Pharm Final: Coagulation and Dislipidemia

Question 1

Select the clotting disorder:
Hate clotting

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 1

a. Hemophilia

Question 2

Select the clotting disorder:
Love clotting

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 2

• b. Inherited Hypercoagulable States

c. Acquired Hypercoagulable States

Question 3

Select the clotting disorder:
Factor V Leiden

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 3

b. Inherited Hypercoagulable States

Question 4

Select the clotting disorder:
Factor II, VII, VIII, XI deficiency

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 4

a. Hemophilia

Question 5

Select the clotting disorder:
Prothrombin gene mutation (20210a)

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 5

b. Inherited Hypercoagulable States

Question 6

Select the clotting disorder:
Cancer

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 6

c. Acquired Hypercoagulable States

Question 7

Select the clotting disorder:
Recent Trauma or Surgery

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 7

c. Acquired Hypercoagulable States

Question 8

Select the clotting disorder:
Pregnancy

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 8

c. Acquired Hypercoagulable States

Question 9

Select the clotting disorder:
Hormone replacement therapy or oral contraceptive use

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 9

c. Acquired Hypercoagulable States

Question 10

Select the clotting disorder:
Elevated levels of fibrinogen

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 10

b. Inherited Hypercoagulable States

Question 11

Select the clotting disorder:
Von Willebrand disease

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 11

a. Hemophilia

Question 12

Select the clotting disorder:
HIT (Heparin Induced Thrombocytopenia)

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 12

c. Acquired Hypercoagulable States

Question 13

Select the clotting disorder:
Antiphospholipid antibody syndrome

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 13

c. Acquired Hypercoagulable States

Question 14

Select the clotting disorder:
Deficiencies of protein C and S

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 14

b. Inherited Hypercoagulable States

Question 15

Select the clotting disorder:
Hyperhomocysteinemia

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 15

c. Acquired Hypercoagulable States

Question 16

Select the clotting disorder:
Elevated levels of Factor VIII

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 16

b. Inherited Hypercoagulable States

Question 17

Select the clotting disorder:
Previous deep vein thrombosis or pulmonary embolism

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 17

c. Acquired Hypercoagulable States

Question 18

Select the clotting disorder:
Myeloproliferative disorders such as polycythemia vera or essential thombocytosis

a. Hemophilia
b. Inherited Hypercoagulable States
c. Acquired Hypercoagulable States

Answer 18

c. Acquired Hypercoagulable States

Question 19

PE vs. DVT?

Answer 19

Deep Vein Thrombosis: clot in the venous system (usually legs)

Pulmonary Embolism: clot in the pulmonary veins (commonly emboli from a DVT)

Question 20

PE vs. DVT therapy implications?

Answer 20

DVT: leg pain, swelling, or may be asymptomatic
PE: Shortness of Breath, chest pain, cough

Question 21

Herparin
Uses:
Purpose:
Mechanism of Action:
Side Effects:

Answer 21

Herparin
Uses: First line use--> very fast onset and elimination
-ACS
-Atrial fibrillation
-Medical and Surgical VTE prophylaxis
-Prosthetic heart valves
-Traume
-Venous thromboembolism

Purpose: prevents clot formation

Mechanism of Action: by controlling function and synthesis of clotting factors

Side Effects: bleeding, thrombocytopenia (decreased platelets)

• Not orally available, can only be given IV or subcutaneously
• Derived from pork
• Protamine sulfate is reversal agent

Question 22

What is Heparin induced thrombocytopenia (HIT)?

Answer 22

Profound thrombocytopenia secondary to heparin use: fall in platelets

• platelet drop occurs 5-10 days after heparin exposure
• drop can occur within a day if patient previously exposed to heparin
• “Heparin allergy” designation once patient experiences HIT

Question 23

Warfarin
Purpose:
Side Effects:
Mechanism of Action:
Reversal Agent:

Answer 23

Warfarin
Purpose: 
-Prophylaxis of venous thrombosis (high-risk surgery)
-Treatment of VTE
-Prevention of systemic embolism
-Acute MI
-Valvular heart disease
-Atrial Fibrillation
-Heart valves (tissue, mechanical)
-Anti-phospholipid Antibody Syndrome

Side Effects: bleeding, skin necrosis

Mechanism of Action: reduces vitamin L (there are 4 k-dependent clotting factors)

Reversal Agent: vitamin k

Question 24

P2Y12 Inhibitors
Purpose:
Side Effects:
Mechanism of Action:

Answer 24

P2Y12 Inhibitors
Purpose: use with aspirin for at least 1 year in patients who are post-ACS, undergoing PCI, and sometimes CABG

Side Effects: bleeding, headache, dyspnea (ticagrelor only)

Mechanism of Action: amplified and stabilizes ADP-induced platelet aggregation

Question 25

Thrombolytics TPA? Use: Purpose:

Answer 25

TPA = tissue plasminogen activator: helps breakdown clots Use: Stroke (alteplase only) AMI Massive PE Catheter Clearance (alteplase only) Purpose: break down already formed thrombus --> reestablishes blood flow

Question 26

Statins Theraputic Use: MOA: Side Effects:

Answer 26

Statins Theraputic Use: Dyslipidemia, Post MI, Primary prevention of CVD (work best if given at bed time) MOA: Decrease cholesterol production, increase LDL breakdown, decrease VLDL production, plaque reduction, antioxidant effects and antithrombotic effects Side Effects: Headache, GI, Myalgia, rhabdomyolysis (rare but serious)