SkP - Blood/Inflammation

Anticoagulants

#1 Beaver dam

fibrin clot

Anticoagulants

#2 Throm-beaver

thrombin

Anticoagulants

#3 Throm-beaver preparing stick

thrombin transforms fibrinogen into fibrin

Anticoagulants

#4 Throm-beaver’s II shaped teeth

factor II (thrombin)

Anticoagulants

#5 FoX

factor X

Anticoagulants

#6 FoX waking up throm-beaver

factor Xa converts prothrombin into thrombin

Anticoagulants

#7 Heppy hunting

heparin

Anticoagulants

#8 Heppy hunter father

unfractionated heparin

Anticoagulants

#9 Trap with III shaped bars

unfractionated heparin binds antithrombin III

Anticoagulants

#10 trapped throm-beaver and foX

the unfractionated heparin-antithrombin III complex irreversiby inactivates thrombin and factor Xa

Anticoagulants

#11 Birdwatching father

monitor PTT to assess unfractionated heparin level

Anticoagulants

#12 PTT woodpecker

activated partial thromboplastin time (PTT)

Anticoagulants

#13 woodpecker inside treetrunk

PTT measures the function of the intrinsic pathway of the coagulation cascade

Anticoagulants

#14 hunting at the iliofemoral river

heparin can be used for deep vein thrombosis (DVT) prophylaxis

Anticoagulants

#15 beaver dam on the iliofemoral river

heparin can be used for acute treatment of deep vein thrombosis (DVT)

Anticoagulants

#16 lung shaped tree

pulmonary arterial tree

Anticoagulants

#17 bird’s nest on ischemic branch

heparin can be used for prophylaxis and acute treatment of pulmonary embolism (PE)

Anticoagulants

#18 broken heart strings

heparin is used in the setting of an acute MI

Anticoagulants

#19 Ivy

administer IV heparin in the setting of an acute DVT, PE, or MI

Anticoagulants

#20 shooting four clay plates

antibodies against heparin bound to platelet factor 4 cause heparin induced thrombocytopenia (HIT)

Anticoagulants

#21 broken plates

heparin can cause thrombocytopenia

Anticoagulants

#22 Throm-beaver dam around broken plates

HIT results in paradoxical thrombosis in the setting of thrombocytopenia

Anticoagulants

#23 depleted mineral mine

heparin can cause hypoaldosteronism (a mineralcorticoid)

Anticoagulants

#24 Big K

heparin induced hypoaldosteronism (Type 4 RTA) causes hyperkalemia

Anticoagulants

#25 Porous termite damage

heparin can cause osteoporosis

Anticoagulants

#26 protected area deterring the hunter

protamine sulfate reverses the anticoagulant effect of unfractionated heparin (less effective for LMWH and fondaparinux)

Anticoagulants

#27 “Danger - positively charged”

protamine sulfate is a positively charged molecule that binds to unfractionated heparin (negatively charged)

Anticoagulants

#28 Heppy hunter daughter

low molecular weight heparin (LMWH)

Anticoagulants

#29 trap with III

LMWH binds antithrombin III

Anticoagulants

#30 FoX in small trap

the LMWH-antithrombin complex inhibits factor Xa with less of an effect on thrombin

Anticoagulants

#31 long tapering flag

LMWH has a prolonged half-life

Anticoagulants

#32 decay flag breaking a kidney shaped rock

renal insufficiency prolongs the half-life of LMWH

Anticoagulants

#33 Heppy pregnant hunter

heparin is safe in pregnancy

Anticoagulants

#34 intact clay plates

LMWH is less likely to cause HIT

Anticoagulants

#35 Fido with a pair of foXes

fondaparinux

Anticoagulants

#36 Fido with two cages

fondaparinux binds antithrombin III with higher specificity than LMWH

Anticoagulants

#37 FoX in small trap

the fondaparinux-antithrombin complex inhibits factor Xa with less of an effect on thrombin

Anticoagulants

#38 Fido with no broken plates

fondaparinux has the lowest risk of HIT

Anticoagulants

#39 No intRUDIN

bivaliRUDIN is a direct thrombin inhibitor

Anticoagulants

#40 Big GATOR

arGATROban and dabiGATRAN are direct thrombin inhibitors

Anticoagulants

#41 Intrudin’ gator directly eating the throm-beaver

use direct thrombin inhibitors (argatroban, dabigatran, bivalirudin) in HIT

Anticoagulants

#42 Banned foXes

direct factor Xa inhibitors rivaroXaBAN and apiXaBAN

Anticoagulants

#43 directly grabbing foX

factor Xa inhibitors bind directly

Anticoagulants

#44 open mouth

factor Xa inhibitors are oral medications

Anticoagulants

#45 irregularly irregular TV signal

direct Xa inhibitors are used for long term anticoagulation in atrial fibrillation

Warfarin

#1 Vit K medic stops bleeding

vitamin K is a cofactor for the enzymatic activation of clotting factors

Warfarin

#2 Vit K medic applies gamma-shaped bandage

vitamin K promotes gamma carboxylation of coagulation factors II, VII, IX, X

Warfarin

#3 Throm-beaver with II shaped teeth

factor II (thrombin)

Warfarin

#4 seven deadly sins devil

factor VII

Warfarin

#5 nine lives cat

factor IX

Warfarin

#6 FoX

factor X

Warfarin

#7 GL

gamma carboxylation occurs at the glutamic acid residue on factors II, VII, IX, X

Warfarin

#8 V-KOR supply boat

vitamin K epoxide reductase (VKOR) converts vitamin K epoxide (inactive) into vitamin K (active)

Warfarin

#9 corporal

vitamin K promotes gamma carboxylation of proteins C

Warfarin

#10 Sergant

vitamin K promotes gamma carboxylation of proteinsS

Warfarin

#11 Corporal and Seargeant hold their troops back

proteins C and S are anticoagulant factors

Warfarin

#12 Warhead destroying V-KOR supply boat

warfarin inhibits vitamin K epoxide reductase (VKOR)

Warfarin

#13 incapacitated vit K medic

inhibition of VKOR prevents activation of Vit K

Warfarin

#14 wounded VII soldier

factor VII is the fiirst clotting factor to be reduced when starting warfarin

Warfarin

#15 delayed warhead detonation

warfarin’s onset of action is 8-12 hours

Warfarin

#16 open mouth

oral administration

Warfarin

#17 long tapering flag

long half-life

Warfarin

#18 ParaTrooper

monitor warfarin activity with prothrombin time (PT)

Warfarin

#19 extrinsically parachuting in

PT is a measure of the function of the extrinsic coagulation pathway

Warfarin

#20 parachuting VII soldier

factor VII is the main component of the extrinsic coagulation pathway

Warfarin

#21 INtercom Radio

the international normalized ratio (INR) is also used to measure warfarin activity

Warfarin

#22 INtercom Radio 2-3

goal INR 2-3 for prevention and treatment of thrombosis

Warfarin

#23 irregularly irregular signal

warfarin is used for long term anticoagulation in atrial fibrillation

Warfarin

#24 warship protecting the iliofemoral river

warfarin can be used for DVT prophylaxis

Warfarin

#25 teratogenic tarantula

warfarin can cause hemorrhage and abnormal bone formation in utero

Warfarin

#26 soldiers charging past the injured corporal

the anticoagulant protein C is reduced early in warfarin therapy, resulting in a hypercoaguable state

Warfarin

#27 black soot on corporal

warfarin induced skin necrosis due to early hypercoaguable state

Warfarin

#28 Heparin hunters patrolling the bridge

coadministration of heparin when starting warfarin therapy prevents the early hypercoaguable state (heparin bridge)

Warfarin

#29 Distant Vit K medic reinforcements

warfarin anticoagulation can be reversed with vitamin K (delayed effect)

Warfarin

#30 FFP fighter pilot

fresh frozen plasma (FFP) provides coagulation factors for immediate reversal of warfarin anticoagulation

Warfarin

#31 CYP-450 chrome tank crushing warhead

warfarin is a substrate of cytochrome P450

Antiplatelet Agents

#1 peeling Von Wille brand Field

damaged vascular epithelium exposes collagen and con Willebrand factor

Antiplatelet Agents

#2 Holding 1b bat

binding of von Willebrand factor to GP1b receptors activates platelets

Antiplatelet Agents

#3 home plate

activated platelet degranulation

Antiplatelet Agents

#4 aggregated players

platelet degranulation releases ADP, 5-HT, and TXA2, stimulating platelet aggregation

Antiplatelet Agents

#5 aggregate Da Players! Play Youth ball 2-12y

adenosine diphosphate (ADP) binds to the P2-Y12 receptor on platelets causing aggregation

Antiplatelet Agents

#6 thrown happy face helmet

platelet degranulation releases serotonin (5-HT), causing platelet aggregation and vasoconstriction

Antiplatelet Agents

#7 batters box

platelet degranulation releases thromboxane A2 (TXA2), causing aggregation and activation

Antiplatelet Agents

#8 Head Coach Cox

COX-1 synthesizes prostanoids (eg prostaglandins, TXA2) within platelets

Antiplatelet Agents

#9 sleeping assistant coach

COX-2 expression induced by inflammation

Antiplatelet Agents

#10 AA minor league dugout

COX-1 synthesizes TXA2 from the precursor molecule arachidonic acid (AA)

Antiplatelet Agents

#11 Coach Cox twisting hat

TXA2 (synthesized by COX-1) causes vasoconstriction

Antiplatelet Agents

#12 ASA umpire

aspirin (ASA)

Antiplatelet Agents

#13 acetyl-whistle

aspirin irreversibly acetylates COX-1 & 2

Antiplatelet Agents

#14 ASA umpire ejecting the coaches

aspirin irreversibly inhibits COX-1 & 2

Antiplatelet Agents

#15 hot dog grill

thienopyridines with “-grel” suffix (eg clopidogrel, ticagrelor, prasugrel) are ADP receptor inhibitors

Antiplatelet Agents

#16 Grill man catching the baseball

thienopyridnies (eg clopidogrel) irreversibly bind to the P2Y12 ADP receptor preventing platelet aggregation

Antiplatelet Agents

#17 swollen ASA umpire

aspirin “pseudo-allergy” due to excess leukotriene synthesis (use clopidogrel instead)

Antiplatelet Agents

#18 greasy grill pipe

antiplatelet agents (eg aspirin, ADP receptor inhibitors) reduce cardiovascular events in patients with peripheral artery disease

Antiplatelet Agents

#19 angina anvil

antiplatelet agents (eg aspirin, ADP receptor inhibitors) reduce cardiovascular events in patients with coronary artery disease

Antiplatelet Agents

#20 broken heart strings

use antiplatelet therapy (eg aspirin, ADP receptor inhibitors) in the setting of MI and other acute coronary syndromes

Antiplatelet Agents

#21 ASA umpire chewing tablets

give chewable aspirin in the setting of acute MI

Antiplatelet Agents

#22 corked bat

dual antiplatelet therapy (eg aspirin, ADP receptor inhibitors) prevents coronary stent thrombosis

Antiplatelet Agents

#23 black paint stroke

antiplatelet therapy (eg aspirin, ADP receptor inhibitors) prevents ischemic stroke in patients with atherosclerosis and known cerebrovascular disease

Antiplatelet Agents

#24 Ty Cobb

ticlopidine (an ADP receptor inhibitor)