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PCol I - Final Exam
blood/anticoagulants/antiplatelet/thrombolytic drugs
| Question | Answer |
|---|---|
| red thrombus | venous thrombosis --> usually due to blood stasis; has low platelet and high fibrin content |
| white thrombus | arterial thrombosis --> associated w/atherosclerosis; high platelet and low fibrin content |
| substance located in the subendothelial matrix that activates platelets when blood comes into contact with it in instances of vascular injury | collagen |
| extrinsic pathway requires what | tissue factor (something outside of blood) |
| common pathway b/w extrinsic and intrinsic pathways | Xa splits prothrombin into thrombin (factor V, PL, Ca present) |
| prothrombin time (PT) | time required for plasma to clot when exogenous tissue factor is added |
| fibrin digesting enzyme responsible for thrombolysis | plasmin (activated by t-PA from plasminogen) |
| converts fibrinogen to fibrin | thrombin |
| helps solidify platelet plugs to patch up small holes, insoluble | fibrin |
| vitamin K dependent factors (4) | II, VII, IX, X (2, 7, 9, 10) - synthesized in the liver; required for clotting cascades |
| white thrombus generally responsible for | for acute MI, stroke, etc; LDL usually involved |
| red thrombus generally responsible for | Deep vein thrombosis (DVT) and pulmonary embolism |
| three potential causes for red thrombus | vessel wall damage (hip/knee surgery), stasis, hypercoagulability |
| are antiplatelet drugs more effect for white thrombus or red thrombus related disorders | white thrombus (atherosclerotosis related) disorders more responsive to antiplatelet drugs (aspirin) |
| heparin | injectible anticoagulant; 5-50 kDa; accelerates antithrombin III (ATIII); inhibits thrombin (IIa) and Xa; requires PT monitoring - good for immediate relief |
| LMWH | low-molecular weight heparins; 1-10 kDa; accelerates ATIII; inhibits Xa, but NOT thrombin; more predictable than heparin; doesn't require PT monitoring - good for home use |
| critical length for binding pocket in antithrombin III (ATIII) | 5 units (highly acidic) - pentasaccharides |
| Fondaparinux | heparin derivative for prevention/treatment of VTE; once daily, predictable; doesn't bind platelets (no heparin-induced thrombocytopenia) |
| direct thrombin inhibitors - parenteral(3) | Hirudin – irreversible binds to thrombin; Bivalirudin – analog of hirudin; Argatroban – non-covalent reversible binding |
| direct thrombin inhibitors - oral (1) | Ximelagatran - non-covalent reversible binding, first oral form. |
| only FDA approved oral anticoagulant in US | warfarin - vitamin K antagonist |
| warfarin MOA | interferes w/synthesis of factors II, VII, IX, X, but their half-life is 8 - 60 hours so requires bridge therapy; target INR 2 - 3; initial PT changes due to depletion of factor 7, but takes a few weeks to turn over factor 10 |
Created by:
Krafty
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