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