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absite heme
| Question | Answer |
|---|---|
| what's initial response to vascular injury | vasoconstrict, plt adhesion, thrombin generation |
| steps of intrinsic coag pathway | exposed collagen, prekallikrein, HMW kininogen+F12 ->11,9,8 then 10 and 5 (then common) |
| steps of extrinsic coag pathway | tissue factor from injured cells+F7 -> 10 and 5 |
| common steps of intrinsic/extrinsic pathway | 10/5 converts prothrombin (F2) to thrombin, which converts fibrinogen to fibrin |
| components of prothrombin complex | F10,5, platelet factor, Ca++, prothrombin --> this then catalyzes thrombin |
| what does tissue factor inhibitor do | inhibits F10 |
| plt plug composed of | plts and fibrin |
| what does F13 do | crosslink fibrin |
| what does thrombin do (2) | converts fibrinogen to fibrin and fibrin spit products, activates plts |
| what does AT3 do | inhibits thrombin, inhibits F9,10,11…key bc heparin binds to this |
| what does protC do | degrades F5,8 and fibrinogen |
| what does protS do | protC cofactor |
| what are steps of fibrinolysis | tissue plasminogen activator (TPA) is rel from endothel and converts plasminogen to plasmin, that degrades F5,8,fibrinogen and fibrin that causes plt plug to degrade |
| what is alpha2 antiplasmin | inhibitor of plasmin, released from endothelium |
| which coag F has shortest t1/2 | F7 |
| which coag factor not synthesized in liver | F8 |
| which factors are labile and lost in stored blood but not FFP | F5,8 |
| vit K dependent factors | F2,7,9,10, prot C,S |
| how long does FFP coagulation last | 6hrs and effect is immediate |
| prothrombin is aka F what? | F2 |
| t1/2 of RBC | 120d |
| where is prostacyclin made? Role? Aka, what does it antagonize | PGI2, endothelium, decreases plt aggreg and promotes vasodilation (antagonizes TXA2) |
| where is TXA2 made? Role? Aka, what does it antagonize | plts, increases plt aggreg and vasoconstrict, triggers rel of Ca++ in plts exposes GpIIb/IIIa and causes plt-plt binding and plt-coll binding; activates PIP to further incrs Ca++ |
| when use Cryoppt | VWD and hemoA bc VWF and F8 |
| what's in FFP | basically all coag factors, AT3 |
| what do DDAVP and conjugated estrogens do? | cause rel of F8 and VWF from endothel |
| PT measures which factors | extrinsic, 7 + common 2 (prothrombin), 5, 10, fibrinogen |
| PTT measures which factors | most F exc 7, 13 |
| goal PTT for most anticoag | 60-90 |
| ACT for most anticoag, for CPB | 150-200, 460 |
| INR contraindication for surgery; INR for central line, perQ needle bx, eye surgery | 1.5; 1.3 |
| 4common causes incrsd PTT | Hemophilia A, VWD, DIC (also incrsd PT, BT, etc), anticardiolipin but won't correct w mixing |
| common causes incrsd PT | liver dz, DIC (also warfarin) |
| what does thrombin time measure | fibrinogen |
| when is ristocetin plt aggreg decrsd | vWD, Bernard Soulier |
| when is ADP, epi, collagen time abnl | Glanzmann |
| MC causes abnl bleeding | incomplete hemostasis |
| what does VWF do | link GpIb R on plts to collagen |
| labwork in VWD | nl PT, long BT, ristocetin test abnl and does resolve w plasma |
| VWDI and tx | I: AD, MC, mild sympt w decrsd quantity VWF, tx=DDAVP |
| VWDII and tx | AD, defect in molecule itself, tx: recombinant F8;vWF, cryo |
| VWDIII and tx | AR, more severe bleeding, reduced quantity, tx=DDAVP, recombinant, cryo |
| labwork in HemoA, which F defic? | long PTT, F8 defic (but this F crosses placenta so circumcision could be nml) |
| what levels req'd HemoA preop, postop | preop need be 100%, post op 30% |
| what is christmas dz | hemoB (F9) defic |
| inheritence HemoB | sexlinked recessive (like HemoA) |
| tx HemoB | recombinant F9 or FFP |
| labwork in F7 defic | long PTT, nml PT |
| tx F7 defic | F7 concentrate, FFP |
| at what level of F7 defic does spont bldg occur | <1% |
| 2 MC causes of acquired thrombocytopenia | H2 blockers, heparin |
| problem in Glanzmann's, tx | GpIIb/IIIa so plts can't bind to ea other, tx=plts |
| problem in Bernard-Soulier, tx | GpIb plts can't bind to coll, tx=plts |
| how ticlodipine works, tx | decrses ADP in plts, prevents exposure of GpIIB/IIIA (for plt aggreg), tx=plts |
| how dipyridamole works, tx | inhibits cAMP ->decrses ADP induced plt aggreg, tx=plts |
| how pentoxifylline works, tx | inhibits plts aggreg; tx=plts |
| how does clopidogrel (Plavix) work | ADP R antagonist, tx=plts |
| how do PCN and cephalo affect plts | binds plt so can incrs bldg time |
| what plt# nec before surgery, after | 50K before, 20K after |
| what happens to coag s/p prostate surgery, why? Tx? | rel of urokinase activates plasminogen leading to thrombolysis, tx=amicar |
| best way to predict bldg risk | H&P |
| which Ab is in HIT | IgG PF4 ab to plts |
| characteristics of DIC (labwork); tx | low fibrinogen, high fibrin split products, high D dimer, decrsd plt, long PT and PTT…often initiated by tissue factor. Tx=underlying cause |
| MC hypercoag inherited | F5 leiden, resistance to activated prot C |
| tx F5 leiden | heparin, warfarin |
| name 7 hypercoag states | F5Leiden, hyperhomocysteinemia, prothrombin defect, Prot C/S, AT3 defic, polycythemia vera, Lupus |
| tx AT3 defic | can't use hep, need recombinant AT3 of FFP followed by heparin or hirudin, warfarin |
| what goal Hct, Plts for Polycythemia vera; tx | Hct<48, plts <400; tx=ASA |
| what is the gene defect in prothrombin | G20210A |
| what's the tx for most inherited procoag; what are the exceptions | heparin, warfarin, exc are homocys (folate, b12) and polycyth vera (ASA) |
| tx for homocysteinemia | folate, B12 |
| labwork for lupus anticoag | long PTT, +Russell viper venom, false + syphillis RPR |
| if >55 and venous thrombotic lab/gene w/u negative you should | CT scan for cancer |
| what is w/u arterial thrombosis | venous w/u + TTE w bubble looking for shunt, lipid panel and lipoprotein a |
| what causes hypercoag state s/p CPB | F12 (hageman) activation |
| what is cause of warfarin induced skin necrosis | protC and S have short t1/2 |
| key elements of venous thrombosis | Virchow's triad: stasis, endothel injury, hypercoag |
| key element arterial thrombosis | endothelial injury |
| tx DVT depending on whether provoked | provoked=3-6mo, unprovoked 1st: 6mo, 2nd 1yr or life |
| inherited thrombotic dz and no h/o DVT, tx? What if DVT | no tx if no DVT, otherwise anti coag |
| indications greenfield | contraindications to anti coag, PE while on anti coag, s/p pul embolectomy, free floating ileofemoral, IVC or femoral DVT |
| how many of + V/Q have negative U/S | 1/3 |
| mech of warfarin | prevents vit K dependent decarbosxylation of glutamine residues on vit K dependent coag factors |
| which crosses placenta: hep or warfarin | warfarin |
| where does hirudin come from? Type of anticoag? | leeches, direct thrombin inhibitor |
| longterm SE heparin | osteoporosis, alopecia |
| protamine cross reacts w what in DM pts | NPH insulin |
| which is a revesible direct thrombin inhib | bivalirudin |
| which pts be careful of argatroban in | liver pts |
| where does ancrod come from? What does it do? | from Malayan pit viper venom, stimulates tPA |
| how does amicar work, when is it used | an antifibrinolytic that inhibits plasmin, used in DIC and s/p CPB |
| name 3 thrombolytics, which has highest antigenicity | streptokinase (high Ag), urokinase, tPA |
| how does dextran work as anticoag | inhibits plts and coag factors |
| how reverse hep (Dose) | protamine 1-1.5/100U or 1mg hep |
| how is hep cleared | reticuloendothelial system |
Created by:
ehstephns
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