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C. Year 3: Core Drugs > Patient on Anti-Platelet Therapy > Flashcards

Patient on Anti-Platelet Therapy Flashcards

1
Q

There are 3 key layers that surround the lumen of blood vessels:

  • tunica intima
  • tunica media
  • tunica externa

Which of these layers is responsible for causing vasodilation and vasoconstriction?

A
  • tunica media
  • tunica intima (endothelial cells)
  • tunica media (smooth muscle cells and sheets of elastin)
  • tunica externa (loosely woven fibres of collagen)
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2
Q

Primary haemostasis, can be subdivided into 5 stages. Which 2 of the following happens during stage 1, called endothelial injury?

1 - nerves detect damage to blood vessel and induce vascular spasms
2 - release of nitric oxide from endothelial cells
3 - release of prostoglandins
4 - release of endothelin

A

1 - nerves detect damage to blood vessel and induce vascular spasms

4 - release of endothelin

  • both causes smooth muscle contraction and a reduction in blood flow to the area
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3
Q

Primary haemostasis, can be subdivided into 5 stages. In stage 2, called exposure, damaged endothelium leads to exposure of the collagen in blood vessels. What is released by damaged endothelium that then binds with the collagen?

1 - nitric oxide
2 - Von Willebrands factor
3 - adenosine diphosphate
4 - platelets

A

2 - Von Willebrands factor

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4
Q

Once von Willebrands factor has become bound to collagen, it is able to bind with platelets. This is the 3rd step of primary haemostasis, called adhesion. Which receptor on platelets facilitates this binding and then activates platelets?

1 - GPIIB/IIIA
2 - serotonin
3 - adenosine diphosphate
4 - GP1-B

A

4 - GP1-B

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5
Q

The 4th step of primary haemostasis is called activation, which is when platelets come into contact with von Willebrand factor. Which of the following then happens in the activated platelets?

1 - conformation change forming appendages that encourage binding to other platelets
2 - release von Willebrand factor
3 - release serotonin
4 - release Ca2+
5 - all of the above

A

5 - all of the above
- all part of positive feedback loop to activate more platelets

  • serotonin = signals platelets to the area
  • Ca2+ = important in secondary haemostasis
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6
Q

The 4th step of primary haemostasis is called activation, which is when platelets come into contact with von Willebrand factor. Which 2 of the following are released by activated platelets that can then go on and activate more platelets and cause platelets to stick to collagen?

1 - adenosine diphosphate
2 - nitric oxide
3 - thromboxane 2
4 - prostaglandins

A

1 - adenosine diphosphate
3 - thromboxane 2

  • both part of positive feedback loop to activate more platelets
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7
Q

Once adenosine diphosphate and thromboxane-2 bind to platelets they become fully active and produce a new surface protein. What is this new surface protein called?

1 - GPIIB/IIIA
2 - thromboxane receptor (Tx)
3 - P2Y-12
4 - GP1-B

A

1 - GPIIB/IIIA

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8
Q

On platelets which receptor binds with thromboxane-2?

1 - GPIIB/IIIA
2 - thromboxane receptor (Tx)
3 - P2Y-12
4 - GP1-B

A

2 - thromboxane receptor (Tx)

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9
Q

On platelets which receptor binds with adenosine diphosphate?

1 - GPIIB/IIIA
2 - thromboxane receptor (Tx)
3 - P2Y-12
4 - GP1-B

A

3 - P2Y-12

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10
Q

In primary haemostasis, what 2 molecules do undamaged endothelial cells secrete that ensures platelets do not become activated?

1 - adenosine diphosphate
2 - nitric oxide
3 - thromboxane 2
4 - prostaglandins

A

2 - nitric oxide
4 - prostaglandins

  • both are classed as platelet inhibitors
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11
Q

The 5th stage of primary haemostasis is called aggregation. What is able to bind with the surface protein on fully activates platelets that contributed to forming a plus?

1 - fibrinogen
2 - plasminogen
3 - von Willebrand factor
4 - all of the above

A

1 - fibrinogen

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12
Q

What is the role of COX in primary homeostasis?

1 - binds collagen and allows platelets to bind
2 - release collagen
3 - release nitrate
4 - activates platelets

A

4 - activates platelets

  • as more platelets are activates there will be more COX
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13
Q

Aspirin is an anti-platelet medication. What is the mechanism of action for aspirin?

1 - ADP receptor antagonist
2 - irreversible COX inhibitor
3 - GP 2b/3a antagonists
4 - vitamin K antagonist

A

2 - irreversible COX inhibitor

  • no COX means platelets are not activated
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14
Q

Which of the following is NOT one of the 3 core anti-platelet ADP receptor antagonist that we need to know?

1 - clopidogrel
2 - Ticagrelor
3 - Abciximab
4 - Prasugrel

A

3 - Abciximab

This is a Glycoprotein IIb/IIIa inhibitor

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15
Q

Clopidogrel (MAIN drug)
Ticagrelor and Prasugrel are anti-platelet medications we need to be aware of. What is the mechanism of action for these drugs?

1 - ADP receptor antagonist
2 - irreversible COX inhibitor
3 - GP2b/3a antagonists
4 - vitamin K antagonist

A

1 - ADP receptor antagonist
- irreversible inhibitors

  • discourages platelets binding collagen
  • reduces platelet activation
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16
Q

Abciximab is an anti-platelet medication that we need to be aware of. What is the mechanism of action for these drugs?

1 - ADP receptor antagonist
2 - irreversible COX inhibitor
3 - GP 2b/3a antagonists
4 - vitamin K antagonist

A

3 - GP2b/3a antagonists

  • stops platelets binding with fibrinogen and forming platelet plug
17
Q

Aspirin and ADP receptor antagonist are indicated in patients with acute coronary syndrome (ACS). Why are the medications good in ACS?

1 - inhibit secondary haemostasis
2 - improves healing of endothelial cells so no platelet plug is required
3 - limits thrombosis
4 - all of the above

A

3 - limits thrombosis

  • reduces mortality
  • drugs used in combination
18
Q

Aspirin and ADP receptor antagonist are indicated in patients with stent occlusion? Why are the medications good in stent occlusion?

1 - inhibit secondary haemostasis
2 - reduces risk of platelet plugs forming
3 - limits thrombosis
4 - all of the above

A

2 - reduces risk of platelet plugs forming

  • drugs used in combination
19
Q

Aspirin and ADP receptor antagonist in combination are indicated in patients with ACS and stent occlusion. Which of the following is the other indication for use of these drugs in combination?

1 - secondary prevention of cardiovascular events
2 - hypertension
3 - renal stenosis
4 - liver fibrosis

A

1 - secondary prevention of cardiovascular events

  • IHD
  • cerebrovascular disease
  • PVD
  • can be used alone or in combination
20
Q

Which of the following are indications for the use of Abciximab, the GPIIbIIIa antagonist?

1 - ACS
2 - stent occlusion
3 - stroke
4 - percutaneous transluminal coronary intervention

A

4 - percutaneous transluminal coronary intervention

  • pevents ischaemic complications in high-risk patients undergoing percutaneous transluminal coronary intervention.
21
Q

Clopidogrel (MAIN drug)
Ticagrelor and Prasugrel are anti-platelet medications that irreversibly acts as ADP receptor antagonist. Which of the following are the most common adverse events?

1 - bleeding
2 - GI upset
3 - thrombocytopenia
4 - all of the above

A

4 - all of the above

22
Q

Aspirin is an irreversible COX-1 inhibitor antiplatelet medication. Which of the following is NOT a common adverse event of asprin?

1 - GI upset
2 - peptic ulcer
3 - hypokalaemia
4 - haemorrhage
5 - bronchospasm
6 - tinnitus

A

3 - hypokalaemia

23
Q

Why should aspirin not be taken in children <16 y/o?

1 - toxic to liver
2 - reyes syndrome
3 - toxic to kidneys
4 - increased risk of hypersensitivity

A

reyes syndrome

  • rare and dangeorous syndrome that mainly affects the brain and liver
24
Q

Which 2 of the following examples should aspirin not be used in?

1 - previous hypersensitivity to aspirin or NSAIDs
2 - 3rd trimester of pregnancy
3 - peptic ulcers
4 - gout

A

1 - previous hypersensitivity to aspirin or NSAIDs

2 - 3rd trimester of pregnancy
- can cause premature closing of the ductus arteriosus

25
Q

Which 2 of the following examples should aspirin not be used, but with caution?

1 - previous hypersensitivity to aspirin or NSAIDs
2 - 3rd trimester of pregnancy
3 - peptic ulcers
4 - gout

A

3 - peptic ulcers
4 - gout

  • can trigger an attack in both
26
Q

Clopidogrel (MAIN drug)
Ticagrelor and Prasugrel are anti-platelet medications that irreversibly acts as ADP receptor antagonist. Which 2 of the following must they NOT be used in?

1 - active bleeding
2 - <7 days days before surgery
3 - hepatic failure
4 - renal failure

A

1 - active bleeding
2 - <7 days days before surgery

27
Q

Clopidogrel (MAIN drug)
Ticagrelor and Prasugrel are anti-platelet medications that irreversibly acts as ADP receptor antagonist. Which 2 of the following can they be used in, but with caution?

1 - active bleeding
2 - <7 days days before surgery
3 - hepatic failure
4 - renal failure

A

3 - hepatic failure
4 - renal failure

28
Q

Although there are no major interactions between aspirin and anti-platelet ADP receptor antagonists, caution must be used when using it alongside anti-platelets or anticoagulants. Why is this?

1 - toxic to liver
2 - toxic to kidney
3 - increased risk of bleeding
4 - all of the above

A

3 - increased risk of bleeding

29
Q

Clopidogrel is a pro-drug meaning it needs to be metabolised prior to it becoming active. Cytochrome P450 (CYP). Other drugs may inhibit CYP, which would do what to clopidogrel?

A
  • reduce efficacy
  • drug metabolism is slow so drug will not have full effect and could become toxic or increase adverse events
30
Q

Tigagrelor is not a pro-drug, but does interact with Cytochrome P450 (CYP) inhibitors and inducers. Other drugs may inhibit CYP, which would do what to clopidogrel?

A
  • CYP inhibitor = increased toxicity
  • CYP inducer = reduced efficacy
31
Q

Which of the following are typical dosages of aspirin?

1 - 75mg
2 - 300mg
3 - 4g
4 - all of the above

A

4 - all of the above

  • 75mg = long term use
  • 300mg = initial dosing in ACS
  • 4g = daily dosage for pain
  • generally taken with food to reduce GI upset
32
Q

In patients taking aspirin, who are at risk of GI complications, they should also be prescribed which class of drug?

1 - proton pump inhibitors
2 - laxative
3 - lithium
4 - antacids

A

1 - proton pump inhibitors

33
Q

Clopidogrel is the most commonly prescribed ADP-receptor antagonist. It is can be prescribed at 75mg for continued dose or 300mg loading dose in ACS. How is this drug taken?

1 - IV
2 - SC
3 - orally
4 - suppository

A

3 - orally

  • not needed to be taken with food, but regular intervals are needed
34
Q

Is aspirin or clopidogrel preferred for long term single agent use in coronary artery and peripheral vascular disease?

A
  • aspirin
35
Q

Is aspirin or clopidogrel preferred for long term single agent use following stroke and transient ischaemic attacks?

A
  • clopidogrel

C. Year 3: Core Drugs (125 decks)

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