, increased DDIMERS tx tPA and urokinase |
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TTP
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neuro, febrile, hemolytic anemia, renal impair, thrombocytopenia
inhibition adamsts13 tx plasma |
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thrombin time
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detetcts fibrinogenemia, dysfibrinogenemia, heparin, ddimers
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ristocetin
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Dx for vWD, antibiotic reacts with vWF, wont clump in pt deficient in vWF
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hemophilia a mgmt
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DDAVP (releases factor VIII)
viii concentrates |
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heme b management
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factor IX concentrates
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heme C tx
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fresh frozen plasma
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factor VIII inhibitor
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IgG to factor VIII
catastrophic bleeding preg, autoimmune, tumors, skin disease if give factor VIII concetrates, will not improve much (because antibody present) |
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antiphospholipid synfdome
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Ig reacts with phospholipids involved with coagulation
also called lupus anticoagulant SLE, viral infx, cocaine, procainamide, quinine, antibiotics can cause recurrent miscarriage, thrmobosis, stroke dementia, visual changes PTT not corrected with plasma, PT prolonged too no bleeding problems, thrombosis problems |
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TFPI
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inhibits extrinsic pathway
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atiii
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inhibits thrombin activation
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Factor V leidin
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apc resistnace
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thrombomodulin, protein C and S
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prevent thrombin activation factor V
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HIT
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PFIV
alpha granules binds heparin, generates anticomplex IgG Fc binds platelet, activates, clumping, reduces platelets tx with direct thrombin inhibitors and cooumadin after normal platelet counts |
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ddavp contrainidcated
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if ristocetin clumps platelets
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itp diagnosis
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of exclusion
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statins
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HMG-coA reductase inhibitors
inhibits serum cholesterol lowers BP increases eNOS |
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ezetimibe
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blocks chol reuptake form gut
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bile acid resins
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binds bile acids, prevents reabsorption
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niacin
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inhibit lipase activity
inhibit generation VLDL increase HDL most |
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bile acid binding resins
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colestipol, cholestyramine,
not used as monotherapy lower ldl, increase HDL impair absorption vitamins, gi problems increased VLDL increased TG sythesis by liver |
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statins
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force liver cells to import LDL from bloodstream
decrease absorption from meal, decreased LDL increased synth LDLR platelet inhibition increased eNOS elevated liver enzymes, elevated CPK (myopathy) carcinogen, teratogenic |
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ezetimibe
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used with statins
inh absorption choelsterol from gut |
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niacin
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inhibit adipose lipolysisi
decreased FFA supply to liver, decreased LDL, increased HDL GOUT, HYPERURICEMIA vasomotor flushing |
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fibric acid derivatives
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increased transcription of LPL
gemfibrozil activate receptor in liver and muscle that increases LPL?FA oxidation decrease TG synthesis GALLSTONES liver enzymes myopathy fenofibrate lower myopatthy |
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statins and pregnancy
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contraindicated
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cholestyramine monotherapy bad
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increased VLDL TG
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EtOH
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increased TG
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FIBRATES
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LPL, gallstones
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statins
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liver enzymes
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antianginals decrease O2 demand
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beta blockers, ca2 blockers, nitrates
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increase o2 supply antianginals
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vasodilators, ca2 blockers, statin, antithrombitcs, bypass
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adenosine
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reduce tachicardia
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atropine
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increase heart contraction
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nitrates
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pools blood in veins, decrease wall tension, relieves vasospasm, decreased platelet aggregation
nitrogylcerin patch-longer term rebound tachycardia dilation, dizziness, reflex tach |
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angina tx with nitrates
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acute, unstable, stable, variant
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ca2 channel blockers
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inhibits contraction
verapimil/diltiazem-cardiac and vasodilator activity high doses cause CHF (decreased HR, CO) be careful with beta blockers nifedipine(dihydropyridines)only vasodilator (variant, stable angina) no cardiac effect\ reflex tach arteriolar dilators peripheral edema |
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angina tx with ca2 blockers
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variant, stable
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beta blockers
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b1-metoprolol-decrease HR, SV, o2 demands, increase diastolic perfusion time
b2-propanolol-peripheral vasoconstriction block tach reflext by nitrates and ca2blockers not effective for vasospasm |
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beta blockers angina tx
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stable, unstable
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nitrates
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meningeal headaches, increase HR, cardiac force
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prophylactic for stable angina
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diltiazem
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diuretics
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reduce sodium, water, filling pressure
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digoxin
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increase Ca++
heart failure inotropic |
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dobutamine and milrinone
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increase cAMP, PKC, CA++
inotropic heart failure |
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ace inhibitors
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prevent angI--angII
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inhibit cardiac remodeling
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metoprolol
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stops aldosterone
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ace inhibitor and potassium sparing diuretic
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long term inotropic
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digoxin
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contraindicated in CHF
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ca2blockers
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digoxin milrinone dobutamine
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increase CO, force contraction
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diuretics/venodilators
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decrease preload,
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arterial vasoldilators
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decrease afterload
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increase cardiac output
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ace II/ANG II blockers
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decrease pre and afterload
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low dose beta blockers
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decrease SNS, bisprolol., carvediol, metoprolol
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digoxin MOA
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inhibts NA atpase
stimulates vagus nerv, decrease HR, od causes bradycardia and heart block systolic dysfx, fix and cause antoarrythmia |
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dobutamine MOA
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beta agonst, brings CA++ in
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digoxin tox cure
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K+ and Mg, reduced CA
increased quinidine increase dig toxicity because similar mechanisms |
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beta agonists
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dobutamine for acute CHF
increase contraction |
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milrinone/inamrirone
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increase contraction, vasodilator decreases pre and afterload
phosphodiesterase inhibitor acute chf |
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beta blockers
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stable chf
block RAAS, SNS |
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digtoxin bradycardia blocked by
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atropine
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gm-csf
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increase neutrophils in response to kidneys
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epo
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released by kidney in response to hypoxia
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b12 def
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neural problems
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b12, folate def
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macrocytic
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iron def
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microcytic
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iron tox
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emesis, lavage, chelator, bicarb
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etoh
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increase VLDL
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exacerbates gallstones
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gemfibrozil
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CPK affected
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statins
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raises HDL, lowers LDL
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niacin
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all angina tx
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nitrates
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stable unstable angina
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beta blockers
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variant and stable agina
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ca2 blockers
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nitrate side
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reflect tach, contractility
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cause orthostatic hypotension
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nitroglycerin/prazosin
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isoproterenol
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increase o2 demand, worsen angina
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nifedipine
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exclusiveley reduces afterload
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verapimil
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variant angina
causes tach |
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metoprolol
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decrease contractility
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nitroglycerin
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increase venous capacitance
rapid |
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chronic recurrent stable angina
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metoprolol
esmolol has short half life |
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beta blockers reduce chf mortality and negative inotropic effect
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carvediol, metoprolol ,bisprolol
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digoxin
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increase ef
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atropine
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counteracts dig bradycardia
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