Pharmacology Hemostasis And Thrombosis

Front 1

Phytonadione represents which Vitamin?

Back 1

Vitamin K1

Front 2

Is Phytonadione lipid or water soluble

Back 2

Lipid soluble

Front 3

Where is Phytonadione absorbed?

Back 3

proximal small intestine

goes from intestine to the lymphatic system

Front 4

What two things must be present for Phytonadione to be absorbed?

Back 4

Bile acids and pancreatic juice

Front 5

What type of process is the absorption of Phytonadione?

Back 5

Saturable and energy-dependent

Front 6

Where is phylloquinone (Phytonadione) concentrated? Where does it not accumulate?

Back 6

Concentrated in liver initially (conc declines rapidly)
Very little vit K1 accumulates in tissues

Front 7

Vit K mechanism of action?

Back 7

Promotes the maturation of coagulation factors
Factors II, VII, IX, X (Prothrombin)

Front 8

How are residues added to prothrombin in activation of prothrombin precursor?

Back 8

Carboxylation of glutamic acid residues of prothrombin

Front 9

What is formed after the residues are added to prothrombin in the activation of prothrombin precursor?

Back 9

Forms gamma-carboxyglutamate residues

Front 10

Formation of gamma-carboxyglutamate residues in activation of prothrombin precursor allows what to happen? What element is required?

Back 10

Allows prothrombin, IIa to be localized at negatively-charged phospholipid surfaces

also requires Ca++

Front 11

Dosage forms of Vit K? (2)

Back 11

Oral and parenteral

Front 12

Vit K usage (4)

Back 12

*Treatment of anticoagulant toxicity
*Hypoptrothrombinemia associate with
-Obstructive jaundice
-Hepatocellular damage
*Prevention of hemmorrhagic disease in newborn

Front 13

Heparin is highly positively or negatively charged?

Back 13

Negatively!

Front 14

Where is heparin found?

Back 14

Secretory granules of mast cells

Front 15

LMW heparin is prepared from..?

Back 15

unfractionated heparin

Front 16

unfractionated heparin is administrated in what form?

Back 16

Parenteral
-SQ or IV

not absorbed from GI tract because of charge and large size

Front 17

Where is unfractionated heparin metabolized and excreted?

Back 17

Metabolized in liver and excreted in the urine

doesn't cross placental or transfer into maternal milk

Front 18

Vit K works through activation of...?

Back 18

Prothrombin precursor

Front 19

Heparin inhibits blood clotting with ..?

Back 19

antithrombin III

-Naturally occuring inhibitor of thrombin IIa
-Heparin-antithrombin III complex (Can't access thrombin bound to fibrin clots or to cells)

Front 20

Heparin also release and stablizes .... from tissues

Back 20

Lipoprotein

Front 21

Lipoprotein lipase hydrolyzes substances bound to ..... cells?

Back 21

Lipoprotein lipase hydrolyzes substances bound to capillary endothelial cells

Substances include: triglycerides, chylomicrons, VLDLs

to form fatty acids and partial glycerides

Front 22

Heparin is available in what forms? (3)

Back 22

IV
SQ
Intrapulmonary administration of aerosolized heparin

Front 23

How is heparin monitored?

Back 23

APTT

Activated partial thromboplastin time

Front 24

What are the toxicity side effects of heparin? (5)

Back 24

1) Hemorrhage - chief danger
2) Osteoporosis and spontaneous fractures
3) Hypersensitivity reactions (chills, fever, urticaria, anaphylactic shock (rare))
4) Transient alopecia
5) Heparin-induced thrombocytopenia

Front 25

In HIT type I, ..... are targeted for removal from circulation and the ...... count decreases by 50-75%

Back 25

antibody coated platelets
platelet count

Front 26

Upon heparin withdrawal in HIT type 1 what happens?

Back 26

transient and rapid reverse of thrombocytopenia

Front 27

In HIT type 2, ......... induced antibodies not only target platelets for destruction but also act as ........ to ...... the platelets.

Back 27

heparin induced antibodies
act as agonists to activate the platelets

..leading to platelet aggregation, endothelial injury, and potentially fatal thrombosis

Front 28

Is there a higher incidence of HIT in patients receiving unfractionated heparin or in LMW heparin?

Back 28

Higher incidence of HIT in patients recieving unfractionated heparin

Front 29

Antidote for heparin toxicity

Back 29

Protamine sulfate

Front 30

Contraindications for heparin (5)

Back 30

Bleeding tendencies
Threatened abortion
Recent brain or cord surgery
Renal disease
Severe hypertensive disease