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104 Cards in this Set
- Front
- Back
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Factors present in the clot promote wound healing by signaling other cells (phagocytes) to carry offy waster products and dead cells that accumulate at the site of injury. This protective mechanism (_____) is always functioning to maintain homeostasis.
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hemostasis
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Ocassionally, the mechanism of clot formation becomes too active or the blood vessels become too narrow (atherosclerosis) to allow the clots to pass through easily. As a result, clots may become jammed in blood vessels, forming a _______, which prevent sthe normal flow blood to other tissues. The heart, the lungs and the brain are especially susceptible to damage caused by a loss or reduction in blood flow subsequent to thrombosis.
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thromboembolism
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______ are used to prevent venous cloting in patients who have thromboembolic disorders because these drugs interfere with the ability of the blood to form stable clots.
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anticoagulants
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Many substances in the blood, such as _____ and clotting factors are responsible for intitiating coagulation.
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platelets
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When an injury occurs, platelets (thromocytes) immediately migrate to the damaged area. Because platelets stick to each other (aggregation) and to the vessel walls (adhesion), they form a plug around the injured tissue. Plasma clotting factors reach the platelet plug and interact with each other to form a _____ blood clot.
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stable
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_____ is the balance between clot formation and clot breakdown that occurs throughout the day.
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Hemostasis
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Stage 1. ____ is produced by two different mechanisms- the intrinsic and extrinsic systems.
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thromboplastin
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The _____ system requires many clotting factors and platelets to stimulate production of thromboplastin.
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intrinsic
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The _____ system requires factor VII and tissue extract, a substance that is released from injured cells.
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extrinsic
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Stage 2. Thromboplastin converts prothrombins to ____.
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thrombin
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Stage 3. Thrombin converts fibrinogen to ___ and activates several clotting factors (V, VIII, XIII, an protein C).
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fibrin
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Fibrin is the primary element of a blood clot, and these activated factors (V, VIII, XIII, and protein C) build up a fibrin ____ that holds the platelets (developing clot) together. The factors necessary for clot formation require calcium ions in order to function efficiently. The clot is dissolved once the function has ended.
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mesh
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Stage 4: ____ is formed from the conversion of plasminogen by tissue plasminogen activator (tPA). It is an enzyme that acts upon the fibrin elements to produce a more soluble product.
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Plasmin
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Antiplatelet drugs inhibit platelet aggregation, so the platelet plug does not form, or they block platelet ____ so plug does not attach to the wall of the blood vessel and block blood flow. These drugs make the platelets less sticky by directly attaching to membrane-bound receptors and by interfering with enzymes that express platelet function.
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adhesion
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Antiplatelet drugs include ____, dipyridamole, clopidogrel and ticlopidine.
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aspirin
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____ primarily inhibit plasma clotting factors. These drugs either block the formation of special proteins that are part of the coagulation cascade, or they attach to the preformed protein and isable it from performing its normal function.
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anticoagulants
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_____ and the antithrombin inhibitors bind to circulating clotting factors, thromboplastin and glycoprotein IIa and prevent thrombin formation or the coagulation cascade that thrombin activates.
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Heparin
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Heparin and the coumarin derivatives are most frequently employed to prevent venous thrombosis, especially pulmonary embolism. These agest are used in the therapy of myocardial infarction, _____ (inflammation of the walls of the veins), and stroke.
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thrombophlebitis
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Standard ____ is always the preferred drugs when an anticoagulant must be given to a pregnant woman.
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heparin
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Heparin is a naturally occuring _____ first identified in 1928. Then, as now, the main source of heparin is extraction from the lungs and intestines of cattle and pigs.
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mucopolysaccharide
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Standard hepain, also called _____ heparin, contains the full complement of saccharides of endogenous heparin.
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unfractionated
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Several _____ heparins are derived from porcine heparin but only contain an active anticoagulant fraction of heparin
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low molecular weight
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All heparins bind to thromboplastin (factor III) and then proceed to inactivate factor ___.
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X
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Although the LMX heparins are more effective at binding active factor X, standard heparin is more effective at inactivation factor ____(fibrin-stabilizing factor) and finding thrombin (active factor II).
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XIII
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Unlike the LMW heparins, standard heparin also depresses platelet _______.
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aggregation
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Standard heparin, therefore, is usually administered intravenously or subcutaneously. LMW heparins are only administered ______. Intramuscular injection should be avoided because painful hematomas can occur.
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subcutaneously
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In patients with normal renal function, the LMW heparins can be dosed based on what without coagulation test monitoring. Standard heparin requires periodic coagulation monitoring to adjust the therapeutic dose, minimize the bleeding potential and maintaining adequate clot suppresion.
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body size
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Standard always in ___.
LMWH in ____ or ___. |
units
units or mgs |
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In addition to the anticoagulant action, heparin and ____ have the ability to clear fatty molecules from the plasma.
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ardeparin
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Heparin stimulates an enzyme (lipoprotein lipase) that hydrolyzes the _______ in the blood. This enzyme reaction reduces large fat molecules in the plasma.
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tryglycerides
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Eventually, heparin is metabolized by ____ or excreted unchanged into the urine. Patients with renal impairment or kidney disease tend to accumulate heparin because they cannot efficiently clear it from the blood.
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liver
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The major toxicity associated with the used of heparin is _____. At high levels, heparin causes bleeding to occur in mucous membranes (petechiae) and open wounds, such as scratches, cuts, abrasion.
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hemorrhage
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The is the term used for bleeding occuring in the mucous membranes
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petechiae
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If hemorrhage occurs in the GI membranes, patient's blood pressure and _____ may fall even though there are no external signs of bleeding.
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hematocrit
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What is the antidote for standard heparin toxicity? This drug binds to the heparin molecules and inhibits the anticoagulant action. It should always be accompanied by coagulation tests to determine the degree of clot suppression that is present
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Protamine sulfate
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Other side effects seen with any chronic ____ use include hypersensitivity, fever, alopecia (hair loss), osteoporosis, and thrombocytopenia (decrease in the number of blood platelets),j
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heparin
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_____ is confirmed by a reduction in platelets by 50 percent, within 2 weeks of initiating treatment.
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thrombocytopenia
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With thrombocytopenia, decrease in platelets appears to be mediated through an immune response. Heparin complexes with platelet factor 4(PF-4) and binds to the platelet membrane. I is this complex that is ______.
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immunogenic
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LMW heparins and heparinoids have an additional warnign in the product use lable which identifies a potential risk of developing epidural or spinal hematomas when these anticoagulants are administered to patients receiving _____ or ____ anestheisia. The risk of irreversibgle paralysis from the spinal hematoma is increased when the patient is also receiving additional anticoagulants, and nonsteroidal antiinflammatory platelet inhibitors.
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epidural
spinal |
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Thrombin inhibitors (_____,____,____) reversibly bind with thrombin and reduce the thrombin-catalyzed activations of factors V, VIII, XIII, protein C and platelet aggregatioin.
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lepirudin, argatroba, anhd bivalirudin
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These thrombin inhibitors are highly selective for thrombin and are indicated specifically for the prophylaxis and treatment of heparin-induced ______. Coagulation is suppressed while heparin is withdrawn.
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thrombocytopenia
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Thrombin inhibitors are synthetic (____) or recombinant rDNA hiriudin (lepirudin) that mimic the anticoagulant activity of polypeptides extracted from leech salive.
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argatroban
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_____ is approved for use in patients with unstable angina who are undergoing percutaneous transluminal coronary angioplasty and concurrently taking aspirin for platelet inhibition.
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Bivalirudin
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The coumarin derivatives include ____ and warfarin sodium.
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dicumarol
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_____ (bishydroxycoumarin) was originally discovered as a product of spoiled sweet clover. Cattle that grazed on the contaminated clover developed hemorrhagic disease. In addition, people who drank the milk from these cows developed hemorrhages because they ingested the active anticoagulant substance.
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dicumarol
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the coumarins are significantly different from heparin because they can be administered oraly. For this reason, these drugs are usually referred to as the oral anticoagulants. The oral anticoagulant of choice is ____ _____.
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warfarin sodium
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The oral anticoagulants are highly bound to plasma _____ and are eventually metabolized by the liver.
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proteins
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____ is always the major toxicity associated with the use of an anticoagulant.
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hemorrhage
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____ (blood or red blood cells in the urine), bleeding of the gums, and petechiae are common side effects that reflect local hemorrhaging
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hematuria
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In the presence of hemorrhage, the action of the coumarins cannot be rapidly reversed by merely dicontinuing the drug. The antidote for overdose includes 2.5 -25 mg of ______ (phytonadione) given parentally (usually IM, SC). Because the mechanism of action involves synthetic pathways in the liver, administraiton of phytonadione cannot be expected to produce immediate results.
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vitamin K
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In severe hemorrhage, fresh whole blood or ____ may also be administered to provide a full complement of normal clotting factors.
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plasma
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Other side effects accompanying the use of oral anticoagulants include nausea, diarrhea, _____, and alopecia. To reduce GI distress, large doses of oral anticoagulants may be administered in divided doses.
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urticaria
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____ of any type are contraindicated in patients with subacute bacterial endocarditis, ulcerative lesions (GI), visceral carcinoma, threatened abortion, severe hypertension, and recent surgery on the brain or spinal cord.
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anticoagulants
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Any patient with active bleeding tendencies should not receive anticoagulants. _____ are contraindicated in patients with a hypersensitivity to individual heparins, pork products, sulfites, benzyl alcohol, or heparin-induced thrombocytopenia.
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heparins
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The oral anticoagulants should not be used in patients known to be _____ deficient
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vitamin K
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Administration of oral anticoagulants during pregnancy will result in a phenonmenon known as what?
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hemorrhagic diseas of the newborn (HDN)
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Intravenous administration of vitamin K (phytonadione) is not recommended because sever anaphylactic type reactions have occured. However, if the intravenous route must be used, the _____ must be injected slowly, not to exceed 1 mg per minute.
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phytonadione
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Natural _____ promotes syntheis of prothrombin (factor II), proconvertin (factor VII), plasma thromboplastin component (factor IX), and Stuart factor (X).
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vitamin K
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Vitamin K(phytonadione) and vitamin K3 (menadione) are fat soluble, whereas ______ (menadiol) is water soluble.
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Vitamine K4
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The ____ (anisindione) are oral anticoagulants that produce essentially the same pharmacological actions as the coumarins.
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indandiones
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Afer administration of indandiones the toxic reactions may include fever, rash, hepatitis, renal damage, and ______.
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agranulocytosis
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After oral administration of indandiones, these drugs color the urine ______, which may resemble hematuria. This discolorization is of no clinical importance, but it may alarm patients if the side effect as not been explained.
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red-orange
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The class of oral ______ drugs include aspirin, dipyridamole, clopidogrel, and ticlopidine. All of these drugs are well absorbed following oral administration.
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antiplatelet
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______ interfere with platelet activity causing a balance between prostacyclin and thromboxane A2 activity keeps the platelet plugs from significantly blocking blood flow and oxygenation of the tissues.
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antiplatelets
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Aspirin is doses from 81 mg (baby aspirin) to 325 mg (adult aspirin) irreversibly alters platelet ______.
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cyclooxygenase
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_______ cannot be generated until new platelets are formed which inhibits vasoconstriction and platelet aggregation.
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Thromboxane
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_____ (Plavix) and _____ (Ticlid) inhibit platelet aggregation by blocking adenosine diphosphate (ADP) binding to membrane receptors and preventing ADP activation of glycoproteins IIa/ IIIb in the coagulation cascade. These drugs irreversibly modify the receptor so the platelet cannot respond to ADP for the rest of its life span (8-10 days) They prevent stroke and MI.
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Clopidogrel
Ticlopidine |
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_____ (Persantine, Aggrenox) is a weak antiplatelet inhibitor. It reversibly interferes with platelet aggregation by increasing adenosine, an inhibitor of platelet reactivity, and inhibiting phosphodiesterase with in the platelets, it prevents thromboembolism
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Dipyridamole
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____ is the most inexpensive, effective antiplatelet drug recommmended by physicians to reduce the incidence of clots that might injure the heart.
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Aspirin
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_____ is significantly more costly than aspirin and is used to reduce MI, stroke, and death, especially in patients who are sensitive to GI bleeding induced by aspirin.
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Clopidogrel
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____ is only used for prevention of thromboembolism after heart valve replacement surgery.
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Dipyridamole
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The _____ drugs are used in combination to produce clinically significant reductions in reinfaction and death following MI in men. The same clinical benefit has not been shown to occur in women post myocardial infarction.
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antiplatelet
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Common less serious side effects associated with ____ drugs are similar to aspirin and include HA, vomitting, rash, diarrhea, and dizziness.
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antiplatelet
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_____ and ______ can produce sever thrombocytopenia, a dramatic reduction in platelets that does not allow the patient to clot so internal bleeding occurs.
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Ticlopidine
Clopidogrel |
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Chelating drugs, such as edetic acid (ethylenediaminetetraacetic acid (EDTA) and ____ acid, bind calcium ioins so that the coagulation schem is interrupted. These agents are not routinely employed as systemic anticoagulants.
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oxalic
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____ acid in particular is present in commercially prepared test tubes to prevent the coagulation of blood taken for routine hematological tests.
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oxalic
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Peripheral vascular disease includes ____, a condition in which thrombi form within the lower extremeties usually as a result of poor circulation. Patients who are recuperating from surger (hip and knee replacement), orhave chronic inflammatory illness such as Chrohn's disease, or women during pregnancy are more likley to develop this.
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DVT deep vein thrombosis
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The most significant clinical risk in DVT is that thrombi will break loose, enter the circulation within the lungs and block critical blood flow within the pulmonary system. This blockage could lead to tissue death due to stagnant blood flow and interrupted oxygenation of the tissues (ischemia). ______ can be a life threatening condition.
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pulmonary embolism
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"_____ _____" syndrome is a genuine condition associated with inactivity especially during long air flights, but it is not restricted tot he economy section of the plane. Dehydration, through increased alcohol intake or reduced water consumption, reduces the blood volume (makes if relatively thicker) and fosters an environment of stasis and local clot formaiton
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Economy Class
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____ is approved for prophylaxis and treatment of venous thrombosis, and emboli associated with peripheral arteries and atrial fibilation. It is also indicated for prevention of post-op DVT and pulmonary embolism
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Heparin
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______ heparins are approved for use in prevention of DVT in selective procedures as follows: ardeparin(knee replacement), dalteparin (abdominal surgery), and enoxaparin (knee and hip replacement and abdominal surgery).
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low molecular weight
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Oral ____ are approved for used in prophylaxis and treatment of venous thrombosis, pulmonary embolism and atrial fibrillation with emolization.
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anticoagulants
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Anticoagulants and ____ drugs are also indicated in coronary artery disease, to prevent heart attack, stroke, or angina. Antiplately drugs are routinely used in angioplasty and coronary stents to keep arteries previously obstructed by blood clots clear.
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antiplatelet
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Any drugs that are known to affect platelet aggregation will probably cause increased ____ when taken concomitantly with heparin. Such drugs include nonsteroidal antiinflammatory drugs (aspirin, ibuprofen, indomethacin, phylbutazone), dextran, and high doses aof penicillin. and digetalis and tetracyclin.
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bleeding
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Heparin is often administered by intermittent intravenous infusion. concomitant parental medications should not be administered into the heparin infusion line (____) to avoid potential incompatibility reactions that would inactivate the anticoagulants.
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piggyback
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When drawing blood, especially for the purpose of evaluating patients' coagulation status, sample should always be taken form the _____ arm (non-iv line) to avoid false activated partial thromboplastin time (APTT) values.
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opposite
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Among the tests used to monitor ___ status are whole blood clotting time, partial thromboplastin time (PTT), prothrombin time (PT), and the international normalized ration (because commercial thromboplastin response to anticoagulants vary greatly between batches. The INR calibrates the commercial rabbit thromboplastins against an international human reference standard.)
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coagulation
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____ enzymes are used to dissolve preformed blood clots and therefore are called clotbusters. These enzymes stimulate the synthesis of fibrinolysin which breaks the clot into soluble products.
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thrombolytic
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Alteplase, also referred to as tissue plasminogen activate (tPA), and reteplase are thrombolytic enzymes produced through the biotechnology of recombinary ____.
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DNA
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____ is a purified glycoprotein (527 amino acids) that binds to fibin within the clot, stimulates conversion of plasminogen to plasmin, and initiates clot dissolution (fibrinolysis).
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Alteplase
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______ _____ are used to lyse pulmonary emboli and coronary artery thromboses during acute MI. To receive maximum benefit, the enzymes must be administered as soon as possible following indications that a clot or infarct has occured.
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Thrombolytic enzymes
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The major advers effect associated with the use of thrombolytic enzymes is ? Other include allergic reactions include skin rash, itching, nausea, headache, fever, bronchospasm, or musculoskeletal pain.
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hemorrhage
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Contraindications to the use of ______ drugs include conditons such as active internal bleeding, cerebral vascular accident with in the past 2 months, intracranial aor intraspinal surgery, or intracraial tumors.
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thrombolytic
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Alteplase and reteplase ahve been associated with cardiogenic shock,_____, and recurrent ischemia amond the reported adverse effects; however, these are frequent sequelae of myocaridal infarction and may or may not be attributable to the drug.
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Arrhythmias
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Thombolytic enzymes are approved for use in the management of acute myocardial infarction, acute, ischemic stroke, and pulmonary embolism. Streptikinase is also approved for ___ of deep vein thrombosis.
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lysis
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Streptokinas and urokinas ahve been used for clearance of ____ ateriovenous cannulae or IV catheters obstructed by clotted blood or fibrin.
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occluded
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____ has the added requirement that it be protected from excessive exposure to light. None of these enzyme infusion solutin should have other medications added to them.
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Alteplase
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Aminocaproic acid (Amicar) inhibits fibrinolysin activation in situations when excessive clot dissolution is occuring. At a dose of 5 g orally or IV, aminocaproic acid promotes clotting and appears to concetrate in the newly formed _____ so no dissolution can occur.
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thrombus
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The major danger with the use of ______ acid is the production of generalized thrombosis. Otherwise, the side effects include HA, diarrhea, cramps, and rash.
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aminocaproic
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______(Thrombogen, Thrombostate), obtained from cattle, is a direct activator of fibrin formations. this plasma protein initiates clot formation when applied topically to actively oozing injuries.
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Thrombin
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____ is never administered intravenously due to the potential danger of generalized thrombosis or antigenic reactions.
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Thrombin
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Gelatin spone, gelatin file, and oxidized dellulose expand in contact with large amounts of blood. These gause or sponse preparation also permit ____ to occur along their surfaces when used as wound dressings and surgical packings.
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clotting
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_______ cellulose, in particular, cannot be used as a permanent implant because it interferes with bone regeneration. It may also produce cyst formation and reduce epitelialization (healing )of surface wounds.
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oxidized
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What pregnancy catagory are oral anticoagulants?
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X
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