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BCR 1 > Pharmacology - Anti-coagulant drugs > Flashcards

Pharmacology - Anti-coagulant drugs Flashcards

1
Q

what is the common product of both pathways of the coagulation cascade?

a. XIIa
b. Xa
c. X
d. II

A

b.Xa

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2
Q

abnormal/ damaged surface leads to which branch of the coagulation cascade being activated?

a. intrinsic
b. extrinsic
c. final common

A

a.intrinsic

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3
Q

trauma/tissue damage leads to which branch of the coagulation cascade being activated?

a. intrinsic
b. extrinsic
c. final common

A

b.extrinsic

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4
Q

which pathway of the coagulation cascades involves some components derived from outside of the blood?

a. intrinsic
b. extrinsic
c. final common

A

b.extrinsic

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5
Q

unfractionated and low molecular weight are two types of which drug?

a. anti platelet
b. anti coagulant
c. heparin
d. warfarin
e. NOACS

A

c.heparin

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6
Q

which of these drugs is a coumarin?

a. heparin
b. warfarin
c. streptokinase
d. alteplase

A

b.warfarin

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7
Q

where is heparin normally released from?

a. liver
b. kidney
c. intact blood vessel endothelium
d. damaged blood vessel endothelium

A

c.intact blood vessel endothelium

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8
Q

which type of drug is best at preventing thrombus formation in veins?

a. anti platelet agents
b. anti coagulants
c. fibrinolytics

A

b.anti coagulants

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9
Q

the family of glycosaminoglycans of variable chain length 3-330 kDa are known as..

a. low moleuclar weight heparin
b. unfractionated heparin

A

b.unfractionated heparin

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10
Q

true or false low molecular weight heparin is longer acting and has a more predictable anticoagulant effect?

a. true
b. false

A

a.true

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11
Q

enoxaparin sodium is an example of which type of drug?

a. coumarin
b. heparin
c. UFH
d. LMWH

A

d.LMWH

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12
Q

what does heparin bind to in order to activate it?

a. Xa
b. IIa - thrombin
c. ATIII

A

c. ATIII

anti thrombin III

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13
Q

what does the UFH-ATIII complex inactivate by binding to it?

a. IIa and Xa
b. II and Xa
c. I and Ia
d. II and IIa

A

a. IIa and Xa

thrombin and Xa

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14
Q

the main effect of LMWH is to inactivate which component of the coagulation cascade?

a. VIII
b. Xa
c. IIa
d. II

A

b.Xa

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15
Q

which of these factors does not take part in the extrinsic pathway?

a. tissue factor
b. VIIIa
c. XIIa

A

c.XIIa

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16
Q

which of these factors does not take part in the intrinsic pathway?

a. XIIa
b. XIa
c. IXa
d. VIIa

A

d.VIIa

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17
Q

how if UFH given?

a. IV
b. IM
c. subcutaneous
d. oral

A

a.IV

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18
Q

how if LMWH given?

a. IV
b. IM
c. subcutaneous
d. oral

A

c.subcutaneous

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19
Q

which of these drugs is immediately active and has a half life of 40-90 mins?

a. UFH
b. LMWH

A

a.UFH

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20
Q

which of these drugs requires 1x / 2x daily dose ?

a,UFH
b,LMWH
c.heparin
d.warfarin

A

b,LMWH

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21
Q

how is LMWH excreted?

a. hepatic
b. renal

A

b.renal

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22
Q

caution/dose adjustment should be made when giving which drug to a patient with renal failure?

a. UFH
b. warfarin
c. heparins
d. LMWH
e. NOACS

A

d.LMWH

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23
Q

what is used in treatment of thromboembolic disease in pregnancy?

a. heparin
b. warfarin
c. NOACS

A

a.heparin

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24
Q

what is used in treatment of pleural effusion initially together with warfarin?

a. heparin
b. DOACS
c. NOACS

A

a.heparin

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25
Q

what is used in treatment of deep vein thrombosis initially together with warfarin?

a. heparin
b. DOACS
c. NOACS

A

a.heparin

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26
Q

what drug is used in prevention of thromboembolic disease especially before surgery in high risk patients?

a. warfarin
b. heparin
c. dipyridamole
d. NOACS

A

b.heparin

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27
Q

which of these drugs is used in haemodyalisis?

a. warfarin
b. heparin
c. NOACS
d. DOACS

A

b.heparin

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28
Q

what is the main side effect of heparin?

a. hyperkalaemia
b. reduced aldosterone secretion
c. osteoporosis and alopecia
d. haemorrhage
e. hypersensitivity reactions

A

d. haemorrhage

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29
Q

which drug should be avoided in bleeding disorders and gastric ulcers?

a,heparin

b. warfarin
c. NOACS
d. DOACS

A

a,heparin

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30
Q

protamine sulphate is a chemical antagonist for which anticoagulant drug?

a. warfarin
b. heparin
c. NOAC
d. DOACS
e. ezetimibe

A

b.heparin

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31
Q

which of these reverses the action of heparin ?

a. vitamin K
b. protamine sulfate

A

b.protamine sulfate

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32
Q

thrombocytopenia is relatively common when taking heparin. what is thrombocytopenia?

a. reduced rbc
b. reduced platelets
c. increased destruction of rbc
d. reduced blood vol
e. increased platelet count

A

b.reduced platelets

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33
Q

a 50% drop in platelet count 5-10 days after treatment onset accompanied by a rash and thrombosis?

a. immune mediated HIT
b. thrombocytopenia
c. haemolysis

A

a. immune mediated HIT

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34
Q

what needs to be routinely monitored in patient taking heparin?

a. fbc and heparin platelet antibodies
b. platelet count and fbc
c. platelet count and heparin platelet count

A

c. platelet count and heparin platelet count

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35
Q

what is heparin dose adjusted according to?

a. bleeding time
b. activated partial thromboplastin time
c. clotting time

A

b. activated partial thromboplastin time

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36
Q

how is UFH given intially?

a. IM
b. IV
c. IV bolus
d. oral

A

c.IV bolus

37
Q

which pathways are tested by activated partial thromboplastin time?

a. intrinsic and extrinsic
b. intrinsic and final common
c. final common
d. extrinsic and final common

A

b. intrinsic and final common

no tissue factor activity

38
Q

which type of heparin does not effect APTT?

a. LMWH
b. UFH

A

a.LMWH

39
Q

which of these clotting factors is not affected by warfarin?

a. Xa
b. II
c. VII
d. IX
e. X

A

a.Xa

40
Q

what enzyme is inhibited by warfarin?

a. cox 1
b. cox 2
c. vit k epoxide reductase
d. phosphodiesterase

A

c. vit k epoxide reductase

stops regenration of reduced vit k for clotting factor synthesis

41
Q

in order for clotting factor precursors for X, IX, VII and II to be converted to complete clotting factors what happens to vit K?

a. reduced vit k converted to oxidised vit k
b. oxidised vit K reduced to reduced vit k

A

a.reduced vit k converted to oxidised vit k

42
Q

what does vit k epoxide reductase do?

a. oxidise vit K
b. reduce vit K

A

b.reduce vit K

43
Q

how long is the onset for the anti coagulant effect of warfarin?

a. immediate
b. 2-5 days
c. 10 days
d. 3 days

A

b.3 days
covered by LMWH

time for already formed active factors to be degraded

44
Q

what is given to cover the delayed onset of warfarin?

a. LMWH
b. UFH
c. NOACS

A

a.LMWH

45
Q

what is the duration of action of warfarin?

a. 2-5 days
b. 3-4 days
c. 7-10 days

A

a.2-5 days

46
Q

which of these drugs is used in prophylaxis and treatment of thromboembolic disease as first line?

a. heparin
b. warfarin
c. DOACS

A

b.warfarin

47
Q

which of these drugs is used as prophylaxis in atrial fibrillation to reduce stroke risk?

a. warfarin
b. heparin
c. NOACS
b. DOACS

A

a. warfarin

48
Q

which drug is used as prophylaxis with prosthetic heart valves in order to prevent valve emboli

a. heparin
b. warfarin
c. NOACS
b. DOACS

A

b. warfarin

49
Q

what measurement is used to inform dose of warfarin?

a. APTT
b. PT
c. bleeding time
d. clotting time

A

b.PT

prothrombin time

50
Q

the international normalised ratio is the ratio of a patients PT to a control sample

a. true
b. false

A

a.true

51
Q

what INR should be aimed for for a patient on warfarin with DVT/PE/AF?

a. 3.5
b. 2.5

A

b.2.5

52
Q

what INR should be aimed for for a patient on warfarin with mechanical valves?

a. 3.5
b. 2.5

A

a.3.5

53
Q

how long is a loading dose of warfarin given?

a. 1-3 days
b. 2-3 days
c. 5-7 days
d. 4 days

A

a.1-3 days

54
Q

before a loading dose is given of warfarin what should be measured?

a. PT
b. APTT
c. bleeding time

A

a.PT

55
Q

what is the main adverse effect of warfarin ?

a. haemorrhage
b. unexplained Hb fall
c. GI upset
d. teratogen
e. alopecia

A

a.haemorrhage

56
Q

in which of these cases should warfarin be avoided

a. obese
b. hypertensive
c. elderly
d. pregnant

A

d.pregnant

57
Q

what is the reversal agent for warfarin if major bleeding occurs?

a. protamine sulphate
b. vitamin K

A

b.vitamin K

58
Q

how is vit k asministered?

a. IV
b. IM
c. IV bolus
d. oral

A

d.oral

or slow IV

59
Q

wha can be given if major bleeding on warfarin?

a. RBC
b. FFP
c. Thromin

A

b.FFP or prothrombin complex concentrate

60
Q

if patient has an INR of < 8 and no bleeding what should be done?

a. vit k administered
b. warfarin withdrawal
c. Prothrombin complex concentrate given
d. increased warfarin dose given

A

b. warfarin withdrawal

61
Q

patient has INR>8 with no/minor bleeding what is the most appropriate course of action ?

a. withdraw warfarin
b. give vit k
c. give base and withdraw warfarin
d. give protamine sulfate

A

c. give base and withdraw warfarin

62
Q

which of these is not a contraindication for warfarin?

a. bacterial endocarditis
b. active bleeding
c. peptic ulcer
d. uncontrolled sever hypertension
e. atrial fibrillation

A

e. atrial fibrillation

63
Q

which of these drugs has varying effect based on diet, disease, genetic variation and interactions?

a. heparin
b. LMWH
c. warfarin
d. NOACS

A

c. warfarin

64
Q

which of these diseases does not contribute to variation in warfarin effect?

a. liver disease
b. congestive heart failure
c. small bowel disease
d. pulmonary oedema

A

d. pulmonary oedema

65
Q

genetic variation in the vitamin k epoxide reductase enzyme ay affect the efficacy of which of these drugs?

a. LMWH
b. UFH
c. warfarin
d. NOACS
e. DOACS

A

c.warfarin

66
Q

genetic variation in the CYTOCHROME P450-2C9 affect the efficacy of which of these drugs?

a. LMWH
b. UFH
c. warfarin
d. NOACS
e. DOACS

A

c.warfarin

67
Q

Which of these drugs would decrease the effect of warfarin?

a.antibiotics
b.azole antifungals
c/cimetidine
d. anti epileptics
e.acute diet and alcohol changes

A

d. anti epileptics

68
Q

most antibiotics, azole antifungals and which of these drugs increases the effect of warfarin?

a. cimetidine
b. rifampicin
c. barbituates
d. carbamazepine

A

a.cimetidine

69
Q

which of these antibiotics decrease the effect of warfarin?

a. metronidazole
b. rifampicin
c. doxycycline
d. erythromycin

A

b.rifampicin

70
Q

antiepileptics, rifampicin, chronic changes in diet and alcohol and which group of drugs decrease the effect of warfarin?

a. azole antifungals
b. cimetidine
c. barbituates

A

c.barbituates

71
Q

what is inhibited by rivaroxaban?

a. Xa
b. IIa
c. II
d. X

A

a.Xa
rivaroXaban
direct Xa inhibitor

72
Q

what is inhibited by dabigatran?

a. Xa
b. IIa
c. II
d. X

A

b. IIa

dabigATran - Anti Thrombin

73
Q

true or false DOACS have a reduced risk of haemorrhage and shorter duration in comparison to warfarin and heparin?

a. true
b. false

A

a.true

74
Q

what drug is given in order to prevent DVT/PE after orthopaedic surgery?

a. warfarin
b. heparin
c. DOACS

A

c.DOACS

75
Q

in non valvular atrial fibrillation what is given in order to prevent stroke?

a. warfarin
b. heparin
c. DOACS

A

c. DOACS

76
Q

what is the main side effect of DOACS?

a. haemorrhage
b. GI upset
c. thrombocytopenia
d. dyspepsia

A

b.GI upset

77
Q

true or false INR is needed for DOACS?

a. true
b. false

A

b.false

78
Q

before which drug treatment is U and E, LFT,FBP and a coagulation profile done?

a. warfarin
b. IV bolus heparin
c. DOACS

A

c. DOACS

79
Q

What is monitored 3 months into DOAC treatment?

a. U and E, FBP ,LFT, coagulation profile
b. U and E, FBP, LFT
c. adherence, adverse reactions and efficacy

A

c.adherence, adverse reactions and efficacy

80
Q

What is monitored 6 months into DOAC treatment?

a. U and E, FBP ,LFT, coagulation profile
b. U and E, FBP, LFT
c. adherence, adverse reactions and efficacy

A

b. U and E, FBP, LFT

81
Q

azole antifungals, NSAIDS, aspirin, clarithromycin, SSRIS, verapamil, rifampicin and carbamazepine shouls not be given with?

a. warfarin
b. heparin
c. DOACS

A

c.DOACS

82
Q

How are DOACS administered?

a. orally
b. IV
c. IM

A

a.orally

83
Q

which of these is a reversal agent for dabigatran?]

a. vit k
b. protamine sulphate
c. idarucizumab
d. andexanet alfa

A

c.idarucizumab

84
Q

how is idarucizu,ab given?

a. orally
b. IV
c. IM

A

b.IV

85
Q

true or false no adjustment of dose is required for dabigatran based on renal function, age or weight

a. true
b. false

A

a.true

86
Q

which of these is a reversal agent for Xa inhibitors?

a. vit k
b. protamine sulphate
c. idarucizumab
d. andexanet alfa

A

d.andexanet alfa

87
Q

when is andexanet alfa given?

a. minor bleeding
b. life threatening bleeding

A

b.life threatening bleeding

xa inhibitor reversal agent

88
Q

Which DOACS can be used in pregnancy, artifical heart valves, liver disease or malignancy?

a. dabigitran
b. rivaroxaban
c. apixaban
d. none

A

d.none

BCR 1 (60 decks)

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