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Pharmacology > Anticoagulants-Antiplatelets /tPA Sem 1 QQ > Flashcards

Anticoagulants-Antiplatelets /tPA Sem 1 QQ Flashcards

1
Q

The following describe how various classes of anticoagulant medications act, except :
A. Inhibition of synthesis of coagulation factor precursors
B. Activation of anticlotting factors
C. Direct activation of factor Xa
D. Direct inhibition of thrombin

A

C

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2
Q

Please match the following medications with their mechanism of action: HEPARIN, DABIGATRAN, WARARIN, RIVOZABAN

A)Binds to antithrombin III, enhancing antithrombins inhibition of Xa and other clotting factors

B)Direct inhibition of thrombin

C)Inhibits vitamin K synthesized clotting factors

D) Direct factor Xa inhibitor

A

A - Heparin
B - Digigatran
C - Warfarin
D - Rivaroxaban

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3
Q

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

A. Is nearly 99% bound to plasma albumin
B. Has a wide therapeutic index
C. Is eliminated by renal metabolism
D. Has variable absorption

A

A

side note : Warfarin is “completely absorbed” and metabolized via liver; it also has a narrow therapeutic index

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4
Q

Warfarin:

A. Activates Vitamin K syntheseis
B. Interferes with Vitamin K synthesis
C. Increases the activity of protein C
D. Directly inhibits thrombin (IIa)

A

B

(side: it acts on II (Prothrombin) not IIa (Thrombin)….it also inhibits on 7, 9, 10 (VII. IX. X)…protein C and S in the phospholipid membrane that activate clotting cascade.)

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5
Q

Heparin is classified as which of the following:

A. Direct inhibitor of thrombin
B. Protein C activator
C. Activator of anticlotting factors
D. Inhibitor of coagulation factor synthesis

A

C

?

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6
Q

All of the following are true regarding HIT EXCEPT for:

A. Type 1 HIT occurs in approx. 25% of patients
B. Type 1 HIT is a severe antibody mediated thrombocytopenia
C. There are 2 kinds of HIT
D. Type 1 HIT is benign

A

B

(aside: wo distinct types of HIT can occur: nonimmune (I) and immune-mediated (II). Nonimmune HIT, which occurs most frequently, is characterized by a mild decrease in the platelet count and is not harmful. The second type, immune-mediated HIT, occurs much less frequently but is dangerous.

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7
Q

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

A. LMWH has the same efficacy and action of UFH
B. LMWH is primarily metabolized hepatically and needs to be monitored in hepatic failure
C. The activity of LMWH is less predictable than UFH
D. LMWH is only capable of deactivating factor Xa and mild factor IIa

A

D

LMHH more effective, more predictable and is metabolized only by kidneys

UFH is metabolized by both liver and kidneys

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8
Q

Which of the following does not act on factor Xa to inhibit thrombin

A. Apixaban
B. Heparin
C. Fondaparinux
D. Warfarin

A

D

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9
Q

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

A. LMWH
B. UFH
C. Warfarin
D. DOAC

A

A

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10
Q

Select all of the following medications that have strong interactions with DOACs:

Select all that apply.

A.	Phenytoin
B.	Ventolin 
C.	Certain antiarrhythmics
D.	Anti-platelet
E.	Any medications that alters CYP metabolic enzymes
F.	Certain antibiotics
A

A, C, D, E and F

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11
Q

After oral administration of aspirin:

A. All of the options
B. Peak levels occur in 30-40 minutes
C. It is rapidly absorbed from the GI tract
D. Permanently inactivates COX 1 dependent TXA2 production

A

A

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12
Q

Match the following interactions: 1 (ASA +NSAID) ; 2 (ASA +Catecholamine) ; 3(Clopidogrel +Statins) ; 4(Clopidogrel +PPI)

A- increased risk of thrombosis
B-decreased antiplatelet effects
C -Impairment of aspirins efficacy
D - increased residual platelet reactivity

A

A = 3
B =4
C = 1
D = 2

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13
Q

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

A

B

Platelet Reactivity Test/ This test measures the extent of platelet aggregation in the presence of P2Y12 inhibitor drugs such as clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta) and ticlopidine (Ticlid). - - - - - Cardiac Issues predispose one to have a higher platelet reactivity.

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14
Q

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

A. Inhibition of COX dependent TXA production
B. Inhibition of IIa
C. Activation of protein C
D. Binds to platelet P2Y12 receptors, and irreversibly inhibits ADP-induced platelet aggregation

A

D

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15
Q

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

A. HPR does not occur in clopidogrel
B. Increased risk of bleeding when administered with a statin
C. It is rapidly well absorbed in the GI tract
D. Clopidogrel must be metabolized to generate its active metabolite

A

D

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16
Q

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

A. Ticagrelor inhibits ADP induced platelet aggregation through inhibition of IIb
B. Ticagrelor reversibly binds to and inhibits COX2
C. Ticagrelor irreversibly binds to and inhibits ADP
D. Ticagrelor reversibly binds to P2Y12 to inhibit ADP induced platelet aggregation

A

D

17
Q

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

A. Ticagrelor does not require metabolic activation
B. Ticagrelor is poorly absorbed
C. Ticagrelor produces many metabolites
D. Ticagrelor takes longer to reach therapeutic levels compared to Clopidogrel

A

A

18
Q

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

A

TRUE

19
Q

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

A. Direct thrombin inhibitor
B. Binds to fibrin and converts plasminogen to plasmin
C. Antagonizes plasminogen activator
D. Converts plasmin to plasminogen

A

B

20
Q

Which of the following is true about tissue plasminogen activator?

A. Produced by mast cells
B. Weakly binds to fibrin
C. Does not have fibrin specificity
D. Does not activate plasminogen freely floating in the blood

A

D

21
Q

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

A.	Increased depletion of fibrinogen
B.	Shorten half life 
C.	Less depletion of fibrinogen
D.	Increased specificity
E.	Decreased fibrin specificity 
F.	Prolonged half life
A

C, D and F

22
Q

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

A.	Internal hemorrhage 
B.	Hypertension
C.	Cholesterol emboli
D.	Superficial bleeding 
E.	Arrhythmia/tPA
A

B

Pharmacology (8 decks)

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