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Pharm BMED 575


What is the initial step in hemostasis? Vasospasm (vascular constriction)
What is the second stage of hemostasis? Platelet adhesion, activation and aggregation
What is the final step of hemostasis? Fibrin formation and reinforcement of the platelet plug.
What are the three phases in hemostasis? vascular, platelet and coagulation
What initiates the immediate smooth muscle contraction of a vasospasm? exposure to plasma
What chemical released by platelets contributes to vasospasm? thromboxane A2
What chemical produced by intact endothelium is so short acting that disruption of its continuous production contributes to vasospasm? the vasodilator nitric oxide
Describe how serotinin contributes to vasospasm (notes aren't clear, need to look in book)
Name three substances produced by the endothelium that contribute to inhibition of clotting Nitric oxide, heparin sulfate, PGI2
Name three circulating factors that inhibit the clotting cascade antithrombin (ATIII), protein C and S, TFPI
What is TFPI tissue factor pathway inhibitor
Does TFPI reduce clotting or reduce bleeding? TFPI contributes to hemostasis by inhibiting excessive clotting
What precursor is PGI2 a metabolite of? arachidonic acid
Where is PGI2 produced? endothelial cells
What function does PGI2 have? inhibits platelet aggregation and secretion
Is PGI2 a procoagulant? No, PGI2 acts to inhibit clotting on the interior of the vascular system
Where does nitric oxide come from NOS (nitric oxide synthase) in EC
What effect does NO have? vasodilation and platelet inhibition
What role does antithrombin play? ATIII inhibits activated clotting factors
EC produce what compound that accelerates the activity of ATIII heparin sulfate
Protein C is a plasma zymogen or cofactor? zymogen
Protein S is plasma zymogen or cofactor? cofactor
What role does protein C and S play in hemostasis? they degrade Va and VIIIa
How do protein C and S work and where The activity of protein C and S rely on the presence of thrombin at the thrombomodulin docking site at the EC
Where is TFPI found? tissue factor pathway inhibitor is a circulating antithrombotic (reduces clotting) plasma protein
What portion of the plasma is TFPI found? the lipoprotein fraction
Who does TFPI act on? binds and inhibits Xa
What stimulates platelets to create a clot? exposed collagen
what do platelets that have adhered to exposed collagen release? activated platelets release thromboxane A2 and ADP
What receptor plays a role in platelet adhesion? GPIIb/IIIa
what stimulates fibrinogen to convert to fibrin? thrombin
What stimulates prothrombin to convert to thrombin? Xa
Protein C in the presence of thrombin at the thrombomodulin site on EC converts to protein C (act), what clotting factors does protein C (act) down regulate? XIa, IXa, Xa
what factors are inhibited by heparin? VIIa, XIa, IXa, Xa and most importantly IIa
Where do oral anticoagulants work? decrease production of zymogens II, VII, IX and X
What drug does the aPTT monitor? heparin
What pathway is aPTT specific for? the intrinsic pathway
Why is a protime specific for warfarin dosing? Because only warfarin affects factor VII production
What pathway is the PT/INR specific for? extrinsic
what activity does plasmin accomplish? Plasmin breaks down fibrin
Created by: lisamccunesSS