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Physio III - Final Exam - Groups 9 & 10
Terms in this set (47)
What are the 2 important roles of von willebrands in the coagulation cascade?
1. binds to GpIb when vessels are damaged
2. stabilizes factor VIII
what is the most common inherited bleeding disorder occurring in 1% of the population?
von willebrands disease
which type of vWD is considered "classic" is is the most common. This type has a quantitate defect in plasma vWF levels
type 1 vWD
which type of vWD is considered "variant" and is a qualitative defect in plasma vWF that has 4 different subtypes based on the domain of the protein being affected
type 2 vWD
what are the 4 subtypes of type 2 vWD?
A, M, B, N
Which subtype of type 2 vWD do you not give DDAVP to?
which type of vWD is considered "severe" and is described as the virtual absence of circulating vWF, low levels of vWF activity and factor VIII
type 3 vWD
What is the most common sign and symptom of vWD?
mucocutaneous bleeding (epistaxis, menorrhagia, prolonged bleeding from minor wounds/dental extractions)
Which type of vWD is the only one that will likely cause spontaneous hemorrhage in joints and soft tissues?
true or false: PT/aPTT lab tests are often normal in patients with vWD
BUT...aPTT can be prolonged depending on levels of VIII
What 2 laboratory tests besides PT and aPTT can be done to help determine severity of vWD?
RPFA (rapid platelet function assay)
true or false: patients with mild vWD generally have near-normal test basic results, but in those with more severe disease the RPFA is normal and the platelet count is lower.
false = in severe vWD the RFPA is prolonged and platelet count is normal
All of the following can be used as therapeutic management of a patient with vWD except...
E. Humate P
What agent stimulates release of vWF and FVIII activity when given IV in order to enhance platelet function and shorten bleeding time?
true or false: DDAVP can be used to manage patients with mild hemophilia A under going minor surgery
DDAVP partially corrects platelet functional abnormalities due to which 4 things?
3. liver disease
4. glycosylphosphatidyl glycan Ib/IIIa inhibitors
true or false: DDAVP has a mild antidiuretic effect
What is contained in cryoprecipitate?
factors VIII and XIII
true or false: treatment of hemophilia A means you can treat vWD
false - it doesn't
All of the following are true regarding DDAVP except:
b. can increase vWF 3-5 time their original value
c. lasts 48 hours
d. helps control bleeding in tooth extractions or minor surgeries in vWD and mild hemophilia A patients
C. = lasts 12-24 hours
Which drug mimics endogenous ADH and acts on selective V2 receptors expressed the renal collecting duct to increase water reabsorption and reduce urine production?
true or false: cryo can transmit infection
true = so give purified commercial preparation of factor VIII-vWF concentrate
Plavix, Effient, and Brilinta all have a MOA to inhibit _______ dependent platelet aggregation
all of the following are adverse effects of ASA except:
A. prolonged bleeding
C. heart burn
All of the following are adverse effects of Plavix/Effient/Brilinta except:
ASA irreversibly inhibits what 3 things?
what can cause inactivation of Plavix?
Heparin binds to ______ and enhances its inactivation to factor _______
Which of the following is not an adverse effect of heparin?
what are 3 adverse effects of LMWH?
1. bleeding duhhh
What is the reversal for Xarelto?
what are 3 examples of anti-factor Xa inhibitors?
which anti-factor Xa inhibitor has an increased risk of stroke?
Which drug agent directly binds to the active site of thrombin and thereby inhibits its downstream effects?
direct thrombin inhibitors are approved for use in patients with ________, and are initially formulated from what??
What are some adverse side effects of warfarin?
-purple toe syndrome
which anticoagulant was initially used as pesticides for rodents?
All of the following are considered bleeding risk factors except:
B. older age
F. prior stroke or PVD
H. renal/hepatic dysfunction
A. = its actually females
What does "CHADS2" mean?
C = CHF
H = Hypertenison
A = Age >75
D = diabetes
S2 = Stroke or TIA
risk factor scale for thromboembolism
0-2 = low
3-4 = moderate
5-6 = high risk
What agents are used for bridge therapy in terms of anticoagulant use?
short term anticoagulants (LMWH) used during interruption of longer acting agents (warfarin)
Bridging therapy for patients with high risk of thrombosis reduces the risk of ________ by tp to 80%
you should stop warfarin about ______ days before procedure
-start within _____ hours after last warfarin dose
-if twice daily regimen = last dose no less than _____ hours preoperatively
-if once daily regimen = last dose no less than ______ hours preoperatively
If heparin is used by continuous infusion, stop ______ hours before surgery
Oral anticoagulants should not be interrupted for procedures with low or high bleeding risks?
true or false: patients with low risk for thromboembolism should not be bridged
-when is it resumed after surgery?
-how long is bridging therapy continued?
-when should you recheck INR after restarting warfarin?
-within 12-24 hours postop
-until INR reaches therapeutic levels (2-3 seconds)
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