Anticoagulants 1, 2 & 3 - QUIZ

Question 1

The following describe how various classes of anticoagulant medications act, except :

a) Inhibition of synthesis of coagulation factor precursors
b) Direct activation of factor Xa
c) Activation of anticlotting factors
d) Direct inhibition of thrombin

Answer 1

b) Direct activation of factor Xa

Question 2

List the MOA of the following medications:

a) Heparin
b) Dibigatran
c) Warfarin
d) Rivaroxaban

Answer 2

a) Heparin - binds to antithrombin III (ATIII) enhancing it’s inhibition of Xa & other clotting factors
b) Dibigatran - direct inhibition of thrombin
c) Warfarin - inhibits vitamin K synthesized clotting factors
d) Rivaroxaban - direct factor Xa inhibitor

Question 3

Which of the following is true regarding the pharmacokinetics of Warfarin:

a) Has a wide therapeutic index
b) Is nearly 99% bound to plasma albumin
c) Has variable absorption
d) Is eliminated by renal metabolism

Answer 3

b) Is nearly 99% bound to plasma albumin

Question 4

Warfarin:

a) Increases the activity of protein C
b) Directly inhibits thrombin
c) Interferes with Vitamin K synthesis
d) Activates Vitamin K syntheseis

Answer 4

c) Interferes with Vitamin K synthesis

Question 5

Heparin is classified as which of the following:

a) Activator of anticlotting factors
b) Direct inhibitor of thrombin
c) Protein C activator
d) Inhibitor of coagulation factor synthesis

Answer 5

a) Activator of anticlotting factors

Question 6

All of the following are true regarding HIT except for:

a) There are 2 kinds of HIT
b) Type 1 HIT is a severe antibody mediated thrombocytopenia
c) Type 1 HIT is benign
d) Type 1 HIT occurs in approx. 25% of patients

Answer 6

b) Type 1 HIT is a severe antibody mediated thrombocytopenia

Question 7

Which of the following is true regarding low molecular weight heparin:

a) LMWH has the same efficacy and action of UFH
b) LMWH is only capable of deactivating factor Xa and mild factor IIa
c) LMWH is primarily metabolized hepatically and needs to be monitored in hepatic failure
d) The activity of LMWH is less predictable than UFH

Answer 7

b) LMWH is only capable of deactivating factor Xa and mild factor IIa

Question 8

Which of the following does not act on factor Xa to inhibit thrombin: 
Apixaban 
a)  Apixaban 
b) Heparin 
c) Fondaparinux
d) Warfarin

Answer 8

d) Warfarin

Question 9

Which of the following anticoagulants, are currently accepted and well studied, for treatment of cancer related thrombus:

a) DOAC
b) UFH
c) Warfarin
d) LMWH

Answer 9

d) LMWH

Question 10

Select all of the following medications that have strong interactions with DOACs:
Select all that apply.
a) Phenytoin
b) Certain antibiotics 
c) Anti-platelet 
d) Certain antiarrhythmics 
e) Any medications that alters CYP metabolic enzymes
f) Ventolin

Answer 10

a) Phenytoin
b) Certain antibiotics
c) Anti-platelet
d) Certain antiarrhythmics
e) Any medications that alters CYP metabolic enzymes

Question 11

After oral administration of aspirin:

a) Permanently inactivates COX 1 dependent TXA2 production
b) All of the options
c) Peak levels occur in 30-40 minutes
d) It is rapidly absorbed from the GI tract

Answer 11

b) All of the options

Question 12

State the following interactions with these combinations:

a) ASA + NSAIDS
b) Clopidogrel + Statins
c) ASA + Catecholamine
d) Clopidogrel + PPIs

Answer 12

a) ASA + NSAIDS - impairment of ASAs efficacy
b) Clopidogrel + Statins - increased risk of thrombosis
c) ASA + Catecholamine - increased residual plateley activity
d) Clopidogrel + PPIs - decreased antiplatelet effects

Question 13

Which of the following is related in increased risk of high platelet reactivity:

a) Hepatic failure
b) Cardiac surgery
c) Renal disease
d) Sickle cell anemia

Answer 13

b) Cardiac surgery

Question 14

Which of the following describes Clopidogrel’s mechanism of action:

a) Inhibition of IIa
b) Binds to platelet P2Y12 receptors, and irreversibly inhibits ADP-induced platelet aggregation
c) Inhibition of COX dependent TXA production
d) Activation of protein C

Answer 14

b) Binds to platelet P2Y12 receptors, and irreversibly inhibits ADP-induced platelet aggregation

Question 15

Which of the following is true regarding the pharmacokinetics of clopidogrel:

a) Clopidogrel must be metabolized to generate its active metabolite
b) It is rapidly well absorbed in the GI tract
c) HPR does not occur in clopidogrel
d) Increased risk of bleeding when administered with a statin

Answer 15

a) Clopidogrel must be metabolized to generate its active metabolite

Question 16

Ticagrelor’s mechanism of action is related to which of the following:

a) Ticagrelor reversibly binds to P2Y12 to inhibit ADP induced platelet aggregation
b) Ticagrelor inhibits ADP induced platelet aggregation through inhibition of IIb
c) Ticagrelor irreversibly binds to and inhibits ADP
d) Ticagrelor reversibly binds to and inhibits COX2

Answer 16

a) Ticagrelor reversibly binds to P2Y12 to inhibit ADP induced platelet aggregation

Question 17

Which of the following is true regarding Ticagrelor’s pharmacokinetics:

a) Ticagrelor does not require metabolic activation
b) Ticagrelor produces many metabolites
c) Ticagrelor is poorly absorbed
d) Ticagrelor takes longer to reach therapeutic levels compared to Clopidogrel

Answer 17

a) Ticagrelor does not require metabolic activation

Question 18

“The effectiveness of thrombolytics is inversely related to the time elapsed since the thrombotic crisis began. “ True or False?

Answer 18

True

Question 19

TNK works to dissolve existing clots through which of the following mechanisms?

a) Direct thrombin inhibitor
b) Antagonizes plasminogen activator
c) Converts plasmin to plasminogen
d) Binds to fibrin and converts plasminogen to plasmin

Answer 19

d) Binds to fibrin and converts plasminogen to plasmin

Question 20

Which of the following is true about tissue plasminogen activator?

a) Does not activate plasminogen freely floating in the blood
b) Weakly binds to fibrin
c) Produced by mast cells
d) Does not have fibrin specificity

Answer 20

a) Does not activate plasminogen freely floating in the blood

Question 21

Which of the following is true regarding tPA and third-generation thrombolytic agents? Select all that apply.

a) Decreased fibrin specificity
b) Prolonged half life
c) Increased specificity
d) Less depletion of fibrinogen
d) Shorten half life
f) Increased depletion of fibrinogen

Answer 21

b) Prolonged half life
c) Increased specificity
d) Less depletion of fibrinogen

Question 22

All of the following adverse reactions can be expected with TNK administration except for ___________?

a) Internal hemorrhage
b) Superficial bleeding
c) Arrhythmia
d) Cholesterol emboli
e) Hypertension

Answer 22

e) Hypertension