Quiz 4 Blood/GIT Flashcards
A 58 year old business executive is brought to the emergency room 2 hours after the onset of severe chest pain during a vigorous tennis game. She has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes cnfirm the diagnosis of myocardial infaraction. The decision is made to attempt to open her occluded artery. Conversion of plasminogen to plasmin is brought about by
a. Heparin
b. Warfarin
c. Reteplase
d. Aminocaproic acid
e. Lepirudin
c. Reteplase
Only tPa
***A 62 year old white man complains of left thigh and leg pain and swelling that are exacerbated by walking. One week earlier, the patient underwent cardiac catheterization. The patient is currently vacationing and has spent the past 28 hours in a car. Which of the following drugs, which might be prescribed in this instance, works by inhibiting the enzyme epoxide reductase?
A. Tissue-type plasminogen activator (tPa) B. Dipyridamole C. Heparin D. Streptokinase E. Acetylsalicylic acid F. Warfarin
F. Warfarin
Warfarin affects INR in blood
If a patient undergoes a percutaneous coronary procedure and placement of a stent in a coronary blood vessel, she may be given EPTIFIBATIDE. The mechanism of EPTIFIBATIDE’s anticlotting action is
A. Reversible inhibition of glycoprotein IIb/IIIa receptors
B. Blockade of posttranslational modification of clotting factors
C. Inhibition of thromboxane production
D. Activation of antithrombin III
E. Irreversible inhibition of platelet ADP receptors
A. Reversible inhibition of glycoprotein IIb/IIIa receptors
A 20 year old varsity hockey player is referred to you by his coach. The young athlete has excessive bruising after a very physical match 2 days before. His knee had been bothering him, so he took two 325-mg aspirin tablets several hours before the contest. He got checked hard into the boards. 10 times during the game, but denies any excessive or unusual trauma. As you ponder the etiology you order several blood tests. Which test or finding do you most likely expect to be abnormal as a result of the prior aspirin use?
A. Platelet count B. Bleeding time C. INR (International normalized ratio) D. Activated partial thromboplastin time (APTT) E. Prothrombin time
B. Bleeding time (prolonged)
A patient develops severe thrombocytopenia in response to treatment with unfractionated heparin and still requires parenteral anti coagulation. The patient is most likely to be treated with
A. Abciximab B. Lepuridin C. Streptokinase D. Urokinase E. Plasminogen
B. Lepuridin
***A 22 year old woman who experienced pain and swilling in her right leg presented at the emergency room. An ultrasound study showed thrombosis in the popliteal vein. The patient, who was in her second trimester of pregnancy, was treated for seven days with intravenous unfractionated heparin. The pain resolved during the course of therapy, and the patient was discharged on day eight. Which one of the following drugs would be most appropriate outpatient follow-up therapy for this patient, who lives 100 miles from the nearest hospital?
A. Streptokinase B. Warfarin C. LMWH D. Unfractionated heparin E. Alteplase
C. LMWH
Low molecular weight heparin
A 67 year old woman with a history of venous thromboembolism is placed on warfarin (Coumadin) prophylactically. The blood concentration of Coumadin becomes too high and bleeding occurs. This bleeding can best be treated by the administration of which of the following?
A. Fibrinogen B. Thrombin C. Platelets D. Protein C E. Vitamin K
E. Vitamin K
A patient who has been a high-dose alcohol abuser for many years presents with hepatic portal-sytsemic encephalopathy. Which of the following drugs, give in relatively high doses, would be most suitable for the relief of signs and symptoms of this condition, and the likely underlying biochemical anomalies?
A. Lactulose B. Esomeprazole C. Diphenoxylate D. Ondansetron E. Loperamide
A. Lactulose
Binds to ammonia ion and excretes it
A 68 year old woman with a history of coronary insufficiency suffers a heart attack and begins taking anticoagulant. One year later, her physician prescribes colestyramine to treat her hypercholesterolemia. A few months after the patient begins colestyramine treatment, she develops gastrointestinal bleeding and is found to have hypothrombinemia. Which of the following mechanisms accounts for how colestyramine causes hypoprothrombinemia?
A. Distribution B. Absorption C. competes with plasma proteins D. Metabolism E. Pharmacodynamics
B. Absorption
What is the most likely mechanism by which losartan lowers blood pressure?
Prevents the cardiovascular effects of angiotensin II mediated by AT-1 receptors
We treat a patient with a drug that affects the clotting-thrombolytic systems for a time sufficient to let the drug’s effects and blood levels stabi- lize at a therapeutic level. We then isolate platelets from a blood sample and test their in vitro aggregatory responses to ADP, collagen, PAF, and throm- boxane A2. Aggregatory responses to ADP are inhibited; responses to the other platelet proaggregatory agonists are unaffected. Which drug did we most likely administer to this patient?
a. Aspirin
b. Bivalirudin
c. Clopidogrel
d. Heparin
e. Warfarin
c. Clopidogrel
It is generally acceptable and common to administer unfractionated heparin along with other classes of drugs that affect some aspect of the coagulation or thrombolytic processes. The proviso, of course, is to moni- tor closely all drug dosages, the appropriate blood tests, and the patient’s responses overall, since the main risk is uncontrolled or excessive bleeding, if not frank hemorrhage.
There is one main exception. With which one of the following drugs is concomitant administration of heparin contraindicated because of an extremely high risk of excessive bleeding or frank hemorrhage?
a. Alteplase (t-PA)
b. Aspirin
c. Clopidogrel
d. Streptokinase
e. Warfarin
d. Streptokinase
SK not clot specific
A 45-year-old man postmyocardial infarction (MI) is being treated with several drugs, including intravenous unfractionated heparin. Stool guaiac on admission was negative, but is now four, and he has had an episode of hematemesis. Which of the following would be the best drug to administer to counteract the effects of excessive heparin remaining in the circulation?
a. Aminocaproic acid
b. Dipyridamole
c. Factor IX
d. Protamine sulfate
e. Vitamin K
d. Protamine sulfate
A 20-year-old varsity hockey player is referred to you by his coach. The young athlete has excessive bruising after a very physical match 2 days before. His knee had been bothering him, so he took two 325-mg aspirin tablets several hours before the contest. He got checked hard into the boards 10 times during the game, but denies any excessive or unusual trauma. As you ponder the etiology you order several blood tests. Which test or finding do you most likely expect to be abnormal as a result of the prior aspirin use?
a. Activated partial thromboplastin time (APTT)
b. Bleeding time
c. INR (International Normalized Ratio)
d. Platelet count
e. Prothrombin time
b. Bleeding time
A 60-year-old man, hospitalized for an acute myocardial infarction, is treated with warfarin (among other drugs). What is the main mechanism by which warfarin is causing the effects for which it is given?
a. Increase in the plasma level of Factor IX
b. Inhibition of thrombin and early coagulation steps
c. Inhibition of synthesis of prothrombin and coagulation Factors VII, IX, and X
d. Inhibition of platelet aggregation in vitro
e. Activation of plasminogen
f. Binding of Ca2+ ion cofactor in some coagulation steps
c. Inhibition of synthesis of prothrombin and coagulation Factors VII, IX, and X
